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 assessments. SETTING: Mid-Atlantic US urban community. PARTICIPANTS: Young adults (n = 988; aged 19-24 years) free of clinical features of DSM-IV drug use disorders at the first young adult assessment and therefore at risk for newly incident drug use disorders during the 1-year follow-up period. MAIN OUTCOME MEASURES: During the 12-month interval between the 2 young adult follow-up assessments, newly incident (1) DSM-IV drug abuse or dependence; (2) DSM-IV drug abuse; (3) DSM-IV drug dependence; and (4) emerging dependence problems (1 or 2 newly incident clinical features of DSM-IV drug dependence), among subjects with no prior clinical features of drug use disorders. RESULTS: Prior PTSD (but not trauma only) was associated with excess risk for drug abuse or dependence (adjusted relative risk, 4.9; 95% confidence interval, 1.6-15.2) and emerging dependence problems (adjusted relative risk, 4.9; 95% confidence interval, 1.2-20.1) compared with the no-trauma group controlling for childhood factors. Subjects with PTSD also had a greater adjusted relative risk for drug abuse or dependence compared with subjects exposed to trauma only (adjusted relative risk, 2.0; 95% confidence interval, 1.1-3.8) controlling for childhood factors. CONCLUSIONS: Association of PTSD with subsequent incident drug use disorders remained substantial after statistical adjustment for early life experiences and predispositions reported in previous studies as carrying elevated risk for both disorders. Posttraumatic stress disorder might be a causal determinant of drug use disorders, possibly representing complications such as attempts to self-medicate troubling trauma-associated memories, nightmares, or painful hyperarousal symptoms.

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

PMID: 18056552 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 Dec;64(12):1427-34.

Exposure to hurricane-related stressors and mental illness after Hurricane Katrina.

Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA, McNally RJ, Ursano RJ,  Petukhova M, Kessler RC.

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA. sgalea@umich.edu

CONTEXT: Uncertainty exists about the prevalence, severity, and correlates of mental disorders among people exposed to Hurricane Katrina. OBJECTIVE: To estimate the prevalence and associations between DSM-IV anxiety-mood disorders and hurricane-related stressors separately among prehurricane residents of the New Orleans metropolitan area and the remainder of the areas in Alabama, Louisiana, and Mississippi affected by Katrina. DESIGN: Community survey. SETTING AND PARTICIPANTS: A probability sample of 1043 English-speaking prehurricane residents of the areas affected by Hurricane Katrina was administered via telephone survey between January 19 and March 31, 2006. The survey assessed hurricane-related stressors and screened for 30-day DSM-IV anxiety-mood disorders. MAIN OUTCOME MEASURES: The K6 screening scale of anxiety-mood disorders and the Trauma Screening Questionnaire scale for posttraumatic stress disorder (PTSD), both calibrated against blinded structured clinical reappraisal  interviews to approximate the 30-day prevalence of DSM-IV disorders. RESULTS: Prehurricane residents of the New Orleans metropolitan area were estimated to have a 49.1% 30-day prevalence of any DSM-IV anxiety-mood disorder (30.3% estimated prevalence of PTSD) compared with 26.4% (12.5% PTSD) in the remainder of the sample. The vast majority of respondents reported exposure to hurricane-related stressors. Extent of stressor exposure was more strongly related to the outcomes in the New Orleans metropolitan area subsample than the remainder of the sample. The stressors most strongly related to these outcomes were physical illness/injury and physical adversity in the New Orleans metropolitan area subsample and property loss in the remainder of the sample. Sociodemographic correlates were not explained either by differential exposure or reactivity to hurricane-related stressors. CONCLUSIONS: The high prevalence of DSM-IV anxiety-mood disorders, the strong associations of hurricane-related stressors with these outcomes, and the independence of sociodemographics from stressors argue that the practical problems associated with ongoing stressors are widespread and must be addressed to reduce the prevalence of mental disorders in  this population.

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

PMID: 18056551 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Dec;45(12):2915-23. Epub 2007 Aug 14.

Autobiographical memory in posttraumatic stress disorder before and after treatment.

Sutherland K, Bryant RA.

School of Psychology, University of New South Wales, New South Wales, Sydney 2052, Australia.

Although overgeneral retrieval of autobiographical memories has been repeatedly demonstrated in posttraumatic stress disorder (PTSD), no studies have indexed overgeneral retrieval before and after treatment of PTSD. Autobiographical memory was assessed in PTSD participants (n=20) prior to commencing cognitive behaviour  therapy and 6 months after therapy completion. Fifteen participants completed both assessments. Improvement in PTSD symptoms was significantly associated with  improved retrieval of specific memories and decreased retrieval of categoric memories in response to positive cues. These data suggest that symptom reduction  during treatment of PTSD leads to greater access to specific memories of positive experiences.

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

PMID: 17897618 [PubMed - in process]

 

Behav Res Ther. 2007 Dec;45(12):2861-73. Epub 2007 May 31.

An analog study of patient preferences for exposure versus alternative treatments for posttraumatic stress disorder.

Becker CB, Darius E, Schaumberg K.

Department of Psychology, Trinity University, One Trinity Place, San Antonio, TX  78212-7200, USA. carolyn.becker@trinity.edu

Although several efficacious treatments for posttraumatic stress disorder (PTSD)  exist, these treatments are currently underutilized in clinical practice. To address this issue, research must better identify barriers to dissemination of these treatments. This study investigated patient preferences for PTSD treatment  given a wide range of treatment options in an analog sample. One hundred and sixty individuals, with varying degrees of trauma history, were asked to imagine  themselves undergoing a trauma, developing PTSD, and seeking treatment. Participants evaluated seven different treatment descriptions, which depicted treatment options that they might encounter in a clinical setting. Participants rated their most and least preferred treatments along with their personal reactions to and the perceived credibility of each treatment. Participants also completed a critical thinking skills questionnaire. Participants predominantly chose exposure or another variant of cognitive-behavioral therapy as their most preferred therapy, and those who chose exclusively empirically supported treatments evidenced higher critical thinking skills. The present study contributes to a growing literature indicating that patients may be more interested in these therapies than indicated by utilization rates. The problem of underutilization of empirically supported treatments for PTSD in clinical practice may be due to therapist factors.

PMID: 17612502 [PubMed - in process]

 

Conscious Cogn. 2007 Dec;16(4):877-85. Epub 2006 Aug 9.

Trauma-related and neutral false memories in war-induced Posttraumatic Stress Disorder.

Brennen T, Dybdahl R, Kapidzić A.

Department of Psychology, University of Oslo, PO Box 1094 Blindern, 0317 Oslo, Norway.

Recent models of cognition in Posttraumatic Stress Disorder (PTSD) predict that trauma-related, but not neutral, processing should be differentially affected in  these patients, compared to trauma-exposed controls. This study compared a group  of 50 patients with PTSD related to the war in Bosnia and a group of 50 controls  without PTSD but exposed to trauma from the war, using the DRM method to induce false memories for war-related and neutral critical lures. While the groups were  equally susceptible to neutral critical lures, the PTSD group mistakenly recalled more war-related lures. Both false and correct recall were related more to depression than to self-rated trauma. Implications for accounts of false memories in terms of source-monitoring are discussed.

PMID: 16901721 [PubMed - in process]

 

J Behav Ther Exp Psychiatry. 2007 Dec;38(4):345-70. Epub 2007 Oct 26.

Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting.

Arntz A, Tiesema M, Kindt M.

Department of Clinical Psychological Science, University of Maastricht, P.O. Box  616, NL-6200 MD Maastricht, The Netherlands.

We tested whether the effectiveness of imaginal exposure (IE) treatment for posttraumatic stress disorder (PTSD) was enhanced by combining IE with imagery rescripting (IE+IR). It was hypothesized that IE+IR would be more effective than  IE by (1) providing more corrective information so that more trauma-related problems can be addressed, and (2) allowing patients to express emotions that they had been inhibiting, such as anger. In a controlled study 71 chronic PTSD patients were randomly assigned to IE or IE+IR. Data of 67 patients were available. Treatment consisted of 10 weekly individual therapy sessions and treatment evaluation was conducted post-treatment and at 1-month follow-up. Results show that when compared with wait-list, treatment reduced severity of PTSD symptoms. More patients dropped out of IE than out of IE+IR before the 8th sessions, 51% vs. 25%, p=.03. Completers and intention-to-treat analyses indicated that both conditions did not differ significantly in reduction of PTSD  severity. IE+IR was more effective for anger control, externalization of anger, hostility and guilt, especially at follow-up. Less strong effects were found on shame and internalized anger. Therapists tended to favor IE+IR as it decreased their feelings of helplessness compared to IE. Results suggest that the addition  of rescripting to IE makes the treatment more acceptable for both patients and therapists, and leads to better effects on non-fear problems like anger and guilt.

PMID: 18005935 [PubMed - in process]

 

J Clin Psychopharmacol. 2007 Dec;27(6):677-81.

A randomized, double-blind, placebo-controlled trial of augmentation topiramate for chronic combat-related posttraumatic stress disorder.

Lindley SE, Carlson EB, Hill K.

Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA. lindleys@stanford.edu

BACKGROUND: Topiramate, a novel anticonvulsant, has been reported to rapidly reduce symptoms of posttraumatic stress disorder (PTSD) in an open-label trial. The present study was designed as a test of topiramate's efficacy as adjunctive therapy in a 7-week, randomized, double-blind, placebo-controlled trial. METHODS: Forty male veterans with PTSD in a residential treatment program were randomized  to flexible-dose topiramate or placebo augmentation. The primary outcome measures were PTSD symptom severity and global symptom improvement. RESULTS: Baseline Clinician-Administered PTSD Scale scores were 62.1 +/- 13.9 for placebo and 61.0  +/- 22.2 for topiramate. There was a high dropout rate from the study (55% topiramate; 25% placebo), with 40% of topiramate and 10% of placebo dropping because of adverse events (AEs). No significant treatment effects of topiramate versus placebo were observed for the primary treatment outcomes. Subjects reporting central nervous system-related AEs and with higher baseline severity of depression were more likely to discontinue because of AEs. CONCLUSIONS: Primary outcome measures failed to demonstrate a significant effect for topiramate over placebo; however, high dropout rate in the treatment group prohibits definitive conclusions about the efficacy of topiramate in this population.

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

PMID: 18004136 [PubMed - in process]

 

J Interpers Violence. 2007 Dec;22(12):1603-12.

The role of cognitive coping in female victims of stalking.

Kraaij V, Arensman E, Garnefski N, Kremers I.

Medical Psychology Department, Leiden University Medical Center, P.O. Box 9555, 2300 RB Leiden, the Netherlands.

The aim of the study is to examine the role of cognitive coping in a sample of 47 female victims of stalking. Stalking victims who blamed themselves more for the stalking report significantly higher symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Respondents who ruminated more about the stalking experience, or respondents who explicitly emphasized the terror of the stalking to a higher extent, also report significantly higher symptom levels. Finally, respondents who thought more about what steps to take and how to handle  the stalking report significantly higher symptom levels of depression, anxiety, and PTSD. This conclusion holds also after controlling for the severity of stalking. If the findings of the present study can be confirmed, this could possibly contribute to the help provided to victims of stalking.

PMID: 17993644 [PubMed - in process]

 

J Nerv Ment Dis. 2007 Dec;195(12):1027-9.

Morphologic alterations in the corpus callosum in abuse-related posttraumatic stress disorder: a preliminary study.

Kitayama N, Brummer M, Hertz L, Quinn S, Kim Y, Bremner JD.

Division of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan. norikita@fd6.so-net.ne.jp

Magnetic resonance imaging (MRI) studies in children with maltreatment-related posttraumatic stress disorder (PTSD) have demonstrated smaller corpus callosum area, with the greatest magnitude of change in posterior portions of the corpus callosum. The purpose of this study was to measure corpus callosum area in adult  female patients with childhood abuse-related PTSD and comparison subjects. MRI was used to measure the midsagittal area of the corpus callosum as well as subregions of the corpus callosum in 9 female subjects with abuse-related PTSD and 9 healthy female subjects. No differences were found in total area of the corpus callosum or in individual subregions, but the subregion/total area ratio was significantly smaller in posterior midbody in PTSD compared with the healthy  subjects. These results suggest that relatively smaller areas of the posterior midbody of the corpus callosum are associated with childhood abuse related PTSD in adults; these findings are consistent with findings in children with abuse-related PTSD.

PMID: 18091198 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Dec;195(12):1004-12.

Screening for posttraumatic stress disorder: what combination of symptoms predicts best?

Ehring T, Kleim B, Clark DM, Foa EB, Ehlers A.

Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom. t.w.a.ehring@uva.nl

Several symptom screening instruments have been developed to identify trauma survivors at risk for chronic posttraumatic stress disorder, but few of these have been thoroughly evaluated to date. In this study, a range of symptom combination scoring rules derived from the literature were applied to the Posttraumatic Diagnostic Scale and evaluated in 4 different samples of trauma survivors (total N = 522) regarding their power to identify people with posttraumatic stress disorder. Results were replicated in a fifth sample (N = 253). Most scoring rules showed lower diagnostic efficiencies than in the original reports. The most stable results were obtained for cutoffs on the Posttraumatic Diagnostic Scale total scale and a new subset of 8 items. The results underscore the need to cross-validate findings before using screening instruments for clinical applications.

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

PMID: 18091194 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2007 Dec;41(12):1019-26. Epub 2006 Oct 9.

Basal cortisol and DHEA levels in women with borderline personality disorder.

Jogems-Kosterman BJ, de Knijff DW, Kusters R, van Hoof JJ.

Institute of Mental Health Care, GGZ Oost Brabant, PO Box 632, 5340 AP Oss, The Netherlands. bjm.jogems@ggzoostbrabant.nl

Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol  levels were not significantly increased in the patient group as a whole but only  in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients' cortisol secretions decreased relatively less steep during the day  than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance  of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.

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

PMID: 17028025 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Dec;20(6):955-64.

Domains of quality of life and symptoms in male veterans treated for posttraumatic stress disorder.

Lunney CA, Schnurr PP.

VA National Center for PTSD, White River Junction, VT.

This study examined the relationship between domains of quality of life and posttraumatic stress disorder (PTSD) symptoms in 319 male veterans in a randomized trial of group psychotherapy. Confirmatory factor analyses suggested a 4-factor model of quality of life (achievement, self-expression, relationships, and surroundings) fit better than a unidimensional model. Clinically meaningful symptom change was associated with greater change in all quality of life domains. At pretreatment, numbing symptoms uniquely predicted all quality of life domains. Change in avoidance and hyperarousal uniquely predicted change in achievement. Change in reexperiencing uniquely predicted change in self-expression. Change in  numbing uniquely predicted change in relationships. Examining change in PTSD symptoms and quality of life domains may provide important information for treatment planning and evaluation.

