Addict Behav. 2008 Feb;33(2):328-35. Epub 2007 Sep 29.

Sleep disturbances associated with posttraumatic stress disorder and alcohol dependence.

Waldrop AE, Back SE, Sensenig A, Brady KT.

Division of Clinical Neuroscience, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, Box 250861,  Charleston, SC 29425, United States.

Sleep disturbances commonly appear in the context of both posttraumatic stress disorder (PTSD) and alcohol use disorders. Sleep symptoms typically reported among clinical populations include delayed sleep onset, poor sleep continuity, early morning awakening, and disturbed sleep architecture. The aim of the present study was to examine multiple forms of sleep disturbances among individuals with  comorbid PTSD and alcohol dependence, PTSD only, alcohol dependence only, and a control group. Both PTSD and alcohol dependence diagnoses were associated with multiple forms of sleep disturbance, but comorbidity of the two disorders did not appear to increase the risk over and above either single disorder for reporting any of the sleep difficulties examined. As PTSD symptom severity increased, so did sleep latency, mid-sleep wakening, and early morning wakening. However, contrary to our hypothesis, no significant direct relationship between severity of alcohol use and sleep disturbances was revealed. These findings suggest a need for thorough assessment of sleep symptoms in patients presenting with PTSD or alcohol dependence.

PMID: 17964738 [PubMed - in process] 

 

Child Maltreat. 2008 Feb;13(1):27-38.

The impact of cumulative maternal trauma and diagnosis on parenting behavior.

Cohen LR, Hien DA, Batchelder S.

Columbia University.

This study examines the relative contributions of cumulative maternal trauma, substance use, depressive and posttraumatic stress diagnoses on parental abuse potential, punitiveness, and psychological and physical aggression in a sample of 176 urban mothers. Participants were categorized into four groups: substance use  (n = 41), depressed (n = 40), comorbid (n = 47), and control (n = 48). Participants in the three diagnostic groups reported significantly greater interpersonal trauma exposure than did controls. Hierarchical regressions reveal  that cumulative trauma is a significant predictor of all parenting outcomes, even after controlling for demographic and diagnostic variables. Substance use and depression are significantly related to abuse potential, and PTSD is significantly negatively related to physical discipline, with no other significant associations between diagnostic status and parenting outcomes. These  findings add to an important growing literature examining the impact of cumulative trauma on parental functioning. Implications for future research and parenting interventions are discussed.

PMID: 18174346 [PubMed - in process]

 

Eur Neuropsychopharmacol. 2008 Feb;18(2):107-16. Epub 2007 Jul 3.

The immediate early gene Arc is associated with behavioral resilience to stress exposure in an animal model of posttraumatic stress disorder.

Kozlovsky N, Matar MA, Kaplan Z, Kotler M, Zohar J, Cohen H.

Ministry of Health Beer-Sheva Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 4600, Beer-Sheva 84170, Israel.

Mechanisms involved in adaptative and maladaptive changes in neural plasticity and synaptic efficacy in various brain areas are pivotal to understanding the physiology of the response to stress and the pathophysiology of posttraumatic stress disorder (PTSD). Activity-regulated cytoskeletal-associated protein (Arc)  is an effector immediate early gene (IEG) which has direct effects on intracellular homeostatic functions. Increased expression of Arc has been associated with increased neuronal activity and with consolidation of long-term memory. It may thus play an important role in mediating experience-induced reorganization and/or development of synaptic connections. This study sought to characterize the pattern of expression of mRNA for the Arc gene in selected brain areas of test subjects classified according to their individual pattern of behavioral response to a stressor, correlated with circulating levels of corticosterone (as a physiological marker of stress response). The hippocampal CA1 and CA3 subregions of individuals whose behavior was minimally or partially disrupted in response to predator scent stress demonstrated significantly increased levels of mRNA for Arc, compared to unexposed controls. The group whose behavior was severely disrupted demonstrated no such upregulation. Consistent with the hypothesis that the Arc gene has a promoting effect on neuronal function and/or structural changes, the lack of Arc expression in the behaviorally and physiologically more severely affected individuals raises the possibility that Arc may be associated with resilience and/or recovery after stress exposure.

PMID: 17611082 [PubMed - in process]

 

J Psychiatr Res. 2008 Feb;42(3):192-8. Epub 2007 Jan 11.

Elevated plasma arginine vasopressin levels in veterans with posttraumatic stress disorder.

de Kloet CS, Vermetten E, Geuze E, Wiegant VM, Westenberg HG.

Department of Military Psychiatry, Central Military Hospital, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Department Psychiatry, University Medical Center, Utrecht, The Netherlands.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with altered hypothalamic-pituitary-adrenal (HPA) axis functioning. Arginine vasopressin (AVP), in conjunction with corticotrophin releasing hormone, has shown to be an important modulator of the HPA axis. In order to evaluate the effect of trauma and PTSD on central AVP secretion we assessed plasma AVP levels in equally trauma exposed veterans with and without PTSD and a non-traumatized healthy control group. METHODS: Assessment of plasma AVP in 29 male veterans with PTSD, 29 traumatized veterans without PTSD, matched for age, gender, year and region of deployment (trauma controls), and 26 age matched healthy controls. RESULTS: Plasma AVP levels were higher in PTSD patients compared to both healthy controls  (p=0.004) and trauma controls (p<0.001). In PTSD patients without a comorbid MDD  a significant correlation was observed between plasma AVP levels and symptoms of  avoidance measured with the Clinician Administered PTSD Scale (CAPS). CONCLUSION: Elevated plasma AVP levels are specifically related to PTSD and not to exposure to traumatic stress during deployment. Our results indicate that AVP may play a role as an anxiogenic factor, but they do not support a role for AVP in the altered response to dexamethasone in PTSD.

PMID: 17222428 [PubMed - in process]

 

Intensive Care Med. 2008 Jan 16 [Epub ahead of print]

Factors associated with posttraumatic stress symptoms in a prospective cohort of  patients after abdominal sepsis: a nomogram.

Boer KR, van Ruler O, van Emmerik AA, Sprangers MA, de Rooij SE, Vroom MB, de Borgie CA, Boermeester MA, Reitsma JB; The Dutch Peritonitis Study Group.

Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, 1100 DE, PO Box 22700, Amsterdam, The Netherlands, j.reitsma@amc.nl.

OBJECTIVE: To determine to what extent patients who have survived abdominal sepsis suffer from symptoms of posttraumatic stress disorder (PTSD) and depression, and to identify potential risk factors for PTSD symptoms. DESIGN AND  SETTING: PTSD and depression symptoms were measured using the Impact of Events Scale-Revised (IES-R), the Post-Traumatic Symptom Scale 10 (PTSS-10) and the Beck Depression Inventory II (BDI-II). PATIENTS AND PARTICIPANTS: A total of 135 peritonitis patients were eligible for this study, of whom 107 (80%) patients completed the questionnaire. The median APACHE-II score was 14 (range 12-16), and 89% were admitted to the ICU. MEASUREMENTS AND RESULTS: The proportion of patients with "moderate" PTSD symptom scores was 28% (95% CI 20-37), whilst 10% (95% CI 6-17) of patients had "high" PTSD symptom scores. Only 5% (95% CI 2-12) of the patients expressed severe depression symptoms. Factors associated with increased PTSD symptoms in a multivariate ordinal regression model were younger age (0.74 per 10 years older, p[Symbol: see text]=[Symbol: see text]0.082), length of ICU stay (OR[Symbol: see text]=[Symbol: see text]1.4 per doubling of duration, p[Symbol: see text]=[Symbol: see text]0.003) and having some (OR[Symbol: see text]=[Symbol: see text]4.9, p[Symbol: see text]=[Symbol: see text]0.06) or many (OR[Symbol: see text]=[Symbol: see text]55.5, p[Symbol: see text]<[Symbol: see text]0.001) traumatic memories of the ICU or hospital stay. CONCLUSION: As many as 38% of patients after abdominal sepsis report elevated levels of PTSD symptoms on at least one of the questionnaires. Our nomogram may assist in identifying patients at increased risk for developing symptoms of PTSD.

PMID: 18197398 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2008 Jan 15;162(1):59-72.

Neural systems for executive and emotional processing are modulated by symptoms of posttraumatic stress disorder in Iraq War veterans.

Morey RA, Petty CM, Cooper DA, Labar KS, McCarthy G.

Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA; Mental Illness Research Education and Clinical Center for Post Deployment Mental Health, Durham VA Medical Center, Durham, NC, USA.

The symptom-provocation paradigms generally used in neuroimaging studies of posttraumatic stress disorder (PTSD) have placed high demands on emotion processing but lacked cognitive processing, thereby limiting the ability to assess alterations in neural systems that subserve executive functions and their  interactions with emotion processing. Thirty-nine veterans from Iraq and Afghanistan underwent functional magnetic resonance imaging while exposed to emotional combat-related and neutral civilian scenes interleaved with an executive processing task. Contrast activation maps were regressed against PTSD symptoms as measured by the Davidson Trauma Scale. Activation for emotional compared with neutral stimuli was highly positively correlated with level of PTSD symptoms in ventral frontolimbic regions, notably the ventromedial prefrontal cortex, inferior frontal gyrus, and ventral anterior cingulate gyrus. Conversely, activation for the executive task was negatively correlated with PTSD symptoms in the dorsal executive network, notably the middle frontal gyrus, dorsal anterior cingulate gyrus, and inferior parietal lobule. Thus, there is a strong link between the subjectively assessed behavioral phenomenology of PTSD and objective  neurobiological markers. These findings extend the largely symptom provocation-based functional neuroanatomy to provide evidence that interrelated executive and emotional processing systems of the brain are differentially affected by PTSD symptomatology in recently deployed war veterans.

PMID: 18093809 [PubMed - as supplied by publisher]

 

Neuropsychopharmacology. 2008 Jan 9 [Epub ahead of print]

Variation in Mouse Basolateral Amygdala Volume is Associated With Differences in  Stress Reactivity and Fear Learning.

Yang RJ, Mozhui K, Karlsson RM, Cameron HA, Williams RW, Holmes A.

1Section on Behavioral Science and Genetics, Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD, USA.

