Papers by Timothy Kimbrell
Psychiatry Research: Neuroimaging, 2008
Bookmarks Related papers MentionsView impact
Biological Psychiatry, 1999
Bookmarks Related papers MentionsView impact
American Journal of Psychiatry, 1997
Nonpharmacologic methods for alleviating depression have recently garnered renewed attention ( 1 ... more Nonpharmacologic methods for alleviating depression have recently garnered renewed attention ( 1 , 2 ). ECT is the most effective nonpharmacologic treatment of depression ( 3 ). Although the mechanisms of antidepressant ...
Bookmarks Related papers MentionsView impact
Biol Psychiat, 2000
Bookmarks Related papers MentionsView impact
The Journal of Neuropsychiatry and Clinical Neurosciences, Feb 1, 2003
Bookmarks Related papers MentionsView impact
Southern Medical Journal, Apr 1, 2003
An important risk factor for suicide is psychiatric illness, but only a limited amount of work ha... more An important risk factor for suicide is psychiatric illness, but only a limited amount of work has been directed at assessing the use of firearms and other weapons by select psychiatric populations at high risk for violent acts. Patients with combat-related posttraumatic stress disorder (PTSD), patients with schizophrenia, and patients undergoing rehabilitation for substance abuse were asked to complete a weapons-use survey and measures of psychopathology. The PTSD patients surveyed related owning more than four times as many firearms as other subjects and reported significantly higher levels of potentially dangerous firearm-related behaviors than the other psychiatric subjects surveyed. High levels of aggression, impulsive and dangerous weapon use, and ready weapon availability may be significant factors in gun-related violence in the PTSD patient population. Additional prospective research is needed to determine whether gun ownership or certain types of weapon use in this population is associated with future acts of violence.
Bookmarks Related papers MentionsView impact
Psychiatric Services, Jul 1, 2003
... Care of Veterans Seeking Compensation. Tim A. Kimbrell, MD; Thomas W. Freeman, MD. Psychiatri... more ... Care of Veterans Seeking Compensation. Tim A. Kimbrell, MD; Thomas W. Freeman, MD. Psychiatric Services 2003;54:910-911. ... Required Field. Comment Author(s)* (if multiple authors, separate names by comma) Example: John Doe. Affiliation & Institution*. Comment Title*. ...
Bookmarks Related papers MentionsView impact
Clinical Neuropharmacology, Jun 30, 1998
Bookmarks Related papers MentionsView impact
Biological Psychiatry
ABSTRACT
Bookmarks Related papers MentionsView impact
The Journal of neuropsychiatry and clinical neurosciences
Using the event-related potential P3a component as a marker, the authors tested the efficacy of r... more Using the event-related potential P3a component as a marker, the authors tested the efficacy of repetitive transcranial magnetic stimulation (rTMS) for reducing hyperarousability to specific threat stimuli in one Vietnam veteran with chronic posttraumatic stress disorder (PTSD), who exhibited an exaggerated P3a response to combat-related pictures. Twenty minutes of 1-Hz rTMS to the right prefrontal area effected a reduction in the P3a amplitude, whereas similar rTMS to the left prefrontal area did not. In addition to providing evidence for the effectiveness of right frontal rTMS for an exaggerated response to trauma-related stimuli, this study provides electrophysiological corroboration of subjective reports of PTSD symptoms.
Bookmarks Related papers MentionsView impact
Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), Jan 26, 2015
Physiological assessment of post-traumatic stress disorder (PTSD) presents an additional avenue f... more Physiological assessment of post-traumatic stress disorder (PTSD) presents an additional avenue for evaluating the severity of PTSD symptoms. We investigated whether the presence of a high number of uncommon symptoms attenuated the relation between self-reported PTSD symptoms and heart rate variability (HRV). Participants were 115 Veterans from the OIF/OEF operations with or without PTSD. Symptom over-report was assessed using the Miller Forensic Assessment of Symptoms Test (M-FAST). Participants completed the Clinician Administered PTSD Scale (CAPS) and M-FAST, and underwent physiological assessment to determine HRV. These data were then entered into a hierarchical linear regression equation to test the moderating effect of over-reporting on the relation between PTSD symptom severity and HRV. The result of this analysis failed to demonstrate a significant moderating effect of over-reporting on the PTSD and HRV relation. HRV was a significant predictor of PTSD symptom severity and t...