PMID: 18157892 [PubMed - in process]

 

J Trauma Stress. 2007 Dec;20(6):945-54.

Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD.

Jakupcak M, Conybeare D, Phelps L, Hunt S, Holmes HA, Felker B, Klevens M, McFall ME.

VA Puget Sound Health Care System, Seattle, WA.

Iraq and Afghanistan War veterans were grouped by level of posttraumatic stress disorder (PTSD) symptomatology and compared on self-report measures of trait anger, hostility, and aggression. Veterans who screened positive for PTSD reported significantly greater anger and hostility than those in the subthreshold-PTSD and non-PTSD groups. Veterans in the subthreshold-PTSD group reported significantly greater anger and hostility than those in the non-PTSD group. The PTSD and subthreshold-PTSD groups did not differ with respect to aggression, though both groups were significantly more likely to have endorsed aggression than the non-PTSD group. These findings suggest that providers should  screen for anger and aggression among Iraq and Afghanistan War veterans who exhibit symptoms of PTSD and incorporate relevant anger treatments into early intervention strategies.

PMID: 18157891 [PubMed - in process]

 

J Trauma Stress. 2007 Dec;20(6):1075-9.

The relationship between acute stress disorder and posttraumatic stress disorder  in injured children.

Bryant RA, Salmon K, Sinclair E, Davidson P.

School of Psychology, University of New South Wales, Sydney, Australia.

This study indexed the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in injured children. Consecutive  children between 7-13 years admitted to a hospital after traumatic injury (n = 76) were assessed for ASD. Children were followed up 6-months posttrauma (n = 62), and administered the PTSD Reaction Index. Acute stress disorder was diagnosed in 10% of patients, and 13% satisfied criteria for PTSD. At 6-months posttrauma, PTSD was diagnosed in 25% of patients who were diagnosed with ASD. Acute stress reactions that did not include dissociation provided better prediction of PTSD than full ASD criteria. These findings suggest that the current ASD diagnosis is not optimal in identifying younger children who are high risk for PTSD development.

PMID: 18157890 [PubMed - in process]

 

J Trauma Stress. 2007 Dec;20(6):923-32.

Pharmacotherapy to prevent PTSD: Results from a randomized controlled proof-of-concept trial in physically injured patients.

Stein MB, Kerridge C, Dimsdale JE, Hoyt DB.

Departments of Psychiatry, and Family & Preventive Medicine, University of California San Diego, and the VA San Diego Healthcare System, San Diego, CA.

Acute physical injury is frequently associated with mental health sequelae, which then accentuate disability and worsen functional outcomes. A pharmacological prevention approach to this problem has been proposed. This proof-of-concept study was a double-blind, randomized controlled trial of 14 days of the beta-blocker propranolol (n = 17), the anxiolytic anticonvulsant gabapentin (n =  14), or placebo (n = 17), administered within 48 hours of injury to patients admitted to a surgical trauma center. Of 569 accessible, potentially eligible subjects, 48 (8%) participated. Outcomes assessments were conducted at 1, 4, and  8 months postinjury. Although well tolerated, neither study drug showed a significant benefit over placebo on depressive or posttraumatic stress symptoms.  Implications are discussed for future pharmacological prevention studies in survivors of acute traumatic injury.

PMID: 18157888 [PubMed - in process]

 

J Trauma Stress. 2007 Dec;20(6):999-1008.

Appearance-related residual injury, posttraumatic stress, and body image: Associations within a sample of female victims of intimate partner violence.

Weaver TL, Resnick HS, Kokoska MS, Etzel JC.

Department of Psychology, Saint Louis University, Saint Louis, MO.

One third of women who experience intimate partner violence (IPV) receive some form of injury. After acute injuries have healed, a victim's physical appearance  may be altered with residual changes including marks or scars. This study included 56 female victims of IPV (31 with appearance-related residual injury and a comparison group of 25 with no appearance-related residual injury) and examined the associations between violence-related experiences, body image distress, and symptoms of posttraumatic stress disorder (PTSD). Appearance-related residual injury status moderated the relationship between body image distress and symptoms of PTSD. In addition, within the appearance-related residual injury group, body image distress emerged a unique predictor of PTSD explaining incremental variance beyond that explained by severity of psychological maltreatment.

PMID: 18157883 [PubMed - in process]

 

J Trauma Stress. 2007 Dec;20(6):1009-1018.

Objective evidence of sleep disturbance in women with posttraumatic stress disorder.

Calhoun PS, Wiley M, Dennis MF, Means MK, Edinger JD, Beckham JC.

VA Mid‐Atlantic Region Mental Illness Research, Education, and Clinical Center (MIRECC), VA Center for Health Services Research in Primary Care, Durham VAMC, Durham VA Medical Center, and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.

Although sleep disturbance is considered a hallmark of posttraumatic stress disorder (PTSD), objective evidence for sleep disturbance in patients with PTSD has been equivocal. The goal of the current investigation was to objectively examine sleep disturbance among women with PTSD in their home environment. Women  with PTSD (n = 30) and a control group (n = 22) completed three nights of actigraphy monitoring. Results from actigraphy indicated that women with PTSD had poorer sleep efficiency, increased sleep latency, and more restless sleep. Actigraphy measures were moderately correlated with self-report sleep-log data, but were unrelated to scores on the Pittsburgh Sleep Quality Index. The current study provides evidence that women with PTSD have objectively measured sleep disturbance in their normal environment at home. Disturbed sleep may have important implications for the health and well-being of individuals with PTSD.

PMID: 18157880 [PubMed - as supplied by publisher]

 

J Trauma Stress. 2007 Dec;20(6):989-98.

Posttraumatic stress disorder and smoking relapse: A theoretical model.

Cook JW, McFall MM, Calhoun PS, Beckham JC.

Puget Sound Heath Care System-Seattle Division, Department of Psychiatry and Behavioral Science, University of Washington, and Veterans Affairs VISN-20 Mental Illness Research Education and Clinical Center, Seattle, WA.

Posttraumatic stress disorder (PTSD) is associated with a high prevalence of cigarette smoking, heavy cigarette consumption, and low cessation rates. To date, little is known about mechanisms impeding smoking cessation among this recalcitrant group of smokers. An important first step in improving smoking cessation treatment efficacy is the assessment of knowledge about mechanisms pertinent to relapse. This theoretical study addresses the gap in the literature  regarding factors potentially influencing smoking relapse among individuals with  PTSD. Mechanisms reviewed that may be particularly relevant to smoking relapse among PTSD smokers include negative affect, positive affect, attention, anxiety sensitivity, distress tolerance, and self-efficacy. Treatment implications as well as methodological advances that may be relevant to examining the proposed relapse model are discussed.

PMID: 18157879 [PubMed - in process]

 

Neuropsychopharmacology. 2007 Dec;32(12):2581-91. Epub 2007 Mar 28.

Enhanced effects of cortisol administration on episodic and working memory in aging veterans with PTSD.

Yehuda R, Harvey PD, Buchsbaum M, Tischler L, Schmeidler J.