A wealth of research identifies the amygdala as a key brain region mediating negative affect, and implicates amygdala dysfunction in the pathophysiology of anxiety disorders. Although there is a strong genetic component to anxiety disorders such as posttraumatic stress disorder (PTSD) there remains debate about whether abnormalities in amygdala function predispose to these disorders. In the  present study, groups of C57BL/6 x DBA/2 (B x D) recombinant inbred strains of mice were selected for differences in volume of the basolateral amygdala complex  (BLA). Strains with relatively small, medium, or large BLA volumes were compared  for Pavlovian fear learning and memory, anxiety-related behaviors, depression-related behavior, and glucocorticoid responses to stress. Strains with relatively small BLA exhibited stronger conditioned fear responses to both auditory tone and contextual stimuli, as compared to groups with larger BLA. The  small BLA group also showed significantly greater corticosterone responses to stress than the larger BLA groups. BLA volume did not predict clear differences in measures of anxiety-like behavior or depression-related behavior, other than greater locomotor inhibition to novelty in strains with smaller BLA. Neither striatal, hippocampal nor cerebellar volumes correlated significantly with any behavioral measure. The present data demonstrate a phenotype of enhanced fear conditioning and exaggerated glucocorticoid responses to stress associated with small BLA volume. This profile is reminiscent of the increased fear processing and stress reactivity that is associated with amygdala excitability and reduced amygdala volume in humans carrying loss of function polymorphisms in the serotonin transporter and monoamine oxidase A genes. Our study provides a unique  example of how natural variation in amygdala volume associates with specific fear- and stress-related phenotypes in rodents, and further supports the role of  amygdala dysfunction in anxiety disorders such as PTSD.Neuropsychopharmacology advance online publication, 9 January 2008; doi:10.1038/sj.npp.1301665.

PMID: 18185497 [PubMed - as supplied by publisher]

 

Acta Psychol (Amst). 2008 Jan 4 [Epub ahead of print]

Specificity of episodic and semantic aspects of autobiographical memory in relation to symptoms of posttraumatic stress disorder (PTSD).

Moradi AR, Herlihy J, Yasseri G, Shahraray M, Turner S, Dalgleish T.

Teacher Training University, Tehran, Iran.

Two studies examined the relationship between the ability to access specific autobiographical material in memory and presence/symptoms of posttraumatic stress. In Study 1, a sample of refugees with a diagnosis of posttraumatic stress disorder (PTSD) completed the Autobiographical Memory Test (AMT) in which they had to generate specific episodic autobiographical memories in response to emotion-related cue words. Results showed that reduced specificity of memories on the AMT was associated with an increased frequency of trauma-related flashbacks but with reduced use of effortful avoidance to deal with trauma-related intrusions in the day-to-day. Study 2 examined retrieval of semantic autobiographical information from previous lifetime periods in groups of cancer survivors with posttraumatic stress and healthy controls. The cancer survivors were able to generate fewer specific semantic details about the personal past compared to the controls. The more symptomatic survivors showed the greatest memory impairment. The data from both studies are discussed in terms of compromised access to specific autobiographical material in distressed trauma survivors reflecting a process of affect regulation.

PMID: 18178168 [PubMed - as supplied by publisher]

 

Addict Behav. 2008 Jan;33(1):180-7. Epub 2007 Jun 9.

Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: an initial evaluation.

Rotunda RJ, O'Farrell TJ, Murphy M, Babey SH.

University of West Florida, Pensacola, Florida 32514, USA. rrotunda@uwf.edu

Outcomes after behavioral couples therapy (BCT) were compared for 19 dually diagnosed veterans with combat-related PTSD and a substance use disorder (SUD, primarily alcohol dependence) and 19 veterans with SUD only. Clients with and without comorbid PTSD had very similar pre-treatment clinical profiles on dimensions of substance misuse, relationship functioning, and psychological symptoms. Further, both PTSD and non-PTSD clients showed good compliance with BCT, attending a high number of BCT sessions, taking Antabuse, and going to AA. Finally, both PTSD and non-PTSD groups improved from before BCT to immediately after and 12 months after BCT. Specific improvements noted were increased relationship satisfaction and reductions in drinking, negative consequences of drinking, male-to-female violence, and psychological distress symptoms. Extent and pattern of improvement over time were similar whether the client had PTSD or  not. The present results suggest that BCT may have promise in treating clients with comorbid SUD and combat-related PTSD.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17628345 [PubMed - in process]

 

Ambul Pediatr. 2008 Jan;8(1):32-35.

Use of a Psychosocial Screen to Detect Children With Symptoms of Posttraumatic Stress Disorder: An Exploratory Study.

Steinbaum DP, Chemtob C, Boscarino JA, Laraque D.

From the Division of General Pediatrics, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY (Dr Steinbaum, Dr Boscarino, and Dr Laraque); Department of Psychiatry, Mount Sinai School of Medicine, New York, NY (Dr Chemtob); and Geisinger Center for Health Research, Geisinger Health System, Danville, Pa (Dr Boscarino).

OBJECTIVE: The aim of this study was to evaluate the sensitivity and specificity  of the parent and youth versions of the 17-item Pediatric Symptom Checklist (PSC-17) for identifying children with symptoms of posttraumatic stress disorder  (PTSD). METHODS: Cross-sectional convenience samples of children aged 8 to 10 years treated at a primary care pediatrics practice in New York City were recruited. The PSC-17 and its 5-item internalizing subscale were used in both parent- and youth-completed formats. Posttraumatic stress disorder symptoms were  identified with the University of California, Los Angeles posttraumatic stress reaction index (UCLA RI), used as a structured interview with the child. RESULTS: One hundred fifty-six children enrolled in the study. Twenty-two percent of children met the UCLA RI cutoff for likely PTSD. The youth version of the PSC-17  and its 5-item internalizing subscale identified these children with sensitivities of 78% and 75% and specificities of 77% and 77%, respectively, relative to the UCLA RI. The parent version of the PSC-17 and the internalizing subscale had poorer sensitivities of 44% and 25% and similar specificities of 79% and 92%, respectively. CONCLUSIONS: Symptoms of PTSD can be identified using the  youth self-report version of the PSC-17. A 5-item subscale of the PSC-17 also performed well and can readily be used in primary care settings.

PMID: 18191779 [PubMed - as supplied by publisher]

 

Ann Fam Med. 2008 Jan-Feb;6(1):44-52.

Intimate partner violence, depression, and PTSD among pregnant Latina women.

Rodriguez MA, Heilemann MV, Fielder E, Ang A, Nevarez F, Mangione CM.

Department of Family Medicine, University of California, Los Angeles, CA 90024, USA. mrodriguez@mednet.ucla.edu

PURPOSE: We undertook a study to describe factors related to depression and posttraumatic stress disorder (PTSD) among pregnant Latinas who were or were not  exposed to intimate partner violence. METHODS: We interviewed 210 pregnant Latinas attending prenatal clinics located in Los Angeles, California. Latinas who did and did not have histories of intimate partner violence were recruited. We then assessed the women for strengths, adverse social behavioral circumstances, posttraumatic stress disorder (PTSD), and depression. RESULTS: Significantly more women exposed to intimate partner violence scored at or above  the cutoff point for depression than women who were not (41% vs 18.6%; P<.001). Significantly more women exposed to intimate partner violence scored at or above  the cutoff point for PTSD than women who were not (16% vs 7.6%; P <.001). Lack of mastery, which measures feelings of being in control of forces that affect life (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62-0.84), a history of trauma not associated with intimate partner violence (OR, 1.33; 95% CI, 1.08-1.63), and exposure to intimate partner violence (OR, 2.43; 95% CI, 1.16-5.11) were associated with depression after adjusting for age, language of interview, and site effects. Stress (OR, 1.72; 95% CI, 1.34-2.2) and a history of trauma (OR, 1.45; 95% CI, 1.03-2.04) were independently associated with PTSD, whereas higher income was associated with decreased risk of PTSD (OR, 0.10; 95% CI, 0.02-0.63), after adjusting for age, language of interview, and site effects. CONCLUSIONS: Intimate partner violence was significantly associated with depression and PTSD but was associated with depression only after controlling for other factors in the multivariate model. The risk for depression declined with greater mastery but increased with a history of trauma or exposure to intimate partner violence. Stress, a history of trauma not associated with intimate partner violence, and lower income were all independently associated with increased risk for PTSD.

PMID: 18195314 [PubMed - in process]

 

Annu Rev Psychol. 2008;59:301-28.

Social bonds and posttraumatic stress disorder.

Charuvastra A, Cloitre M.

Institute for Trauma and Resilience, New York University School of Medicine, New  York, New York 10016; email: marylene.cloitre@nyumc.org.

Retrospective and prospective studies consistently show that individuals exposed  to human-generated traumatic events carry a higher risk of developing Posttraumatic Stress Disorder (PTSD) than those exposed to other kinds of events. These studies also consistently identify perceptions of social support both before and after a traumatic event as an important factor in the determining vulnerability to the development of PTSD. We review the literature on interpersonal traumas, social support and risk for PTSD and integrate findings with recent advances in developmental psychopathology, attachment theory and social neuroscience. We propose and gather evidence for what we term the social ecology of PTSD, a conceptual framework for understanding how both PTSD risk and  recovery are highly dependent on social phenomena. We explore clinical implications of this conceptual framework.

PMID: 17883334 [PubMed - in process]

 

Arch Gen Psychiatry. 2008 Jan;65(1):115-6; author reply 116-7.

Comment on:     Arch Gen Psychiatry. 2007 Mar;64(3):277-85.

Torture, culture, war zone exposure, and posttraumatic stress disorder Criterion  A's bracket creep.

Bracha HS, Hayashi K.

Publication Types:      Comment     Letter     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18180435 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 Jan-Feb;49(1):55-64. Epub 2007 Oct 24.

Coping with posttraumatic stress disorder and comorbidity after myocardial infarction.

Chung MC, Berger Z, Rudd H.

University of Plymouth, Clinical Psychology Teaching Unit, Peninsula Allied Health Centre, Plymouth PL6 8BH, United Kingdom.