Bookmarks Related papers MentionsView impact
Neuropsychiatry, neuropsychology, and behavioral neurology, 2000
To determine the cognitive effects of daily repetitive transcranial magnetic stimulation (rTMS) a... more To determine the cognitive effects of daily repetitive transcranial magnetic stimulation (rTMS) administered under the conditions of a treatment trial for major depression. Although daily left dorsal prefrontal rTMS has improved mood in some patients with treatment-refractory depression, potential cognitive side effects of extended daily treatment have not been systematically studied. In a randomized double-blind treatment study, 10 subjects (mean age, 42 +/- 15 years) with an episode of major depression received either 2 weeks of low-frequency (1 Hz) or high-frequency (20 Hz) rTMS (800 pulses, 20 trains over 20 minutes, 80% of motor threshold, 5 days per week) to the left dorsolateral prefrontal cortex and then were crossed over to the other treatment condition. Patients received cognitive testing at baseline and after the first and second weeks of low- or high-frequency rTMS, which was examined by repeated-measures ANOVA. Of 16 cognitive measures tested after 1 or 2 weeks of rTMS ...
Bookmarks Related papers MentionsView impact
JAMA Psychiatry, 2015
Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychother... more Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychotherapy and pharmacotherapy have proven efficacious in randomized clinical trials, geographic barriers impede rural veterans from engaging in these evidence-based treatments. To test a telemedicine-based collaborative care model designed to improve engagement in evidence-based treatment of PTSD. The Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial design with intention-to-treat analyses. Outpatients were recruited from 11 Department of Veterans Affairs (VA) community-based outpatient clinics serving predominantly rural veterans. Inclusion required meeting diagnostic criteria for current PTSD according to the Clinician-Administered PTSD Scale. Exclusion criteria included receiving PTSD treatment at a VA medical center or a current diagnosis of schizophrenia, bipolar disorder, or substance dependence. Two hundred sixty-five veterans were enrolled from November 23, 2009, through September 28, 2011, randomized to usual care (UC) or the TOP intervention, and followed up for 12 months. Off-site PTSD care teams located at VA medical centers supported on-site community-based outpatient clinic providers. Off-site PTSD care teams included telephone nurse care managers, telephone pharmacists, telepsychologists, and telepsychiatrists. Nurses conducted care management activities. Pharmacists reviewed medication histories. Psychologists delivered cognitive processing therapy via interactive video. Psychiatrists supervised the team and conducted interactive video psychiatric consultations. The primary outcome was PTSD severity as measured by the Posttraumatic Diagnostic Scale. Process-of-care outcomes included medication prescribing and regimen adherence and initiation of and adherence to cognitive processing therapy. During the 12-month follow-up period, 73 of the 133 patients randomized to TOP (54.9%) received cognitive processing therapy compared with 16 of 132 randomized to UC (12.1%) (odds ratio, 18.08 [95% CI, 7.96-41.06]; P < .001). Patients in the TOP arm had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 29.1) compared with those in the UC arm (from 33.5 to 32.1) at 6 months (β = -3.81; P = .002). Patients in the TOP arm also had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 30.1) compared with those in the UC arm (from 33.5 to 31.7) at 12 months (β = -2.49; P=.04). There were no significant group differences in the number of PTSD medications prescribed and adherence to medication regimens were not significant. Attendance at 8 or more sessions of cognitive processing therapy significantly predicted improvement in Posttraumatic Diagnostic Scale scores (β = -3.86 [95% CI, -7.19 to -0.54]; P = .02) and fully mediated the intervention effect at 12 months. Telemedicine-based collaborative care can successfully engage rural veterans in evidence-based psychotherapy to improve PTSD outcomes. clinicaltrials.gov Identifier: NCT00821678.