The Traumatic Stress Studies Program, Psychiatry Department, The Mount Sinai School of Medicine, New York, NY 10468, USA. Rachel.Yehuda@med.va.gov

Though both glucocorticoid alterations and memory impairments have been noted in  posttraumatic stress disorder (PTSD), it is not clear if these phenomena are causally linked. As there is emerging evidence that these domains become further  altered in PTSD with increasing age, it is of interest to examine these relationships in an older cohort. Aging (mean age, 62.7+/-8.9; range, 52-81) combat veterans with (n=13) and without (n=17) PTSD received an intravenous bolus of 17.5 mg hydrocortisone (cortisol), a naturally occurring glucocorticoid, or placebo in a randomized, double-blind manner, on two mornings approximately 1-2 weeks apart. Neuropsychological testing to evaluate episodic and working memory performance was performed 75 min later. Cortisol enhanced episodic memory performance in both groups of subjects, but enhanced elements of working memory performance only in the PTSD+ group. The preferential effect of cortisol administration on working memory in PTSD may be related to the superimposition of PTSD and age, as cortisol had impairing effects on this task in a previously studied, younger cohort. The findings suggest that there may be opportunities for developing therapeutic strategies using glucocorticoids in the treatment of aging combat veterans.

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

PMID: 17392739 [PubMed - in process]

 

Psychosom Med. 2007 Dec;69(9):935-43. Epub 2007 Nov 8.

Autonomic and respiratory characteristics of posttraumatic stress disorder and panic disorder.

Blechert J, Michael T, Grossman P, Lajtman M, Wilhelm FH.

Department of Clinical Psychology and Psychotherapy, University of Basel, Missionsstrasse 60/62, CH-4055 Basel, Switzerland.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and panic disorder (PD) are two anxiety disorders with prominent psychophysiological symptoms. The PTSD criterion of persistent hyperarousal suggests autonomic dysregulation, and the disorder has been associated with elevated heart rate. In contrast, PD has been associated with respiratory abnormalities such as low end-tidal Pco(2). An integrated analysis of automatic and respiratory function in a direct comparison of these anxiety disorders is currently lacking. METHODS: Electrodermal, cardiovascular, and respiratory psychophysiology was examined in 23 PTSD patients, 26 PD patients, and 32 healthy individuals at baseline and during threat of shock. RESULTS: At baseline, the PTSD patients, in contrast to the other two groups, were characterized by attenuated parasympathetic and elevated sympathetic control, as evidenced by low respiratory sinus arrhythmia (a measure of cardiac vagal control) and high electrodermal activity. They also displayed elevated heart rate and cardiovascular sympathetic activation in comparison with healthy controls. PD patients exhibited lower Pco(2) (hypocapnia) and higher cardiovascular sympathetic activation compared with healthy controls. PTSD patients, but not PD patients, sighed more frequently than controls. During the threat of shock phase, the PTSD group demonstrated blunted electrodermal responses. CONCLUSIONS: Persistent hyperarousal symptoms in PTSD seem to be due to high sympathetic activity coupled with low parasympathetic cardiac control. Respiratory abnormalities were also present in PTSD. Several psychophysiological  measures exhibited group-comparison effect sizes in the order of 1.0, supporting  their potential for enhancing differential diagnosis and possibly suggesting utility as endophenotypes in genetic studies of anxiety disorders.

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

PMID: 17991823 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2007 Nov 21 [Epub ahead of print]

The posttraumatic cognitions inventory-Chinese revised: Validation and refinement with a traumatized college sample in Taiwan.

Su YJ, Chen SH.

Department of Psychology, National Taiwan University, No.1, Sec. 4, Roosevelt Road, Taipei 106, Taiwan.

The posttraumatic cognitions inventory (PTCI) is a 33-item self-report measure assessing dysfunctional beliefs following trauma. This study reported the factor  structure and psychometric properties of the Chinese version of the PTCI (PTCI-C), as well as its relationship with PTSD symptoms. Study participants consisted of 240 traumatized college students in Taiwan. Confirmatory factor analyses indicated adequate replication of the original three-factor structure of the PTCI after eliminating four cross-loaded items. The 29-item PTCI-C was thus developed and its psychometric data were evaluated. This measure displays good internal consistency, test-retest stability, concurrent validity, and discriminative validity. The study findings are discussed in terms of intercultural differences in attribution style and the possible contribution of negative cognitions to PTSD development.

PMID: 18162364 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2007 Nov 15;62(10):1095-102. Epub 2007 Jul 12.

The natural history of neuroendocrine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: progressive divergence of noradrenaline and cortisol concentrations over time.

Pervanidou P, Kolaitis G, Charitaki S, Lazaropoulou C, Papassotiriou I, Hindmarsh P, Bakoula C, Tsiantis J, Chrousos GP.

First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Athens, Greece. ppervanid@med.uoa.gr

BACKGROUND: The hypothalamic-pituitary-adrenal axis and the catecholaminergic system are involved in the pathophysiology of post-traumatic stress disorder (PTSD). This was a prospective and longitudinal study of neuroendocrine physiology in children with PTSD following a motor vehicle accident (MVA). METHODS: Sixty children aged 7-18 were studied immediately after an MVA and 1 and 6 months later. Fasting morning plasma catecholamine and serum cortisol concentrations were measured. Salivary cortisol concentrations were measured serially five times daily to examine circadian variation in all three assessments. Values were compared between those who did (PTSD) or did not develop PTSD (non-PTSD) after the trauma and a control group at months 1 and 6. RESULTS:  Twenty-three of the children had PTSD at the 1-month and 9 children at the 6-month evaluations. 1) Plasma noradrenaline concentrations were higher in the PTSD group than in the other two groups at both months 1 and 6 (p = .001 and p =  .001, respectively). Additionally, the PTSD patients presented with significantly higher salivary cortisol concentrations at 18.00 (p = .03) and 21.00 (p = .04) at month 1.2) Eight children suffering from PTSD at both months 1 and 6 had significantly elevated plasma noradrenaline concentrations at month 6 compared with those at month 1 and at baseline and to the other two groups (within subjects: p < .001; between subjects: p = .005). The initially elevated evening salivary cortisol concentrations in this group normalized at month 6. CONCLUSIONS: This progressive divergence of noradrenaline and cortisol concentrations over time might underlie the natural history and pathophysiology of PTSD.

PMID: 17624319 [PubMed - in process]

 

Biol Psychiatry. 2007 Nov 15;62(10):1088-94. Epub 2007 Jul 9.

Differential etiology of posttraumatic stress disorder with conduct disorder and  major depression in male veterans.

Fu Q, Koenen KC, Miller MW, Heath AC, Bucholz KK, Lyons MJ, Eisen SA, True WR, Goldberg J, Tsuang MT.