OBJECTIVE: Literature on the relationship between coping strategies, posttraumatic stress after myocardial infarction (post-MI PTSD), and comorbidity  is limited. This study aimed to fill this gap in literature by investigating this relationship. METHOD: One hundred twenty patients with MI were recruited from 2 general practices and interviewed using the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire, and the COPE Scale. RESULTS: Thirty-one  percent had PTSD. Patients used acceptance-focused coping in that most of them accepted that the MI had happened and that it could not be changed. At the same time, some patients used avoidance-focused coping in that they disengaged themselves mentally and behaviorally from the traumatic effects of MI. When the variables of age, bypass surgery, mental health problems before MI, and angioplasty were held constant, the results showed that patients who used maladaptive coping strategies of emotion-focused and avoidance-focused copings tended to report more comorbid symptoms. Patients who underwent medical procedures or interventions such as bypass surgery and angioplasty tended to report more PTSD symptoms. CONCLUSIONS: The way in which MI patients' coping strategies relate to health outcomes has been shown to be symptom-specific. Using maladaptive coping strategies does not necessarily have a significant impact on PTSD symptoms. On the other hand, medical procedures or interventions for treating MI can play a major role in maintaining PTSD symptoms for patients with  MI.

PMID: 18063042 [PubMed - in process]

 

Crit Care Med. 2008 Jan;36(1):74-80.

Incidence and prediction of psychiatric morbidity after a motor vehicle accident  in Japan: The Tachikawa Cohort of Motor Vehicle Accident Study.

Matsuoka Y, Nishi D, Nakajima S, Kim Y, Homma M, Otomo Y.

From the Division of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan (YM, DN, SN, YK); Clinical Research Institute and Department of Psychiatry, National Disaster Medical Center, Tokyo, Japan (YM, DN); Department of Critical Care and Traumatology, National Disaster Medical Center, Tokyo, Japan (MH); and Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan (YO).

OBJECTIVES:: To assess both the incidence of new-onset psychiatric illness after  involvement in a motor vehicle accident in Japan for comparison with Western data and the predictors of psychiatric morbidity and posttraumatic stress disorder (PTSD) evaluated immediately after the accident. DESIGN:: Prospective cohort study of injured patients assessed immediately and 4-6 wks after involvement in a motor vehicle accident. SETTING:: Intensive care unit in a teaching hospital in Tokyo, Japan. PATIENTS:: Total of 100 consecutive patients with motor vehicle accident-related injuries (mean Injury Severity Score, 11.2; mean Glasgow Coma Scale, 14.5; age, 18-69 yrs) admitted to the intensive care unit. Patients with traumatic brain injury, suicidality, current psychiatric or neurologic illness, or cognitive impairment were excluded. MEASUREMENTS:: An extensive clinical interview and evaluation of vital signs, sociodemographic variables, previous traumatic events, family history of psychopathology, Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Clinician-Administered PTSD Scale, and Mini-International Neuropsychiatric Interview. RESULTS:: A total of 31 patients showed some form of new-onset psychiatric illness at the 4- to 6-wk follow-up. The majority of illnesses consisted of depression (major depression, n = 16; minor depression, n = 7) and PTSD (full PTSD, n = 8; partial PTSD, n = 16). Other illnesses included alcohol dependence (n = 3), obsessive-compulsive disorder (n = 2), agoraphobia (n = 2), and social phobia (n = 1). Both psychiatric morbidity and PTSD were predicted by a sense of life threat (odds ratio, 4.2 and 6.2, respectively), elevated heart rate (odds ratio, 1.6 and 1.7), and higher Impact of Event Scale-Revised intrusion subscale score (odds ratio, 1.1 and 1.1). CONCLUSION:: This study showed that psychopathology and PTSD after  a motor vehicle accident in Japan is common and that the incidence is within the  range of that in Western countries. A combination of a sense of life threat, heart rate, and Impact of Event Scale-Revised intrusion subscale allowed for significant prediction of psychiatric morbidity and PTSD.

PMID: 18090377 [PubMed - as supplied by publisher]

 

Int Clin Psychopharmacol. 2008 Jan;23(1):1-8.

The atypical antipsychotics olanzapine and risperidone in the treatment of posttraumatic stress disorder: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials.

Pae CU, Lim HK, Peindl K, Ajwani N, Serretti A, Patkar AA, Lee C.

aDepartment of Psychiatry, The Catholic University of Korea, College of Medicine, Seoul, South Korea bDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA cInstitute of Psychiatry,  University of Bologna, Bologna, Italy.

Posttraumatic stress disorder (PTSD) is a prevalent and disabling mental illness. Small studies found atypical antipsychotics (AAs) to be beneficial in the treatment of patients with PTSD regardless of psychotic symptoms who are unresponsive to conventional pharmacological treatments such as serotonin selective reuptake inhibitors. This study reports the results of a meta-analysis  of existing randomized, double-blind, placebo-controlled clinical trials (RCTs) of AAs as a monotherapy or augmentation therapy for the treatment of patients with PTSD. Seven RCTs were identified through extensive scans of databases, which included PubMed, MedLine, the National PTSD Center Pilots database, PsycINFO, Cochrane Central Register of Controlled Trials, and the Abstracts Library of the  American Psychiatric Association with predefined inclusion criteria. Dichotomous  and continuous measures were performed using a fixed effects model, heterogeneity was assessed, and subgroup analyses were done. Data from seven RCTs involving a total of 192 PTSD patients (102 randomized to AAs and 90 randomized to placebo) were analyzed. The results show that AAs may have a beneficial effect in the treatment of PTSD, as indicated by the changes from baseline in Clinician Administered PTSD Scale total scores [standardized mean difference (SMD)=-0.45, 95% confidence interval (CI) (-0.75, -0.14), P=0.004]. In addition, the overall SMD of the mean changes in the three Clinician Administered PTSD Scale subscores  was statistically significant (P=0.007) between AAs and placebo groups, favoring  AAs over placebo (SMD=-0.27, 95% CI=-0.47, -0.07). In particular, the symptom of  'intrusion' was mainly responsible for this significance. Clinical significance of the results, however, should be carefully interpreted and translated into clinical practice, given that the quality and availability of currently existing  RCTs included in the analysis.

PMID: 18090502 [PubMed - as supplied by publisher]

 

J Affect Disord. 2008 Jan;105(1-3):109-115. Epub 2007 May 30.

Common genetic liability to major depression and posttraumatic stress disorder in men.

Koenen KC, Fu QJ, Ertel K, Lyons MJ, Eisen SA, True WR, Goldberg J, Tsuang MT.

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard School of  Public Health, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, United States.

BACKGROUND: Major depression (MD) and posttraumatic stress disorder (PTSD) are highly comorbid. The degree to which a common genetic liability explains the etiology of the MD-PTSD association has not been quantified and has important implications for research and prevention. METHODS: This paper presents an analysis of data from 6744 members of the Vietnam Era Twin Registry. MD and PTSD  were assessed using the Diagnostic Interview Schedule-III-R in 1991-92. Bivariate twin modeling was conducted to determine the genetic and environmental etiology of the MD-PTSD association. RESULTS: The best-fitting model for the MD-PTSD association included a substantial genetic correlation (r=.77; 95% CI, .50-1.00)  and a modest individual-specific environmental correlation (r=.34; 95% CI, .19-.48). Common genetic liability explained 62.5% of MD-PTSD comorbidity. Genetic influences common to MD explained 15% of the total variance in risk for PTSD and 58% of the genetic variance in PTSD. Individual-specific environmental influences common to MD explained only 11% of the individual-specific environmental variance in PTSD. LIMITATIONS: Our participants were male Vietnam era veterans and our findings may not generalize to civilians, females or other cohorts. CONCLUSIONS: MD-PTSD comorbidity is largely explained by common genetic  influences. Substantial genetic overlap between MD and PTSD implies that genes implicated in the etiology of MD are strong candidates for PTSD and vice versa. Environmental influences on MD and PTSD explain less of their covariation and appear to be largely disorder-specific. Research is needed to identify environmental factors that influence the development of MD versus PTSD in the context of common genetic liability.

PMID: 17540456 [PubMed - as supplied by publisher]

 

J Burn Care Res. 2008 January/February;29(1):22-35.

Acute Stress Disorder and Posttraumatic Stress Disorder: A Prospective Study of Prevalence, Course, and Predictors in a Sample With Major Burn Injuries.

McKibben JB, Bresnick MG, Wiechman Askay SA, Fauerbach JA.

From the *Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; ‡Johns Hopkins Regional Burn Center, Baltimore, Maryland; §Department of Rehabilitation Medicine, University of Washington, School of Medicine, Seattle, WA.

This is one of the largest prospective studies of patients with major burn injuries to use psychometrically sound methods to track and predict posttraumatic stress disorder (PTSD) across 2 years after burn. The principal objectives were to investigate the utility of self-report measures in detecting acute stress disorder (ASD) and PTSD, and in tracking and predicting PTSD. Participants were adult patients admitted for treatment of a major burn injury. The Stanford Acute  Stress Reaction Questionnaire (SASRQ) was used to assess ASD symptomatology at discharge (n = 178), and the Davidson Trauma Scale was used to assess PTSD symptoms at scheduled follow-ups at 1 (n = 151), 6 (n = 111), 12 (n = 105), and 24 (n = 71) months after burn. The prevalence of in-hospital ASD was 23.6%, and 35.1, 33.3, 28.6, and 25.4% of the participants met PTSD criteria at 1, 6, 12, and 24 months, respectively. Clinically significant and reliable change in PTSD symptomatology during the 24 months was uncommon. SASRQ diagnostic cutoff and total scores each robustly predicted PTSD at the first three follow-ups and all four follow-ups, respectively. A SASRQ empirically derived cutoff score (>/=40) yielded moderate-high sensitivities (0.67-0.71) and specificities (0.75-0.80), and predicted PTSD at each follow-up. In conclusion, ASD and PTSD are prevalent following major burn injuries, ASD symptomatology can reliably predict PTSD up to 24 months later, and, once established, PTSD usually persists. Research is needed to determine whether early recognition and treatment of persons with in-hospital  ASD can improve long-term outcomes.

PMID: 18182894 [PubMed - as supplied by publisher]

 

J Child Psychol Psychiatry. 2008 Jan;49(1):79-87. Epub 2007 Nov 1.

Trauma exposure and posttraumatic stress disorder in delinquent female adolescents.

Ariga M, Uehara T, Takeuchi K, Ishige Y, Nakano R, Mikuni M.

Department of Psychiatry and Human Behaviour, Gunma University Graduate School of Medicine, Maebashi, Japan.

