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Appendix H: Minority Opinion of Dr. Thomas Mellman
Pages 209-212

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From page 209...
... method for treating missing data on study outcomes (i.e., the fact that use of LOCF is considered a major limitation) . Finally, I believe that the distinction the committee makes between its evidence-based conclusions intended to inform policymaking and clinical practice guidelines (such as those developed by the International Society for Traumatic Stress Studies or the American Psychiatric Association)
From page 210...
... The assumption that LOCF provides a conservative estimate in medication studies is supported by the extant short-term and long-term medication treatment trajectory data that shows continuing improvement over time. Additional evidence that predominantly male veteran populations with chronic PTSD are less responsive to treatments in general comes from Schnurr et al.
From page 211...
... The fact that this literature highlights severely affected, treatment r ­ efractory veterans would seem of particular interest to VA. Although it would not be advisable to make clinical recommendations for the use of novel antipsychotic medications as a first-line therapy because of the nature of the evidence and concerns regarding their tolerability, it should be noted that three of the studies with few major limitations had positive results, and the remaining with a negative result had a very small total N (15)
From page 212...
... 2003. Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: Results from a department of Veterans affairs cooperative study.

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