Department of Community Health, Saint Louis University School of Public Health, St. Louis, Missouri 63104, USA. qjfu@slu.edu

BACKGROUND: Epidemiologic studies reveal that posttraumatic stress disorder (PTSD) is highly comorbid with both conduct disorder and major depression in men. The genetic and environmental etiology of this comorbidity has not been examined. METHODS: Data were analyzed from 6744 middle-aged male-male monozygotic and dizygotic twins from the Vietnam Era Twin Registry. Conduct disorder, major depression, and PTSD were assessed via telephone interview using the Diagnostic Interview Schedule for the DSM-III-R in 1992. Structural equation modeling was used to estimate additive genetic, shared environmental, and individual-specific  environmental effects common and specific to conduct disorder, major depression,  and PTSD. RESULTS: The association between conduct disorder and PTSD was explained primarily by common shared environmental influences; these explained 10% (95% confidence interval: 6%-17%) of the variance in PTSD. The association between major depression and PTSD was largely explained by common genetic influences; these explained 19% (95% confidence interval: 11%-26%) of the variance in PTSD. CONCLUSIONS: Our findings suggest that different etiologic mechanisms explain the association of conduct disorder and major depression with  PTSD in male veterans. If replicated in other populations, results suggest research aimed at identifying specific genetic and environmental factors that influence PTSD may benefit from starting with those that have been more consistently and strongly associated with major depression and conduct disorder.

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

PMID: 17617384 [PubMed - in process]

 

Biol Psychiatry. 2007 Nov 15;62(10):1175-8. Epub 2007 Jul 5.

Twenty-four hour plasma cortisol and adrenocorticotropic hormone in Gulf War veterans: relationships to posttraumatic stress disorder and health symptoms.

Golier JA, Schmeidler J, Legge J, Yehuda R.

Department of Psychiatry, James J. Peters VA Medical Center, Bronx, New York 10468, USA. Julia.golier@va.gov

BACKGROUND: We aim to characterize the baseline functioning of the hypothalamic-pituitary-adrenal (HPA) axis in Gulf War veterans (GWV) and examine  the extent to which posttraumatic stress disorder (PTSD) and unexplained health symptoms-which commonly co-occur-have similar or different biological correlates. METHODS: Thirty-one GWV, 20 with current PTSD and 11 without current or lifetime  PTSD, and 16 healthy nondeployed subjects not exposed to the Gulf War theater underwent medical and psychiatric examination followed by blood sampling every half-hour over 24 hours for the measurement of cortisol and adrenocorticotropic hormone (ACTH). RESULTS: Gulf War veterans without PTSD or another psychiatric disorder had significantly lower 24-hour plasma ACTH levels, a significantly higher cortisol:ACTH ratio, and no difference in cortisol levels compared to nondeployed subjects and to GWV with PTSD, controlling for body mass index (BMI). Among GWV, health symptoms (mood and cognitive symptoms) were positively associated with, and hyperarousal symptoms were negatively associated with, the cortisol:ACTH ratio. Additionally, the self-reported acute effects of pesticides  and of pyridostigmine bromide during deployment were associated with lower ACTH levels, controlling for BMI and PTSD. CONCLUSIONS: The data provide evidence of HPA axis dysregulation in Gulf War veterans, which may be related to Gulf War deployment exposures. Despite the overlap of chronic unexplained health symptoms  and PTSD in GWV, these symptom constellations appear to be biologically distinct.

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

PMID: 17612507 [PubMed - in process]

 

Biol Psychiatry. 2007 Nov 15;62(10):1179-82. Epub 2007 Jun 1.

Sleep findings in young adult patients with posttraumatic stress disorder.

Habukawa M, Uchimura N, Maeda M, Kotorii N, Maeda H.

Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Fukuoka, Japan. hmitsu@med.kurume-u.ac.jp

BACKGROUND: Laboratory sleep studies in posttraumatic stress disorder (PTSD) have not provided consistent evidence of sleep disturbance, despite apparent sleep complaints. Most of these studies have investigated middle-aged chronic PTSD subjects with a high prevalence of comorbidities such as substance dependence and/or personality disorder. METHODS: Ten young adult PTSD patients (aged 23.4 +/- 6.1 years) without comorbidities of substance dependence and/or personality disorder underwent 2-night polysomnographic recordings. These sleep measures were compared with those of normal control subjects and were correlated with PTSD symptoms. RESULTS: Posttraumatic stress disorder patients demonstrated significantly poorer sleep, reduced sleep efficiency caused by increased wake time after sleep onset, and increased awakening from rapid eye movement (REM) sleep (REM interruption). We found significant positive correlations between the  severity of trauma-related nightmare complaints and the percentage of REM interruption, as well as wake time after sleep onset. CONCLUSIONS: The results indicate that trauma-related nightmares are an important factor resulting in increased REM interruptions and wake time after sleep onset in PTSD.

PMID: 17543289 [PubMed - in process]

 

JAMA. 2007 Nov 14;298(18):2141-8.

Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war.

Milliken CS, Auchterlonie JL, Hoge CW.

Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research,  US Army Medical Research and Materiel Command, Silver Spring, Maryland 20910, USA. charles.milliken@us.army.mil

CONTEXT: To promote early identification of mental health problems among combat veterans, the Department of Defense initiated population-wide screening at 2 time points, immediately on return from deployment and 3 to 6 months later. A previous article focusing only on the initial screening is likely to have underestimated the mental health burden. OBJECTIVE: To measure the mental health needs among soldiers returning from Iraq and the association of screening with mental health  care utilization. DESIGN, SETTING, AND PARTICIPANTS: Population-based, longitudinal descriptive study of the initial large cohort of 88 235 US soldiers  returning from Iraq who completed both a Post-Deployment Health Assessment (PDHA) and a Post-Deployment Health Re-Assessment (PDHRA) with a median of 6 months between the 2 assessments. MAIN OUTCOME MEASURES: Screening positive for posttraumatic stress disorder (PTSD), major depression, alcohol misuse, or other  mental health problems; referral and use of mental health services. RESULTS: Soldiers reported more mental health concerns and were referred at significantly  higher rates from the PDHRA than from the PDHA. Based on the combined screening,  clinicians identified 20.3% of active and 42.4% of reserve component soldiers as  requiring mental health treatment. Concerns about interpersonal conflict increased 4-fold. Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment. Most soldiers who used mental health services had not been referred, even though the majority accessed care within 30 days following the screening. Although soldiers were much more likely to report PTSD symptoms on the PDHRA than on the PDHA, 49% to 59% of those who had PTSD symptoms identified on the PDHA improved by the time they took the PDHRA. There was no direct relationship of referral or treatment with symptom improvement. CONCLUSIONS: Rescreening soldiers several months after their return from Iraq identified a large cohort missed on initial screening. The large clinical burden  recently reported among veterans presenting to Veterans Affairs facilities seems  to exist within months of returning home, highlighting the need to enhance military mental health care during this period. Increased relationship problems underscore shortcomings in services for family members. Reserve component soldiers who had returned to civilian status were referred at higher rates on the PDHRA, which could reflect their concerns about their ongoing health coverage. Lack of confidentiality may deter soldiers with alcohol problems from accessing treatment. In the context of an overburdened system of care, the effectiveness of population mental health screening was difficult to ascertain.

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

PMID: 18000197 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2007 Nov 13 [Epub ahead of print]

Media exposure and dimensions of anxiety sensitivity: Differential associations with PTSD symptom clusters.

Collimore KC, McCabe RE, Carleton RN, Asmundson GJ.

Anxiety and Illness Behaviour Laboratory and Department of Psychology, University of Regina, Regina, SK, Canada.