Background: Although juveniles within the justice system have high psychiatric morbidity, few comprehensive investigations have shown posttraumatic stress disorder (PTSD) in female delinquents. Here, we aim to describe the nature and extent of PTSD and trauma exposure and to clarify the relationships among comorbidity and psychosocial factors in juvenile female offenders. Method: Sixty-four girls were randomly interviewed using structured tools. Self-report measures were used to assess depression, eating behaviour, impulsivity and parental attitude. Results: The PTSD prevalence was 33%, and 77% of the female juvenile offenders had been exposed to trauma. The offenders with PTSD showed a significantly high psychiatric comorbidity. Depression and adverse parenting were associated with PTSD development, and abnormal eating was also correlated with PTSD symptoms. Marked differences in the frequency and intensity of PTSD evaluation depending on the type of comorbidity and trauma were observed. Conclusions: Incarcerated young females in Japan have serious trauma-related problems, and the degree of depression is a strong predictor of PTSD development  and symptoms. This study highlights the importance of adequate diagnosis and treatment of PTSD in delinquent female adolescents.

PMID: 17979964 [PubMed - in process]

 

J Psychiatr Res. 2008 Jan;42(2):158-62. Epub 2007 Jan 3.

Contribution of initial heart rate to the prediction of posttraumatic stress symptom level in accident victims.

Kraemer B, Moergeli H, Roth H, Hepp U, Schnyder U.

Department of Psychiatry, University Hospital, Culmannstrasse 8, CH-8091 Zurich,  Switzerland. bernd.kraemer@usz.ch

Earlier findings of a positive correlation between heart rate (HR) and posttraumatic symptom level have recently been brought into question. Therefore,  we investigated the relationship between resting HR and symptom scores of posttraumatic stress disorder (PTSD) in physically injured accident survivors, controlling for well established predictors for (PTSD and factors influencing HR. A representative sample of 255 accident victims was assessed measuring PRIME-MD,  PDEQ, trauma-related cognitions and CAPS. Initial interviews were conducted five  days post trauma; follow-up assessments took place six months later. Heart rate measurements were obtained from surgical files. We found positive bivariate correlations between HR at hospital admission (HRA) and PTSD symptom levels. However, in multiple regression analysis HRA contributed marginally to the prediction of PTSD symptom levels. We conclude that the initial heart rate is a weak and not independent predictor for PTSD symptom level following accidental injuries.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 17204288 [PubMed - in process]

 

J Psychosom Res. 2008 Jan;64(1):33-40.

Trauma, PTSD, and physical health: An epidemiological study of Australian Vietnam veterans.

O'Toole BI, Catts SV.

ANZAC Research Institute, University of Sydney, Australia.

OBJECTIVE: This study aimed to examine the relative contributions to physical health of combat trauma exposure and posttraumatic stress disorder (PTSD), which  have both been implicated separately in poorer physical health but whose unconfounded effects have not been teased out. METHODS: Data from an epidemiological study of Australian Vietnam veterans, which used personal interviews and standardized physical and psychiatric health assessments, provided the means to assess the independent and joint effects of psychological trauma exposure and PTSD on a wide range of self-reported measures of physical health. Trauma exposure was measured by published scales of combat exposure and peritraumatic dissociation. Logistic regression modeling was used to assess the relative importance of trauma exposure and PTSD to health while controlling for a set of potential confounders including standardized psychiatric diagnoses. RESULTS: Greater health service usage and more recent health actions were associated more strongly with PTSD, which was also associated with a range of illness conditions coded by the World Health Organization International Classification of Diseases, 9th Edition (asthma, eczema, arthritis, back and other musculoskeletal disorders, and hypertension) both before and after controlling for potential confounders. In contrast, combat exposure and peritraumatic dissociation were more weakly associated with a limited number of unconfounded physical health outcomes. CONCLUSIONS: This study provided evidence  that PTSD, rather than combat exposure and peritraumatic dissociation, is associated with a pattern of physical health outcomes that is consistent with altered inflammatory responsiveness.

PMID: 18157997 [PubMed - in process]

 

Neurosci Biobehav Rev. 2008;32(1):161-74. Epub 2007 Aug 6.

Psychobiology of posttraumatic stress disorder in pediatric injury patients: A review of the literature.

Langeland W, Olff M.

Department of Psychiatry, Center for Psychological Trauma, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Department of Psychiatry, Vrije University, 1081 HV Amsterdam, The Netherlands.

Research suggests that about a quarter to a third of children with traffic-related injuries develop posttraumatic stress disorder (PTSD). Early symptoms of PTSD have been found to predict poor mental and physical outcome in studies of medically injured children. However, these symptoms are rarely recognized by physicians who provide emergency care for these children. In addition, there is insufficient knowledge about predictors of posttraumatic stress symptoms in this specific pediatric population. Early identification of those children at particular risk is needed to target preventive interventions appropriately. After some introducing remarks on the classification and the nature of posttraumatic stress reactions, current research findings on psychological and biological correlates of PTSD in pediatric injury patients are  presented. The particular focus in this paper is on the neurobiological mechanisms that influence psychological responses to extreme stress and the development of PTSD. Continued study of the psychobiology of trauma and PTSD in pediatric injury patients, both in terms of neurobiology and treatment is needed.

PMID: 17825911 [PubMed - in process]

 

Neurosci Biobehav Rev. 2008;32(1):99-117. Epub 2007 Jun 29.

Stress-induced changes in sleep in rodents: Models and mechanisms.

Pawlyk AC, Morrison AR, Ross RJ, Brennan FX.

Women's Health and Musculoskeletal Biology, Wyeth Research, Collegeville, PA 19426, USA.

Psychological stressors have a prominent effect on sleep in general, and rapid eye movement (REM) sleep in particular. Disruptions in sleep are a prominent feature, and potentially even the hallmark, of posttraumatic stress disorder (PTSD) (Ross, R.J., Ball, W.A., Sullivan, K., Caroff, S., 1989. Sleep disturbance as the hallmark of posttraumatic stress disorder. American Journal of Psychiatry  146, 697-707). Animal models are critical in understanding both the causes and potential treatments of psychiatric disorders. The current review describes a number of studies that have focused on the impact of stress on sleep in rodent models. The studies are also in Table 1, summarizing the effects of stress in 4-h blocks in both the light and dark phases. Although mild stress procedures have sometimes produced increases in REM sleep, more intense stressors appear to model the human condition by leading to disruptions in sleep, particularly REM sleep. We also discuss work conducted by our group and others looking at conditioning as a factor in the temporal extension of stress-related sleep disruptions. Finally,  we attempt to describe the probable neural mechanisms of the sleep disruptions. A complete understanding of the neural correlates of stress-induced sleep alterations may lead to novel treatments for a variety of debilitating sleep disorders.

PMID: 17764741 [PubMed - in process]

 

Prog Brain Res. 2008;167:299-302.

Posttraumatic stress disorder with secondary psychotic features: neurobiological  findings.

Braakman MH, Kortmann FA, van den Brink W, Verkes RJ.

Institute of Mental Health Care, Wolfheze, the Netherlands and Department of Psychiatry, Radboud University Nijmegen Medical Center, Wolfheze 2, 6874 BE, Wolfheze, The Netherlands. m.braakman@degelderseroos.nl

The neurobiological knowledge on the potentially new diagnostic entity "posttraumatic stress disorder with secondary psychotic features" (PTSD-SP) is reviewed. Studies published between 1980 and 2006 were traced focussing on adult  patients suffering from this "syndrome". Studies on cortisol, corticotrophin releasing hormone, dopamine beta-hydroxylase, smooth pursuit eye movements and psychopharmacology are described and potential pathophysiological mechanisms briefly discussed. More research is needed to validate the nosological status of  PTSD-SP in order to promote neurobiological research and adequate therapeutic interventions.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18037029 [PubMed - in process]

 

Prog Brain Res. 2008;167:293-7.

Precuneal activity during encoding in veterans with posttraumatic stress disorder.

Geuze E, Vermetten E, de Kloet CS, Westenberg HG.

Department of Military Psychiatry, Central Military Hospital, Ministry of Defense, Utrecht, The Netherlands. s.g.geuze@umcutrecht.nl

Impaired attention and memory are symptoms frequently associated with posttraumatic stress disorder (PTSD). Previous studies have identified fronto-temporal alterations during encoding in patients with PTSD. We examine the role of the precuneus (located in the posteromedial parietal lobe) that is known  to play a role in memory, but has largely been neglected in PTSD research. Male veterans with and without PTSD (n=12 per group) were subjected to fMRI during encoding of 12 neutral, non-trauma related word pairs. The precuneus was less activated in veterans with PTSD, which correlated significantly with the severity of PTSD. Like fronto-temporal regions the precuneus is differentially activated during memory formation in veterans with PTSD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18037028 [PubMed - in process]

 

Prog Brain Res. 2008;167:287-91.

Elevated plasma corticotrophin-releasing hormone levels in veterans with posttraumatic stress disorder.

de Kloet CS, Vermetten E, Geuze E, Lentjes EG, Heijnen CJ, Stalla GK, Westenberg  HG.

Altrecht Institute for Mental Health Care, Zeist, The Netherlands. c.de.kloet@altrecht.nl

Posttraumatic stress disorder (PTSD) is associated with alterations in corticotrophin-releasing hormone (CRH) secretion. Plasma CRH levels, which are easily acquired, might serve as a predictor of hypothalamic CRH levels. Assessment of plasma CRH, adrenocorticotrophin hormone (ACTH), and cortisol levels in 31 veterans with PTSD, 30 traumatized veterans without PTSD matched on  age, year, and region of deployment (traumacontrols), and 28 age-matched healthy  controls (HCs) was carried out. Plasma CRH levels were higher in PTSD patients compared to both HCs (p=0.005) and traumacontrols (p=0.007). This led to our conclusion, that elevated plasma CRH levels are specifically related to PTSD and  not to exposure to traumatic stress during deployment.

PMID: 18037027 [PubMed - in process]

 

Prog Brain Res. 2008;167:171-86.

Structural and functional plasticity of the human brain in posttraumatic stress disorder.