Bookmarks Related papers MentionsView impact
ADVANCES IN …, 1998
... modulation. Alexander et al.[37] highlighted the concept of at least 5 important basal gangli... more ... modulation. Alexander et al.[37] highlighted the concept of at least 5 important basal ganglia-thalamocortical loops involvingthe prefrontal lobes. Each segregated and parallel loop includes a separate part of the frontal cortex. ...
Bookmarks Related papers MentionsView impact
Psychiatry Research: Neuroimaging, 2005
Veterans diagnosed with combat-related posttraumatic stress disorder (PTSD) and comparison subjec... more Veterans diagnosed with combat-related posttraumatic stress disorder (PTSD) and comparison subjects underwent single voxel proton magnetic resonance spectroscopy (1H-MRS) of the medial temporal lobe (MTL). PTSD subjects were divided into combat and non-combat groups based on military records. Combat PTSD subjects did not have lower MTL levels of N-acetylaspartate compared with non-combat PTSD subjects.
Bookmarks Related papers MentionsView impact
Psychiatry Research: Neuroimaging, 2006
In this study, single voxel proton magnetic resonance spectroscopic imaging ((1)H-MRS) and volume... more In this study, single voxel proton magnetic resonance spectroscopic imaging ((1)H-MRS) and volumetric analysis of hippocampal magnetic resonance imaging (MRI) images were used to determine if any differences in hippocampal biochemistry or volume were present between former prisoners of war (POWs) with and without posttraumatic stress disorder (PTSD) and control subjects matched for age and education. This study did not find lower hippocampal concentrations of N-acetylaspartate (NAA), smaller hippocampal volumes, or more impaired memory function in older veterans with PTSD compared with a group matched for traumatic experience or a nontraumatized control group.
Bookmarks Related papers MentionsView impact
Psychiatry Research, 2008
Bookmarks Related papers MentionsView impact
Psychiatric Services, 2003
... Care of Veterans Seeking Compensation. Tim A. Kimbrell, MD; Thomas W. Freeman, MD. Psychiatri... more ... Care of Veterans Seeking Compensation. Tim A. Kimbrell, MD; Thomas W. Freeman, MD. Psychiatric Services 2003;54:910-911. ... Required Field. Comment Author(s)* (if multiple authors, separate names by comma) Example: John Doe. Affiliation & Institution*. Comment Title*. ...
Bookmarks Related papers MentionsView impact
Neuropsychopharmacology, 1998
Dramatic changes have recently occurred in the availability of treatment options for bipolar illn... more Dramatic changes have recently occurred in the availability of treatment options for bipolar illness. Second generation mood stabilizing anticonvulsants carbamazepine and valproate are now widely used as alternatives or adjuncts to lithium. High potency benzodiazepines are also used as alternatives to typical neuroleptics, and now atypical neuroleptics are demonstrating efficacy and better side-effects profiles than the typicals. Thyroid augmentation strategies and dihydropyridine L-type calcium channel blockers require further clinical trials to define their role. Putative third generation mood stabilizing anticonvulsants lamotrigine, gabapentin, and topiramate have unique mechanisms of action and deserve further systematic study, as does the potential role for nonconvulsive brain stimulation with repeated transcranial magnetic stimulation (rTMS). These and a host of other potential treatment options now require a new generation of clinical trials to help identify clinical and biological markers of response and optimal use alone and in complex combination therapeutic regimens.
Bookmarks Related papers MentionsView impact
Journal of the American Geriatrics Society, 2010
To explore the association between posttraumatic stress disorder (PTSD) and dementia in older vet... more To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. Veterans Integrated Service Network 16. Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH-, n=3,660), those with PH and no PTSD (PTSD-/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD-/PH-, n=5,165). Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. The PTSD+/PH- group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH- group as in the PTSD-/PH+ or PTSD-/PH- group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care.
Bookmarks Related papers MentionsView impact
Uploads
Papers by Timothy Kimbrell