The present investigation examined the impact of anxiety sensitivity (AS) and media exposure on posttraumatic stress disorder (PTSD) symptoms. Reactions from 143 undergraduate students in Hamilton, Ontario were assessed in the Fall of 2003 to gather information on anxiety, media coverage, and PTSD symptoms related to exposure to a remote traumatic event (September 11th). Regression analyses revealed that the Anxiety Sensitivity Index (ASI; [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual, 2nd ed. Worthington, Ohio: International Diagnostic Systems]) and State-Trait Anxiety Inventory trait form (STAI-T; [Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). State-trait anxiety inventory. Palo Alto, California: Consulting Psychologists Press]) total scores were significant predictors of PTSD symptoms in general. The ASI total score was also a significant predictor of hyperarousal and avoidance symptoms. Subsequent analyses further demonstrated differential relationships based on subscales and symptom clusters. Specifically, media exposure and trait anxiety predicted hyperarousal and re-experiencing symptoms, whereas the ASI fear of somatic sensations subscale significantly predicted avoidance and overall PTSD symptoms. Implications and directions for future research are discussed.

PMID: 18093798 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Nov 9 [Epub ahead of print]

Elevated serum homocysteine levels in male patients with PTSD.

Levine J, Timinsky I, Vishne T, Dwolatzky T, Roitman S, Kaplan Z, Kotler M, -Ami  Sela B, Spivak B.

Department of Psychiatry, Ben Gurion University of the Negev, Beersheva, Israel.

It has been suggested that an elevated serum or plasma homocysteine level may be  a risk factor for neuropsychiatric conditions such as Alzheimer's disease, schizophrenia, and depression. Because depression is closely related to anxiety disorders, and because it has been suggested that stress may be associated with an elevated homocysteine level, we studied whether serum homocysteine levels are  elevated in patients with posttraumatic stress disorder (PTSD). Total serum homocysteine levels in 28 male patients with PTSD were compared to those of 223 healthy controls. The effect of PTSD on the serum homocysteine level was significant (F=42.96, P<.0001). In a regression model for the PTSD patients, the  duration of PTSD was found to predict serum homocysteine levels (t=2.228, P=.035). Our results suggest that elevated levels of homocysteine in male patients with PTSD may be related to pathophysiological aspects associated with the chronicity of this disorder. Depression and Anxiety 0:1-4, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17994587 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Nov 9 [Epub ahead of print]

Negative appraisals and cognitive avoidance of intrusive memories in depression:  a replication and extension.

Williams AD, Moulds ML.

School of Psychology, The University of New South Wales, New South Wales, Sydney.

Recent research has demonstrated that intrusive negative autobiographical memories represent a shared phenomenological feature of posttraumatic stress disorder (PTSD) and depression. A preliminary investigation (Starr and Moulds, 2006) successfully applied a cognitive appraisal model of PTSD to the maintenance of intrusive memories in depression. The current investigation sought to replicate and extend these findings. Two hundred and fifty first-year undergraduate students were interviewed to assess for the presence of a negative  autobiographical memory that had spontaneously intruded in the past week. Participants completed self-report inventories assessing trait and situational employment of cognitive avoidance mechanisms in response to these memories. Consistent with Starr and Moulds, intrusion-related distress correlated with dysphoria, irrespective of intrusion frequency. Assigning negative appraisals to  one's intrusive memory and attempts to control the memory were positively associated with intrusion-related distress, level of depression, and cognitive avoidance mechanisms. Additionally, negative appraisals and control influenced the employment rumination as an avoidant response to a greater degree than the corresponding trait tendency. Finally, negative appraisals and the use of cognitive mechanisms were predictive of depression concurrently. The results support the validity of borrowing from PTSD models to elucidate the cognitive mechanisms that maintain intrusive memories in depressed samples. Depression and  Anxiety 0:1-8, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17994585 [PubMed - as supplied by publisher]

 

Sleep Med Rev. 2007 Nov 8 [Epub ahead of print]

Sleep-specific mechanisms underlying posttraumatic stress disorder: Integrative review and neurobiological hypotheses.

Germain A, Buysse DJ, Nofzinger E.

Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Room E-1124, Pittsburgh, PA 15213, USA.

Posttraumatic stress disorder (PTSD) is a prevalent disorder that is associated with poor clinical and health outcomes, and considerable health care utilization  and costs. Recent estimates suggest that 5-20% of military personnel who serve in current conflicts in Iraq and Afghanistan meet diagnostic criteria for PTSD. Clinically, sleep disturbances are core features of PTSD that are often resistant to first-line treatments, independently contribute to poor daytime functioning, and often require sleep-focused treatments. Physiologically, these observations suggest that PTSD is partially mediated by sleep disruption and its neurobiological correlates that are not adequately addressed by first-line treatments. However, polysomnographic studies have provided limited insights into the neurobiological underpinnings of PTSD during sleep. There is an urgent need to apply state-of-the-science sleep measurement methods to bridge the apparent gap between the clinical significance of sleep disturbances in PTSD and the limited understanding of their neurobiological underpinnings. Here, we propose an integrative review of findings derived from neurobiological models of fear conditioning and fear extinction, PTSD, and sleep-wake regulation, suggesting that the amygdala and medial prefrontal cortex can directly contribute to sleep disturbances in PTSD. Testable hypotheses regarding the neurobiological underpinnings of PTSD across the sleep-wake cycle are offered.

PMID: 17997114 [PubMed - as supplied by publisher]

 

Am J Addict. 2007 Nov-Dec;16(6):431-8.

Childhood Sexual and Physical Abuse Histories, PTSD, Depression, and HIV Risk Outcomes in Women Injection Drug Users: A Potential Mediating Pathway.

Plotzker RE, Metzger DS, Holmes WC.

Center for the Studies of Addiction, HIV Prevention Division, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

We explored links between childhood sexual abuse (CSA), childhood physical abuse  (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug  users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More  than half (56%) reported CSA, 68% CPA, 23% likely were depressed-only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD/depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA-to-risk path is mediated by PTSD/depression. (Am J Addict 2007;16:431-438).

PMID: 18058406 [PubMed - in process]

 

Am J Psychiatry. 2007 Nov;164(11):1693-9.

The serotonin transporter genotype and social support and moderation of posttraumatic stress disorder and depression in hurricane-exposed adults.

Kilpatrick DG, Koenen KC, Ruggiero KJ, Acierno R, Galea S, Resnick HS, Roitzsch J, Boyle J, Gelernter J.

National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, P.O. Box 250852, Charleston, SC 29425, USA. kilpatdg@musc.edu

OBJECTIVE: Disasters are associated with increased risk of posttraumatic stress disorder (PTSD) and major depression, but no study, to the authors' knowledge, has determined whether genotype interacts with disaster exposure and social support to moderate risk of these phenotypes. The authors tested the hypothesis that a polymorphism in the serotonin transporter gene (locus, SLC6A4; variant, serotonin 5-HTTLPR) moderates risk of posthurricane PTSD and major depression given high hurricane exposure and low social support. METHOD: The authors interviewed a household probability sample of adults 6-9 months after the 2004 hurricanes about hurricane exposure, social support, and posthurricane PTSD and major depression. DNA was collected from a subset of participants. Participants were 589 adults ages 18 and older from 38 Florida counties who provided valid DNA samples. Outcome measures were DSM-IV diagnoses of posthurricane PTSD and major depression derived from structured interviews. RESULTS: The low-expression variant of the 5-HTTLPR polymorphism increased risk of posthurricane PTSD and major depression but only under the conditions of high hurricane exposure and low social support after adjustment for sex, ancestry (as determined by Bayesian clustering of genotypes), and age. Similar effects were found for major depression. High-risk individuals (high hurricane exposure, the low-expression 5-HTTLPR variant, low social support) were at 4.5 times the risk of developing PTSD and major depression of low-risk individuals. CONCLUSIONS: The low-expression variant of the 5-HTTLPR polymorphism modifies risk of postdisaster PTSD and major depression under conditions of high hurricane exposure and low social support, confirming and extending previous research.