Bremner JD, Elzinga B, Schmahl C, Vermetten E.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. jdbremn@emory.edu

Posttraumatic stress disorder (PTSD) is associated with long-term changes in neurobiology. Brain areas involved in the stress response include the medial prefrontal cortex, hippocampus, and amygdala. Neurohormonal systems that act on the brain areas to modulate PTSD symptoms and memory include glucocorticoids and  norepinephrine. Dysfunction of these brain areas is responsible for the symptoms  of PTSD. Brain imaging studies show that PTSD patients have increased amygdala reactivity during fear acquisition. Other studies show smaller hippocampal volume. A failure of medial prefrontal/anterior cingulate activation with re-experiencing of the trauma is hypothesized to represent a neural correlate of  the failure of extinction seen in PTSD. The brain has the capacity for plasticity in the aftermath of traumatic stress. Antidepressant treatments and changes in environment can reverse the effects of stress on hippocampal neurogenesis, and humans with PTSD showed increased hippocampal volume with both paroxetine and phenytoin.

PMID: 18037014 [PubMed - in process]

 

Prog Brain Res. 2008;167:151-69.

The functional neuroanatomy of PTSD: a critical review.

Liberzon I, Sripada CS.

Department of Psychiatry, University of Michigan, MCHC, F6135, Ann Arbor, MI 48109, USA. liberzon@umich.edu

Neuroimaging provides an opportunity to understand core processes that mediate the experience of emotions in healthy individuals as well as dysregulation of these processes in conditions such as posttraumatic stress disorder (PTSD). The first decade of neuroimaging research produced symptom provocation, cognitive activation, and functional connectivity studies that highlighted the role of the  medial prefrontal cortex (mPFC), amygdala, sublenticular extended amygdala (SLEA), and hippocampus, in mediating symptom formation in PTSD. There is a growing realization that a number of other psychological processes are relevant to PTSD, and they are emerging as a new focus of neuroimaging research. These include fear conditioning, habituation, and extinction; cognitive-emotional interactions; and self-related and social emotional processing. Neuroimaging findings are reviewed that suggest that the mPFC is implicated in a number of these processes. It is proposed that the mPFC plays a role in the "contextualization" of stimuli, and dysregulation of contextualization processes  might play a key role in the generation of PTSD symptoms.

PMID: 18037013 [PubMed - in process]

 

Prog Brain Res. 2008;167:121-35.

Transgenerational transmission of cortisol and PTSD risk.

Yehuda R, Bierer LM.

The Traumatic Stress Studies Program, Department of Psychiatry, Mount Sinai School of Medicine and Bronx Veterans Affairs, James J Peters VAMC, 116-A, OOMH-PTSD, Bronx, NY 10468, USA. Rachel.yehuda@va.gov

Parental posttraumatic stress disorder (PTSD) appears to be a relevant risk factor for the development of PTSD, as evidenced by a greater prevalence of PTSD, but not trauma exposure, in adult offspring of Holocaust survivors with PTSD, compared to children of Holocaust-exposed parents without PTSD. This paper summarizes recent neuroendocrine studies in offspring of parents with PTSD. Offspring of trauma survivors with PTSD show significantly lower 24-h mean urinary cortisol excretion and salivary cortisol levels as well as enhanced plasma cortisol suppression in response to low dose dexamethasone administration  than offspring of survivors without PTSD. In all cases, neuroendocrine measures were negatively correlated with severity of parental PTSD symptoms, even after controlling for PTSD and even other symptoms in offspring. Though the majority of our work has focused on adult offspring of Holocaust survivors, recent observations in infants born to mothers who were pregnant on 9/11 demonstrate that low cortisol in relation to parental PTSD appears to be present early in the course of development and may be influenced by in utero factors such as glucocorticoid programming. Since low cortisol levels are particularly associated with the presence of maternal PTSD the findings suggest the involvement of epigenetic mechanisms.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18037011 [PubMed - in process]

 

Prog Brain Res. 2008;167:65-77.

Mice that under- or overexpress glucocorticoid receptors as models for depression or posttraumatic stress disorder.

Chourbaji S, Vogt MA, Gass P.

Central Institute of Mental Health, J 5, D-68159, Mannheim, Germany.

Modern molecular and pathophysiological concepts suggest that glucocorticoid receptors (GRs) play a crucial role for the pathogenesis, course and therapy of affective or emotional disorders. Specifically, an impairment of GR signaling has been associated with major depression, whereas overactivity or hyperresponsiveness of GRs have been conceptualized for posttraumatic stress disorder (PTSD). Recently, several research groups have generated transgenic mouse strains that under- or overexpress GRs, respectively. These animals seem to represent valuable tools for studying the foregoing hypotheses. Indeed, first results indicate that mice with a deficit in GR expression show a depression-like behavioral phenotype as well as characteristic neuroendocrinological changes observed in depressive patients. Particularly, GR heterozygous mice with a 50% reduction of GR expression represent a model for combined effects of both genetic and environmental manipulations, since their depression-like behavior becomes only manifest after stress-exposure. Thus, the phenotype of this strain mimics the human situation in depressive disorders, in which individuals at risk are predisposed to develop depressive episodes after stress. It is currently less clear whether, and in which way, mice that overexpress GRs can serve as models for PTSD, or mimic at least specific aspects of the clinical syndrome. The latter strains have still to be subjected to specific tests analyzing conditioning and sensitization processes in fearful situations. So far, mice with compromised GR expression seem to be a good tool to further study molecular, pathophysiological  and cellular/structural alterations that underlie specific behavioral features such as despair or helplessness. A major challenge is to decipher which signs and symptoms in patients correspond to these animal behavioral constructs, and to elucidate whether it is possible to gain insights from the animals' response to specific treatments for human therapy.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18037007 [PubMed - in process]

 

Psychopathology. 2008;41(2):129-34. Epub 2007 Dec 5.

Obsessive-compulsive disorder and posttraumatic stress disorder.

Grabe HJ, Ruhrmann S, Spitzer C, Josepeit J, Ettelt S, Buhtz F, Hochrein A, Schulze-Rauschenbach S, Meyer K, Kraft S, Reck C, Pukrop R, Klosterkötter J, Falkai P, Maier W, Wagner M, John U, Freyberger HJ.

Department of Psychiatry and Psychotherapy, University of Greifswald, Stralsund,  Germany. grabeh@uni-greifswald.de

BACKGROUND: Previous studies suggested an association between exposure to trauma  or stressful life events and obsessive-compulsive disorder (OCD). This study investigates the hypothesis that traumatic events and posttraumatic stress disorders (PTSD) precede the onset of OCD. SAMPLING AND METHODS: 210 cases with OCD from university treatment facilities were compared with 133 sex- and age-matched controls from the adult general population. The data were derived from a German family study on OCD (GENOS). Direct interviews were carried out with the German version of the Schedule for Affective Disorders and Schizophrenia - Lifetime Version for Anxiety Disorders (DSM-IV). RESULTS: Severe traumatization occurred in 6.2% of the OCD cases and in 8.3% of the controls. The lifetime prevalence rates of traumatization, PTSD and acute stress disorder were not different between the subjects with OCD and controls (p > 0.05). In 6 cases, acute stress disorder, subclinical or full PTSD preceded the onset of OCD, in 3 cases the trauma-related disorders and OCD occurred within the same year, in 5 other cases, the trauma-related disorders started after the onset of OCD. CONCLUSION: There is no significant association of traumatization or PTSD with OCD compared with controls. Given the low rate of trauma-related disorders occurring before (2.9%) or within (1.5%) the same year as the onset of OCD other  factors than severe traumatic events determine the onset of OCD in most of the cases. (c) 2007 S. Karger AG, Basel.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18059115 [PubMed - in process]

 

Psychosom Med. 2008 Jan;70(1):27-31. Epub 2007 Dec 24.

Neural correlates of levels of emotional awareness during trauma script-imagery in posttraumatic stress disorder.

Frewen P, Lane RD, Neufeld RW, Densmore M, Stevens T, Lanius R.

London Health Sciences Centre, 339 Windermere Road, London, Ontario, Canada, N6A  5A5.

OBJECTIVE: To examine individual differences in levels of emotional awareness as  a predictor of the blood oxygenation level dependent (BOLD) response to trauma script-driven imagery in trauma-exposed individuals with (n = 25) and without (n  = 16) posttraumatic stress disorder (PTSD). METHODS: Participants completed the Levels of Emotional Awareness Scale (LEAS) and a functional magnetic resonance imaging trauma script-driven imagery paradigm. RESULTS: Patients with PTSD exhibited lower LEAS scores in comparison with the control group. LEAS scores correlated positively with BOLD activity during trauma script-imagery in the ventral anterior cingulate cortex (vACC) in healthy controls, whereas LEAS scores correlated negatively with activation of vACC in individuals with PTSD. CONCLUSION: Patients with PTSD exhibit lower than average levels of emotional awareness. Levels of emotional awareness are differentially associated with vACC  response during trauma script-driven imagery in healthy controls versus individuals with PTSD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18158370 [PubMed - in process]

 

Psychosom Med. 2008 Jan;70(1):13-9. Epub 2007 Nov 8.

Changes in brain electrical activity after cognitive behavioral therapy for posttraumatic stress disorder in patients injured in motor vehicle accidents.

Rabe S, Zoellner T, Beauducel A, Maercker A, Karl A.

Dresden University of Technology, Dresden, Germany.

OBJECTIVE: To explore changes for the first time in neural processing due to effective cognitive behavioral therapy (CBT) in posttraumatic stress disorder (PTSD) after severe motor vehicle accidents. Recent studies have highlighted the  role of right hemisphere activation during withdrawal-related emotions (e.g., anxiety). There has been little research on changes in brain function due to cognitive-behavioral interventions in anxiety disorders. METHODS: We conducted a  randomized, controlled trial comparing cognitive-behavioral therapy with an assessment-only Wait-list condition. Spontaneous electroencephalographic activity was recorded from left and right anterior and posterior regions in participants with PTSD/subsyndromal PTSD receiving CBT (n = 17) before and after a CBT program. Wait-list controls (n = 18) were investigated before and after 3 months. RESULTS: At the pretreatment assessment, a pattern of increased right-sided activation during exposure to a trauma-related picture (relative to a neutral picture) was observed in both CBT and Wait-list participants. At posttreatment, there was a greater reduction of right anterior activation in the CBT group as compared with Wait-list controls. Across both groups, PTSD symptom reduction was  significantly positively correlated with a decrease in right anterior activation  to the trauma stimulus. CONCLUSIONS: These findings suggest that effective CBT treatment of PTSD may be accompanied by adaptive changes in asymmetrical brain function. Future studies are needed to confirm our findings.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 17991819 [PubMed - in process]

 

Psychosom Med. 2008 Jan;70(1):20-6. Epub 2007 Nov 8.

Depression, posttraumatic stress disorder, and mortality.

Kinder LS, Bradley KA, Katon WJ, Ludman E, McDonell MB, Bryson CL.

Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA. lskinder@stanfordalumni.org

OBJECTIVE: To determine whether a history of depression and/or posttraumatic stress disorder (PTSD) is associated with all-cause mortality in primary care patients over an average of 2 years. METHODS: Patients from seven Department of Veterans Affairs medical centers completed mailed questionnaires. Depression and  PTSD status were determined from patient self-report of a prior diagnosis and/or  electronic administrative data. Date of death was ascertained from Veterans Health Information Systems and Technology Architecture and the Department of Veterans Affairs' Beneficiary Identification and Records Locator System. RESULTS: Among 35,715 primary care patients, those with a history of depression without a  history of PTSD (n = 6876) were at increased risk of death over an average of 2 years compared with patients with neither depression nor PTSD after adjustment for demographic variables, health behaviors, and medical comorbidity (hazard ratio (HR) = 1.17; 95% Confidence Interval (CI) = 1.06-1.28). However, patients with a history of PTSD without a history of depression (n = 748) were not at increased risk of death compared with patients with neither depression nor PTSD (HR = 0.84; 95% CI = 0.63-1.13). Patients with a history of both (n = 3762) were  at increased risk of death after adjustment for demographic factors, although not after additional adjustment for health behaviors and medical comorbidity (HR = 0.90; 95% CI = 0.78-1.04). CONCLUSIONS: In a large sample of veterans, a prior diagnosis of depression, but not PTSD, was associated with an increased risk of death over an average of 2 years after adjusting for age, demographic variables,  health behaviors, and medical comorbidity.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17991816 [PubMed - in process]

 

J Behav Med. 2007 Dec 20 [Epub ahead of print]

Posttraumatic stress disorder, alcohol use, and physical health concerns.

Kaysen D, Pantalone DW, Chawla N, Lindgren KP, Clum GA, Lee C, Resick PA.

Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, MO, USA.

PTSD is a risk factor for alcohol problems and both in turn have been independently associated with increased health problems. However, it is unclear whether alcohol use moderates the relationship between PTSD and health. Participants were battered women (N = 336) recruited from local domestic violence shelters and non-shelter victim-assistance agencies. A 2 (PTSD diagnosis) x 3 (abstainer, infrequent/light, regular/heavy drinking) ANCOVA was conducted, with  injuries and length of abuse as covariates and health concerns as the dependent variable. Main effects for PTSD and alcohol use were significant but not the interaction. Women with PTSD reported the greatest number of health concerns. Women who abstained from drinking and those who drank regularly/heavily reported  more health concerns than the infrequent/light drinkers. Health concerns associated with PTSD do not appear to be due to problem drinking. In addition, infrequent/light drinking, even for women with PTSD, may be associated with fewer health concerns.

PMID: 18095150 [PubMed - as supplied by publisher]

 

Child Adolesc Psychiatry Ment Health. 2007 Dec 17;1(1):16 [Epub ahead of print]

Prediction of posttraumatic stress in fathers of children with chronic diseases or unintentional injuries: A six-months follow-up study.

Ribi K, Vollrath ME, Sennhauser FH, Gnehm HE, Landolt MA.

ABSTRACT: BACKGROUND: While fathers were neglected for a long time in research investigating families of pediatric patients, there are now a few studies available on fathers' posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). However, little is known about the course of PTSS and PTSD in fathers of pediatric patients. The present study aimed to compare the prevalence and course of PTSS and PTSD in fathers of children with different chronic and acute conditions and to identify factors that contribute to fathers'  PTSS. METHODS: Sixty-nine fathers of children newly diagnosed with either cancer, type I diabetes mellitus, or epilepsy and 70 fathers of children suffering from an unintentional injury completed questionnaires at 4-6 weeks (Time 1) and six months (Time 2) after diagnosis or injury. RESULTS: Noticeable PTSD rates were found in fathers of children with a chronic disease (26% at Time 1 and 21% at Time 2, respectively). These rates were significantly higher than rates found in  fathers of children with unintentional injuries (12% at Time 1 and 6% at Time 2,  respectively). Within 6 months after the child's diagnosis or accident a decrease in severity of PTSS was observed in both groups. Significant predictors of PTSS at Time 2 were the father's initial level of PTSS, the child's medical condition  (injuries vs. chronic diseases) and functional status, the father's use of dysfunctional coping strategies, and father's level of neuroticism. CONCLUSIONS:  Our findings suggest that fathers with initially high PTSS levels are at greater  risk to experience PTSS at follow-up, particularly fathers of children with a chronic disease. Sensitizing health care professionals to the identification of PTSS symptoms but also to indicators of neuroticism and the use of specific coping strategies early in the treatment course is essential for the planning and implementation of adequate intervention strategies.

PMID: 18086307 [PubMed - as supplied by publisher]

 

Drug Alcohol Depend. 2007 Dec 17 [Epub ahead of print]

Smoking predicts posttraumatic stress symptoms among rescue workers: A prospective study of ambulance personnel involved in the Enschede Fireworks Disaster.

van der Velden PG, Kleber RJ, Koenen KC.

Institute for Psychotrauma (IvP), Zaltbommel, The Netherlands.

BACKGROUND: Examining whether smoking is a risk factor for posttraumatic stress disorder (PTSD) symptoms among rescue workers affected by a disaster. METHODS: Ambulance personnel (N=66) participated in surveys 2-3 weeks (T1) and 18 months after a fireworks disaster (T2). Hierarchical multiple regression analyses were conducted with cigarette consumption at T1 as a predictor of PTSD symptoms at T2. Demographic characteristics, disaster experiences, peritraumatic dissociation, intrusions and avoidance, psychological distress and alcohol consumption assessed at T1 were included as covariates. RESULTS: Regression analyses showed that smoking at T1 independently predicted intrusions, avoidance, hostility, and depression symptoms at T2. Results were not affected by controlling for post-disaster critical incidents at work. CONCLUSIONS: This is the first prospective study among rescue workers demonstrating that smoking soon after a disaster predicts PTSD symptoms in the intermediate term. Findings substantiate results of previous studies indicating that smoking is a relevant risk factor. Future research on how changes in cigarettes consumption post-trauma affect risk  of PTSD is required.

PMID: 18093750 [PubMed - as supplied by publisher]

 

J Immigr Minor Health. 2007 Dec 11 [Epub ahead of print]

Smoking Patterns within a Primary Care Sample of Resettled Bosnian Refugees.

Weaver TL, Cajdrić A, Jackson ER.

Department of Psychology, Saint Louis University, 221 North Grand Blvd, Saint Louis, MO, 63103, USA, weavert@slu.edu.

The interconnections among smoking status, severity of nicotine related physical  dependence (NRPD), posttraumatic stress disorder (PTSD)-related physiological arousal and subjective health were explored within a sample of 66 resettled Bosnian refugees seeking primary healthcare services. Fifty-nine percent (n = 39/66) of the participants reported that they were current smokers and 44% (n = 29/66) indicated that they had smoked prior to the war. Both pre-war smoking and  PTSD arousal independently predicted current smoking. In addition, total PTSD arousal and individual symptoms of sleep difficulties, irritability, concentration, and hypervigilance were significantly and positively associated with NRPD. Severity of PTSD arousal and age uniquely predicted NRPD. While poorer subjective health was significantly associated with positive current smoking status, neither poorer subjective health nor severity of PTSD arousal was significantly associated with interest in quitting/reducing smoking. Findings were discussed within the context of culture and stressor-related issues.

PMID: 18071902 [PubMed - as supplied by publisher]

 

J Immigr Minor Health. 2007 Dec 11 [Epub ahead of print]

The "Lost Boys" of Sudan: Use of Health Services and Functional Health Outcomes of Unaccompanied Refugee Minors Resettled in the U.S.

Geltman PL, Grant-Knight W, Ellis H, Landgraf JM.

Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.

To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire  (CHQ) scales and questions regarding care for symptoms or problems associated with behavioral disorders, i.e. somatization. Posttraumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire (HTQ). Health services questions derived from the National Health Interview Survey. Minors reported high rates of counseling (45%); however no differences were noted in counseling use by those with PTSD compared with others. Counseling was not associated with health outcomes. The majority (76%) reported seeking medical care for symptoms or problems often associated with behavioral and emotional problems; however such care-seeking was more common among those with PTSD (OR = 2.5, 95% CI = 1.004-6.26). Through the efforts of the URMP, the Sudanese unaccompanied minors received high levels of psychosocial support despite the absence of their biological parents. Those with worse functional health were no more likely than others to have received mental health counseling while being more likely to seek  care from any health professional. This was also the case for those with PTSD compared to those without it. In linear regression analyses, reported receipt of  mental health counseling did not impact either positively or negatively on the score of any CHQ scale.

PMID: 18071901 [PubMed - as supplied by publisher]

 

J Pediatr Psychol. 2007 Dec 11 [Epub ahead of print]

Symptoms of Posttraumatic Stress in Parents of Children with Cancer: Are they Elevated Relative to Parents of Healthy Children?

Jurbergs N, Long A, Ticona L, Phipps S.

Division of Behavioral Medicine, St Jude Children's Research Hospital.

OBJECTIVE: To examine posttraumatic stress symptoms (PTSS) in parents of children with cancer as a function of time since diagnosis, treatment status, and relapse  history, and as compared to parents of healthy children. METHOD: Participants included parents of 199 children with cancer, comprising a cross-sectional sample of diagnoses and treatment phases, ranging from currently on therapy to long-term survivors, and 108 parents of healthy children obtained via acquaintance control  methods. Parents completed a standardized self-report measure of PTSS. RESULTS: Within the cancer group, parental report of PTSS differed as a function of treatment status and time since diagnosis. Parents of children on active treatment endorsed similar levels of PTSS as control parents, whereas parents of  children off treatment reported significantly lower levels of PTSS than did controls. Similarly, parents of long-term survivors reported significantly lower  levels of PTSS than did controls, while parents of recently diagnosed children did not differ from controls on PTSS. In contrast, parents of children who had suffered a relapse reported significantly higher levels of PTSS, and were much more likely to be identified as a posttraumatic stress disorder (PTSD) case. CONCLUSIONS: As a group, parents of children with cancer did not demonstrate any  evidence of increased PTSS relative to parents of healthy children. Time since diagnosis, child treatment status, and relapse history are significant determinants of parent PTSS. Only parents of children who experienced a relapse appear to be at increased risk of PTSD. The current results appear discrepant from the existing literature, and possible explanations for these discrepancies are examined.