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

PMID: 17974934 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Nov;164(11):1684-92.

Failure of extinction of fear responses in posttraumatic stress disorder: evidence from second-order conditioning.

Wessa M, Flor H.

Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, Square J 5, 68159 Mannheim, Germany. michele.wessa@zi-mannheim.de

OBJECTIVES: Posttraumatic stress disorder (PTSD) is characterized by the re-experiencing of a traumatic event, although the trauma itself occurred in the  past. The extinction of the traumatic response might be impeded if trauma reminders maintain fear responses by their association with the original trauma through second-order conditioning. METHOD: A differential conditioning paradigm with a trauma-specific picture, used as an acquired unconditioned stimulus, and graphic representations, used as conditioned stimuli, were employed in 14 PTSD patients, 15 trauma-exposed subjects without PTSD, and 15 healthy comparison subjects. The authors used event-related potentials of electroencephalogram (EEG), self-report measures, skin conductance responses, heart rate, and startle  modulation to assess the differential conditioned response among subjects. RESULTS: Trauma-exposed subjects with and without PTSD but not healthy comparison subjects showed successful differential conditioning to the trauma-relevant cue indicative of second-order conditioning. Only PTSD patients exhibited enhanced conditioned responses to the trauma reminder during acquisition and impaired extinction as evident in more negative evaluations of the conditioned stimuli associated with a trauma reminder as well as enhanced peripheral and brain responses. CONCLUSIONS: These findings suggest that PTSD may be maintained by second-order conditioning where trauma-relevant cues come to serve as unconditioned stimuli, thus generalizing enhanced emotional responses to many previously neutral cues and impeding extinction. The extinction deficit in PTSD patients observed in this study underlines the need for therapies focusing on the extinction of learned responses, such as behavioral treatment, with or without the addition of pharmacological substances that enhance the extinction of a learned response.

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

PMID: 17974933 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Nov;164(11):1676-83.

A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder.

Litz BT, Engel CC, Bryant RA, Papa A.

National Center for PTSD Boston VA Healthcare System and Boston University School of Medicine, 150 South Huntington Ave., Boston, MA 01230, USA. brett.litz@va.gov

OBJECTIVE: The authors report an 8-week randomized, controlled proof-of-concept trial of a new therapist-assisted, Internet-based, self-management cognitive behavior therapy versus Internet-based supportive counseling for posttraumatic stress disorder (PTSD). METHOD: Service members with PTSD from the attack on the  Pentagon on September 11th or the Iraq War were randomly assigned to self-management cognitive behavior therapy (N=24) or supportive counseling (N=21). RESULTS: The dropout rate was similar to regular cognitive behavior therapy (30%) and unrelated to treatment arm. In the intent-to-treat group, self-management cognitive behavior therapy led to sharper declines in daily log-on ratings of PTSD symptoms and global depression. In the completer group, self-management cognitive behavior therapy led to greater reductions in PTSD, depression, and anxiety scores at 6 months. One-third of those who completed self-management cognitive behavior therapy achieved high-end state functioning at 6 months. CONCLUSIONS: Self-management cognitive behavior therapy may be a way of delivering effective treatment to large numbers with unmet needs and barriers to  care.

Publication Types:      Comparative Study     Evaluation Studies     Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 17974932 [PubMed - indexed for MEDLINE]

 

Ann Pharmacother. 2007 Nov;41(11):1917-8. Epub 2007 Oct 2.

Comment on:     Ann Pharmacother. 2007 Jun;41(6):1013-7.

Comment: Prazosin treatment of nightmares related to posttraumatic stress disorder.

Strawn JR.

Publication Types:      Comment     Letter

PMID: 17911207 [PubMed - indexed for MEDLINE]

 

Behav Modif. 2007 Nov;31(6):856-66.

Therapist adherence and competence with manualized cognitive-behavioral therapy for PTSD delivered via videoconferencing technology.

Frueh BC, Monnier J, Grubaugh AL, Elhai JD, Yim E, Knapp R.

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

Using secondary analyses from a randomized trial comparing the effectiveness of manualized cognitive-behavioral therapy for posttraumatic stress disorder, we compared ratings of therapist competency and adherence between two service delivery modes: telepsychiatry (TP) and same room (SR). Patients were 38 male treatment-seeking veterans recruited from a veterans affairs medical center. Domains of therapist competence and adherence included structuring sessions, implementing session activities, providing feedback, dealing with difficulties, developing rapport, and conveying empathy. Only one difference emerged between the two treatment conditions, with more favorable ratings on this item in the TP  condition. Findings suggest that therapist competence and adherence to cognitive-behavioral therapy is similar whether the treatment is delivered via TP or by traditional means, and TP does not compromise therapists' ability to effectively structure sessions or build rapport with patients. These data further support the use of TP to address shortages in access to mental health care.

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

PMID: 17932240 [PubMed - indexed for MEDLINE]

 

Gynecol Obstet Fertil. 2007 Nov;35(11):1136-42. Epub 2007 Nov 8.

[Childbirth pain, perinatal dissociation and perinatal distress as predictors of  posttraumatic stress symptoms]

[Article in French]

Boudou M, Séjourné N, Chabrol H.

Centre d'Etudes et de Recherches en Psychopathologie, Université de Toulouse-II-le Mirail, 5, Allée Antonio-Machado, 31058, Toulouse, France.

OBJECTIVE: This prospective, longitudinal study investigated the contributive role of childbirth pain, perinatal distress and perinatal dissociation to the development of PTSD symptoms following childbirth. PATIENTS AND METHODS: One hundred and seventeen women participated at the study. The first day after delivery they completed a questionnaire to evaluate pain, the peritraumatic distress inventory (PDI) and the peritraumatic dissociative experience questionnaire (PDEQ). Six weeks after birth, they completed the impact of event scale-revised (IES-R) to measure posttraumatic stress symptoms and the Edinburgh  Postnatal Depression Scale (EPDS) to assess maternal depression. RESULTS: A multiple regression analysis revealed that only both components of perinatal distress, life-threat perception and dysphoric emotions were significant predictors of posttraumatic stress symptoms. In another multiple regression analysis predicting dysphoric emotions, affective dimension of pain was the only  significant predictor. DISCUSSION AND CONCLUSION: Perinatal distress was the best predictor of posttraumatic stress symptoms. Dysphoric emotions were associated with affective dimension of pain, suggesting that women distressed by the childbirth pain would have higher risk to develop posttraumatic stress symptoms.

Publication Types:      English Abstract

PMID: 17996476 [PubMed - in process]

 

Harefuah. 2007 Nov;146(11):883-8, 908.

[Complex posttraumatic stress disorder]

[Article in Hebrew]

Green T, Kotler M.