PMID: 18073235 [PubMed - as supplied by publisher]

 

Neuroimmunomodulation. 2007 Dec 10;14(5):248-254 [Epub ahead of print]

Disturbance of Serum Interleukin-2 and Interleukin-8 Levels in Posttraumatic and  Non-Posttraumatic Stress Disorder Earthquake Survivors in Northern China.

Song Y, Zhou D, Guan Z, Wang X.

Institute of Mental Health, Beijing University, Beijing, SAR, China.

Objective: It is evident that immune cytokines are involved in the pathophysiology of posttraumatic stress disorder (PTSD), but results of different studies are still inconsistent. Here, serum interleukin (IL)-2, IL-6 and IL-8 levels were compared between earthquake survivors with PTSD, those with non-PTSD  and normal controls to investigate whether there is any relationship between cytokine levels and PTSD. In addition, the relationship of these cytokines with psychological parameters of the disorder was examined as well. Methods: Thirty-four earthquake survivors with PTSD (according to DSM-IV criteria), 30 earthquake survivors with non-PTSD and 34 controls were recruited in northern China using the Composite International Diagnostic Interview instrument. Serum IL-2, IL-6 and IL-8 levels were compared. IL-2 levels were measured by radioimmunometric assay, while serum IL-6 and IL-8 levels were measured using sandwich enzyme-linked immunosorbent assay. Psychological symptoms were assessed  using 3 subscales of the Symptoms Checklist (SCL-90-R), including depression, anxiety and somatization. Results: Only earthquake survivors diagnosed with PTSD  had significantly lower serum IL-8 levels. Also, we found that earthquake survivors (either with PTSD or non-PTSD) had significantly lower serum IL-2 levels and more severe psychological symptoms. The severity of depressive and anxiety symptoms in earthquake survivors was positively related to serum IL-6 levels. Conclusions: PTSD may be associated with a reduced level of serum IL-8, and traumatic survivors may be associated with a lower level of serum IL-2. Copyright (c) 2007 S. Karger AG, Basel.

PMID: 18073500 [PubMed - as supplied by publisher]

 

J Psychiatr Res. 2007 Dec 7 [Epub ahead of print]

Probing reward function in posttraumatic stress disorder: Expectancy and satisfaction with monetary gains and losses.

Hopper JW, Pitman RK, Su Z, Heyman GM, Lasko NB, Macklin ML, Orr SP, Lukas SE, Elman I.

Behavioral Psychopharmacology Research Laboratory, Department of Psychiatry, McLean Hospital and Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA.

BACKGROUND: Posttraumatic stress disorder (PTSD) may be associated with dysfunctional reward processing. The present study assessed for such dysfunction  in both the expectancy and outcome phases of reward processing. METHODS: Male Vietnam veterans with (n=15) and without (n=11) combat-related PTSD were administered a wheel of fortune-type gambling task. Self-reported ratings of expectancy and satisfaction were collected respectively before and after each experience of monetary gain or loss. RESULTS: PTSD participants reported both lower expectancy of reward and lower satisfaction with reward when it was received. The latter result was manifest in a failure of PTSD participants to show the greater satisfaction that normally accompanies rewards received under conditions of low expectancy. CONCLUSION: These results suggest reward function impairment in PTSD related to expectancy, satisfaction, and the expectancy-satisfaction relationship.

PMID: 18068725 [PubMed - as supplied by publisher]

 

Rheumatol Int. 2007 Dec 6 [Epub ahead of print]

Coping styles in fibromyalgia: effect of co-morbid posttraumatic stress disorder.

Ablin JN, Cohen H, Neumann L, Kaplan Z, Buskila D.

Institute of Rheumatology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv, 64239, Israel, ajacob@post.tau.ac.il.

To analyze coping styles of fibromyalgia (FM) patients with specific emphasis on  differences in coping styles between fibromyalgia patients with and without post  traumatic stress disorder (PTSD). Seventy-seven consecutive patients (40 women and 37 men) who fulfilled ACR criteria for FM, and 48 healthy controls, completed questionnaires measuring prevalence and severity of PTSD symptoms, including the  structured clinical interview for DSM-III-R-non-patient edition (SCID-NP) and the clinician administered PTSD scale (CAPS). Subjects were divided into two groups based on the presence or absence of PTSD symptoms. Subsequently, coping styles were measured using the Albert Einstein College of Medicine (AECOM) Coping Style  Questionnaire. Student t tests were used to compare the means of quantitative variables, and proportions were compared by Chi square tests. Analysis of variance (ANOVA) was used to compare the scores of the FM patients with and without PTSD, as well as to estimate the effect of gender on psychiatric variables. FM patients exhibit significantly higher levels of suppression (P < 0.00001), help-seeking (P < 0.007), replacement (P < 0.003), substitution (P < 0.002), and reversal (P < 0.004) compared with healthy controls. FM patients with PTSD and without PTSD differed significantly only on the suppression subscale (P  < 0.02). FM patients that have PTSD presented higher suppression scores compared  to FM patients without PTSD. No significant difference was noted on scales of minimization, help-seeking, replacement, blame, substitution, mapping, and reversal. Our results have delineated coping patterns of FM patients, identifying suppression, help-seeking, replacement, substitution and replacement as strategies more common among these patients. We further identified suppression as the only coping style significantly more common among FM patients with co-morbid  PTSD then among FM patients without such a diagnosis. Our results may serve to further characterize cognitive and behavioral aspects of FM patients and subsequently guide therapeutic interventions.

PMID: 18058105 [PubMed - as supplied by publisher]

 

Am J Med Genet B Neuropsychiatr Genet. 2007 Dec 5;144(8):1087-9.

Dopamine beta-hydroxylase (DBH) activity and -1021C/T polymorphism of DBH gene in combat-related post-traumatic stress disorder.

Mustapić M, Pivac N, Kozarić-Kovacić D, Dezeljin M, Cubells JF, Mück-Seler D.

Division of Molecular Medicine, Rudjer Bosković Institute, Zagreb, Croatia.

The roles of dopamine (DA) and norepinephrine (NE) in posttraumatic stress disorder (PTSD) are unclear. The aim of the study was to determine plasma dopamine beta-hydroxylase (DBH) activity and DBH-1021C/T gene polymorphism in combat veterans with (N = 133) or without (N = 34) chronic PTSD. Similar frequencies in genotype or allele distribution were found between veterans with or without PTSD. War veterans with PTSD had lower DBH activity, associated with the DBH-1021C/T variant in DBH genes, than veterans without PTSD. A significantly lower plasma DBH activity was found in combat veterans with PTSD carrying the CC  genotype as compared to veterans without PTSD carrying the corresponding genotype. Since both groups were exposed to the same trauma, it is possible that  a pre-existing trait difference in regulation of NE function contributed to a differential vulnerability to develop PTSD, or that the regulation of DBH expression was different in response to trauma. The results suggest that that genotype-controlled measurement of plasma DBH activity might be used as a potential biological marker of the response to trauma, and that further studies of DBH and other loci related to DA and NA in PTSD are warranted. 2007 Wiley-Liss, Inc.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 17853400 [PubMed - in process]

 

Pain. 2007 Dec 5;132(3):332-6. Epub 2007 Oct 1.

Pain flashbacks following the July 7th 2005 London bombings.

Whalley MG, Farmer E, Brewin CR.

Sub-Department of Clinical Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. matwhalley@gmail.com

Flashbacks in posttraumatic stress disorder (PTSD) are commonly experienced as visual, auditory, olfactory or tactile re-livings of a previously experienced traumatic event. We present the case report of one survivor of the July 7th 2005  London underground bombings who was diagnosed with PTSD and who experienced painful flashbacks. We present retrospective multidimensional measures of his pain using standardised instruments. The case provides further evidence that somatosensory re-experiencing of pain memories is possible. Findings are discussed with regards to memory for pain.

Publication Types:      Case Reports     Research Support, Non-U.S. Gov't

PMID: 17910905 [PubMed - indexed for MEDLINE]

 

Acta Psychiatr Scand. 2007 Dec;116(6):483-7.

Posttraumatic stress disorder as a risk factor for obesity among male military veterans.

Vieweg WV, Julius DA, Bates J, Quinn JF 3rd, Fernandez A, Hasnain M, Pandurangi AK.

Psychiatry and Medicine Services, Hunter Holmes McGuire Veterans Affairs Medical  Center, Richmond, VA. vvieweg@visi.net

OBJECTIVE: Obesity is a significant public health problem in the United States, particularly among military veterans with multiple risk factors. Heretofore, posttraumatic stress disorder (PTSD) has not clearly been identified as a risk factor for this condition. METHOD: We accessed both a national and local database of PTSD veterans. RESULTS: Body mass index (BMI) was greater (P < 0.0001) among male military veterans (n = 1819) with PTSD (29.28 +/- 6.09 kg/m(2)) than those veterans (n = 44 959) without PTSD (27.61 +/- 5.99 kg/m(2)) in a sample of randomly selected veterans from the national database. In the local database of male military veterans with PTSD, mean BMI was in the obese range (30.00 +/- 5.65) and did not vary by decade of life (P = 0.242). CONCLUSION: Posttraumatic stress disorder may be a risk factor for overweight and obesity among male military veterans.

PMID: 17997727 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2007 Dec;32(12):3015-25. Epub 2007 Jul 19.

Daily stressor sensitivity, abuse effects, and cocaine use in cocaine dependence.

Waldrop AE, Back SE, Brady KT, Upadhyaya HP, McRae AL, Saladin ME.

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Box 250861, Charleston, SC 29425, USA.

This study highlights respondent sensitivity to daily hassles as it relates to situational cocaine use and perceived long-term effects of adverse events in childhood. Data were drawn from a larger study on stress reactivity in cocaine dependent individuals. Participants (n=104) were cocaine dependent men and women  without comorbid posttraumatic stress disorder (PTSD). They completed the Early Trauma Inventory (ETI), the Daily Hassles Scale (DHS), the Inventory of Drug-Taking Situations (IDTS), and the Time-Line Follow-Back (TLFB; for 90 days prior to interview). There were no gender differences in the amount or frequency  of cocaine use, although the patterns of use differed between male and female users. Overall, there were some associations in the patterns of cocaine use and sensitivity to daily hassles, particularly the use in response to conflict with others. Early negative life events were positively related to response to daily hassles, but current triggers were more relevant. Reactivity to cocaine cues was  related to daily hassle sensitivity among women only. Limitations and implications of the findings are discussed.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 17706887 [PubMed - in process]

 

Addict Behav. 2007 Dec;32(12):2900-15. Epub 2007 May 3.

The effects of cigarette smoking on script-driven imagery in smokers with and without posttraumatic stress disorder.

Beckham JC, Dennis MF, McClernon FJ, Mozley SL, Collie CF, Vrana SR.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. jean.beckham@med.va.gov

The study investigated the effects of smoking a nicotinized or denicotinized cigarette on craving, affect and posttraumatic stress disorder (PTSD) symptoms while recalling neutral, stressful and traumatic events in smokers with and without PTSD. Smokers completed laboratory sessions during which they were presented with audiotapes of personalized scripts followed by smoking a cigarette. The effect of the script and cigarette conditions on dependent variables was evaluated. There was a main effect of script type across groups for smoking craving, negative affect and PTSD symptoms, with increased symptoms in trauma and stressful conditions. Responses were significantly higher in PTSD smokers. Smoking either cigarette type resulted in decreased craving, negative affect and PTSD symptoms in both groups. A second script presentation following smoking elicited similar responses, suggesting the ameliorative effect of having  smoked a cigarette was short-lived. These results support that context and non-pharmacologic effects of smoking are important variables in smoking craving and mood, particularly in smokers with PTSD.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17544226 [PubMed - in process]

 

Addict Behav. 2007 Dec;32(12):2788-98. Epub 2007 Apr 14.

The psychometric utility of two self-report measures of PTSD among women substance users.

Harrington T, Newman E.

University of Tulsa, Department of Psychology, 600 South College Avenue, Tulsa, OK 74104, USA. tracy-davis@utulsa.edu

Given the high rates of posttraumatic stress disorder (PTSD) among substance users, integrated programs that target PTSD and substance use are recommended as  best practice. To effectively implement such treatments, accurate and reliable PTSD screening instruments are needed. Unfortunately, no standardized PTSD measure has been validated among women substance abusers. Therefore, the goal of  this investigation was to examine the psychometric utility of two PTSD measures to optimize the number of women clients correctly identified as meeting diagnostic criterion for PTSD. Forty-four women in residential substance use treatment were administered diagnostic interviews for PTSD (Clinician-Administered PTSD Scale) and then completed questionnaires regarding trauma exposure and related symptoms. In this group, 38.6% of the participants met diagnostic criteria for current PTSD. A score of 38 and above on the PTSD Checklist Civilian Version and a Penn Inventory score of 25 and above optimally maximized the number of women with PTSD identified and minimized false negative and false positive rates.

Publication Types:      Comparative Study     Evaluation Studies

PMID: 17507172 [PubMed - in process]

 

Am J Audiol. 2007 Dec;16(2):107-17.

The association between tinnitus and posttraumatic stress disorder.

Fagelson MA.

Department of Communicative Disorders, East Tennessee State University, Box 70643, Johnson City, TN 37614, USA. fagelson@etsu.edu

PURPOSE: Posttraumatic stress disorder (PTSD) affects nearly 10% of the population, a prevalence comparable with that of tinnitus. Similarities between the way PTSD and tinnitus influence auditory behaviors include exaggerated startle responses and decreased loudness tolerance. Tinnitus loudness is often exacerbated by sounds that trigger PTSD-related anxiety. This report addresses physical and psychological relations between PTSD and tinnitus. METHOD: A chart review of veterans seen over a 4-year period for tinnitus services was conducted. Case history and self-assessments of tinnitus handicap were examined in all patients. A review of the literature related to triggers and effects of PTSD was  conducted to explore potential consequences related to the presence of PTSD in the Veterans Affairs Medical Center (VAMC) tinnitus population. RESULTS: Chart review confirmed that 34% of the first 300 patients enrolled in the VAMC Tinnitus Clinic also carried a diagnosis of PTSD. Patient reports citing tinnitus severity, suddenness of tinnitus onset, sound-tolerance problems, and sound-triggered exacerbation of tinnitus were more common for patients with a PTSD diagnosis than patients with tinnitus only. CONCLUSIONS: Several neural mechanisms linked to both tinnitus and PTSD affect auditory behaviors. Audiologists should be aware that patients with tinnitus and PTSD will require test protocols and referrals that address these powerful responses.

PMID: 18056879 [PubMed - in process]

 

Am J Public Health. 2007 Dec;97(12):2160-6. Epub 2007 Oct 30.

The Veterans Health Administration and military sexual trauma.

Kimerling R, Gima K, Smith MW, Street A, Frayne S.

Veterans Administration Health Care System, Palo Alto, Calif, USA. rachel.kimerling@va.gov

OBJECTIVES: We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence. METHODS: We analyzed VHA administrative data for 185,880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003.  RESULTS: Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR]=8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99%  CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic  pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. CONCLUSIONS: The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women's health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17971558 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2007 Dec;97(12):2143-5. Epub 2007 Oct 30.

US Department of Veterans Affairs disability policies for posttraumatic stress disorder: administrative trends and implications for treatment, rehabilitation, and research.

Frueh BC, Grubaugh AL, Elhai JD, Buckley TC.

Department of Psychology, University of Hawai'i, Hilo, HI 96720, USA. frueh@hawaii.edu

An accumulating body of empirical data suggests that current Department of Veterans Affairs (VA) psychiatric disability and rehabilitation policies for combat-related posttraumatic stress disorder (PTSD) are problematic. In combination, recent administrative trends and data from epidemiological and clinical studies suggest theses policies are countertherapeutic and hinder research efforts to advance our knowledge regarding PTSD. Current VA disability policies require fundamental reform to bring them into line with modern science and medicine, including current empirically supported concepts of resilience and  psychiatric rehabilitation.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 17971542 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2007 Dec;97(12):2193-8. Epub 2007 Oct 30.

Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics.

Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, Valenstein M.

Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Health Services Research and Development (HSR&D) Center of Excellence, Department of Veterans Affairs, Ann Arbor, Mich, USA. kzivin@umich.edu

OBJECTIVES: We sought to report clinical and demographic factors associated with  suicide among depressed veterans in an attempt to determine what characteristics  identified depressed veterans at high risk for suicide. METHODS: We used longitudinal, nationally representative data (1999-2004) to determine suicide rates among depressed veterans, estimating time until suicide using Cox proportional hazards regression models. RESULTS: Of 807694 veterans meeting study criteria, 1683 (0.21%) committed suicide during follow-up. Increased suicide risks were observed among male, younger, and non-Hispanic White patients. Veterans without service-connected disabilities, with inpatient psychiatric hospitalizations in the year prior to their qualifying depression diagnosis, with comorbid substance use, and living in the southern or western United States were  also at higher risk. Posttraumatic stress disorder (PTSD) with comorbid depression was associated with lower suicide rates, and younger depressed veterans with PTSD had a higher suicide rate than did older depressed veterans with PTSD. CONCLUSIONS: Unlike the general population, older and younger veterans are more prone to suicide than are middle-aged veterans. Future research should examine the relationship between depression, PTSD, health service use, and suicide risks among veterans.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17971541 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2007 Dec;20(4):353-67.

Examining posttraumatic growth among Japanese university students.

Taku K, Calhoun LG, Tedeschi RG, Gil-Rivas V, Kilmer RP, Cann A.

Department of Psychology, University of North Carolina at Charlotte, North Carolina 28223, USA. ktaku@uncc.edu

To determine the underlying factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J), a principal components analysis was performed on data from 312 Japanese undergraduate students who reported growth due to their most traumatic event within the last 5 years. Results showed the PTGI-J has high internal consistency and, of the original five factors reported by Tedeschi and Calhoun (1996), three were replicated: Relating to Others, New Possibilities, Personal Strength, and a fourth factor integrating Spiritual Change and Appreciation of Life emerged. There were neither gender differences nor relationships with time since trauma. PTGI-J scores were positively associated with posttraumatic symptoms and correlated with type of traumatic event experienced. These results and future directions are discussed from a cross-cultural viewpoint.

PMID: 17999236 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2007 Dec;20(4):337-51.

The role of emotional inexpressivity and experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and aggressive behavior among men exposed to interpersonal violence.

Tull MT, Jakupcak M, Paulson A, Gratz KL.

Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, USA. MTull@psyc.umd.edu

Posttraumatic stress disorder (PTSD) has been found to be associated with aggressive behavior. Recent evidence suggests that the ways in which individuals  respond to their emotions may account for this relationship. In particular, to the extent that aggressive behaviors serve an emotion regulatory function, responding to emotions with avoidance (i.e., experiential avoidance) or the active suppression of emotional expression may heighten emotion dysregulation, increasing the risk for aggressive behavior as individuals attempt to regulate that dysregulated state. This study examined whether these two ways of responding to emotions account for the relationship between PTSD symptom severity and self-reported engagement in aggressive behavior among a diverse sample of 113 men with past exposure to interpersonal violence. Experiential avoidance and emotional inexpressivity each accounted for a significant amount of unique variance in aggressive behavior, above and beyond PTSD symptom severity and trait anger. Clinical and research implications of findings are discussed.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 17999235 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 Dec;64(12):1435-42.

Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: do early life experiences and predispositions matter?

Reed PL, Anthony JC, Breslau N.

Biomedical Research & Informatics Center, Michigan State University, 100 Conrad Hall, East Lansing, MI 48824-1327, USA. reedph@ht.msu.edu

CONTEXT: Most estimated associations of posttraumatic stress disorder (PTSD) with DSM-IV drug dependence and abuse are from cross-sectional studies or from prospective studies of adults that generally do not take into account suspected causal determinants measured in early childhood. OBJECTIVE: To estimate risk for  incident drug disorders associated with prior DSM-IV PTSD. DESIGN: Multiwave longitudinal study of an epidemiologic sample of young adults first assessed at entry to first grade of primary school in the fall semesters of 1985 and 1986, with 2 young adult follow-up assessm