Ness-Ziona, Beer-Yaakov Mental Health Center. dekelgr@netvision.net.il

The characteristic symptoms resulting from exposure to an extreme trauma include  three clusters of symptoms: persistent experience of the traumatic event, persistent avoidance of stimuli associated with the trauma and persistent symptoms of increased arousal. Beyond the accepted clusters of symptoms for posttraumatic stress disorder exists a formation of symptoms related to exposure  to extreme or prolonged stress e.g. childhood abuse, physical violence, rape, and confinement within a concentration camp. With accumulated evidence of the existence of these symptoms began a trail to classify a more complex syndrome, which included, but was not confined to the symptoms of posttraumatic stress disorder. This review addresses several subjects for study in complex posttraumatic stress disorder, which is a complicated and controversial topic. Firstly, the concept of complex posttraumatic stress disorder is presented. Secondly, the professional literature relevant to this disturbance is reviewed and finally, the authors present the polemic being conducted between the researchers of posttraumatic disturbances regarding validity, reliability and the need for separate diagnosis for these symptoms.

Publication Types:      English Abstract     Review

PMID: 18087837 [PubMed - indexed for MEDLINE]

 

Int J Nurs Stud. 2007 Nov;44(8):1406-17. Epub 2006 Sep 20.

Posttraumatic stress in long-term young adult survivors of childhood cancer: a questionnaire survey.

Lee YL, Santacroce SJ.

School of Nursing, College of Medicine, National Taiwan University, 1, Jen-Ai Road, Section 1, Taipei 10063, Taiwan. yallee@ha.mc.ntu.edu.tw

BACKGROUND: Posttraumatic stress is one of many psychological late effects in young adult survivors of childhood cancer and needs to be explored thoroughly. OBJECTIVE: The purpose of this study was to examine the characteristics and correlates of posttraumatic stress symptoms in a sample of young adult survivors  of childhood cancer. DESIGN: Cross-sectional and correlational descriptive design was used. Data was collected by a mailed survey. The University of California at  Los Angeles Post Traumatic Stress Disorder Index (PTSDI) was the measure selected for the evaluation of posttraumatic stress. SETTING: The study took place in a medical center in the Eastern part of the United States. PARTICIPANTS: The inclusion criteria for participants were: (a) diagnosis of childhood cancer between birth and 19 years of age; (b) 3 or more years post successful completion of cancer treatment; (c) free of active cancer; (d) at least 19 years of age; and (e) able to read and write English. A total of 51.1% (N=46) of the potentially eligible survivors responded to the survey. The analysis was based on the data from 45 respondents who had a mean age of 27.4 years. RESULTS: The mean PTSDI score was 15.7 (SD=11.0, range=0-43). Thirteen percent (n=6) of participants had  PTSDI scores that exceeded the cutoff point of 32, which is considered indicative of clinically significant posttraumatic stress disorder (PTSD). Participants who  lived alone (t=-2.17, p=.035), had no health insurance (t=2.08, p=.044) and did not have a history of bone marrow transplantation (t=4.52, p=.000) reported significantly higher scores on PTSDI than others. The clinically significant PTSD group had a significantly higher rate of living alone than the non-PTSD group (p=.038). CONCLUSION: Cancer-related posttraumatic stress emerges in childhood cancer survivors in young adulthood. Health care providers should screen childhood cancer survivors for posttraumatic stress so that referrals can be made to provide survivors with further assistance.

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

PMID: 16989835 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 Nov;116(4):837-41.

Impaired specific autobiographical memory as a risk factor for posttraumatic stress after trauma.

Bryant RA, Sutherland K, Guthrie RM.

School of Psychology, University of New South Wales, Sydney, Australia. r.bryant@unsw.edu.au

This study tested the proposal that impaired retrieval of specific autobiographical memories is a risk factor for psychological disturbance after trauma exposure. Trainee firefighters (N = 60) were assessed during training (before trauma exposure) on the Autobiographical Memory Test, Clinician Administered PTSD Scale, Beck Depression Inventory (BDI-II), and Traumatic Events Questionnaire. Participants were reassessed 4 years later (N = 46) on the Posttraumatic Diagnostic Scale and BDI-II. All participants had been exposed to multiple traumatic events, and 15% met criteria for posttraumatic stress disorder. Impaired retrieval of specific memories in response to positive cues prior to trauma exposure significantly predicted posttraumatic stress severity after trauma exposure. These findings provide initial evidence that impaired specific retrieval of memories may be a risk factor for posttraumatic stress. (c) 2007 APA

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

PMID: 18020729 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 Nov;116(4):786-95.

Levels of specificity of autobiographical memories and of biographical memories of the deceased in bereaved individuals with and without complicated grief.

Golden AM, Dalgleish T, Mackintosh B.

Emotion Research Group, Medical Research Council Cognition and Brain Sciences Unit, Cambridge, England. ann-marie.golden@mrc-cbu.cam.ac.uk

Traumatized individuals experiencing posttraumatic stress have difficulty retrieving specific autobiographical memories to cue words on the Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). This  may represent a generalized, functional avoidance of the personal past. However,  such individuals also often report specific intrusive memories of their trauma in the day-to-day. This raises the possibility that memories tied to the source of the person's distress are immune to this putative avoidance process. This was investigated in bereaved individuals with complicated grief (CG) who reported intrusive, specific memories from the life of their deceased loved one, and matched bereaved controls without CG. Participants performed the AMT and two Biographical Memory Tests (BMTs), cueing memories from the life of the deceased (BMT-Deceased) and from a living significant other (BMT-Living). To negative word cues, the CG group showed reduced specificity for the AMT and BMT-Living, relative to controls, but this effect was reversed on the BMT-Deceased. These data support the proposal that memories tied to the source of an individual's distress are immune to the processes that underlie the standard reduced specificity effect. (c) 2007 APA

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

PMID: 18020724 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 Nov;116(4):734-40.

The effects of torture-related injuries on long-term psychological distress in a  Punjabi Sikh sample.

Rasmussen A, Rosenfeld B, Reeves K, Keller AS.

Division of General Internal Medicine, New York University School of Medicine, Bellevue/New York University Program for Survivors of Torture, Bellevue Hospital, New York, NY, USA. andrew.rasmussen@med.nyu.edu

Torture survivors often report chronic debilitating physical and psychological distress. Prior research on the relationship between physical and psychological trauma suggests that the 2 are not independent. Injury sustained during torture may increase the likelihood of subsequent distress as either a moderator or mediator. For long-term psychopathology in a sample of Punjabi Sikh survivors of  human rights violations (N = 116), chronic injuries mediated the path between torture and posttraumatic stress disorder, specifically the severity of numbing symptoms. Although injuries were associated with major depression, torture was not, and injuries did not moderate the relationship between major depression and  torture. Chronic injuries may represent trauma severity or persistent traumatic cues. These findings emphasize connections between physical and psychological trauma and the importance of an interdisciplinary approach to torture treatment.  (c) 2007 APA

PMID: 18020719 [PubMed - indexed for MEDLINE]

 

J Affect Disord. 2007 Nov;103(1-3):131-8. Epub 2007 Feb 7.

Monoamine oxidase (MAO) intron 13 polymorphism and platelet MAO-B activity in combat-related posttraumatic stress disorder.

Pivac N, Knezevic J, Kozaric-Kovacic D, Dezeljin M, Mustapic M, Rak D, Matijevic  T, Pavelic J, Muck-Seler D.

Rudjer Boskovic Institute, Division of Molecular Medicine, PO Box 180, HR-10002 Zagreb, Croatia. npivac@irb.hr

BACKGROUND: The neurobiology of posttraumatic stress disorder (PTSD) involves alterations in multiple neuroendocrine and neurotransmitter systems. Platelet monoamine oxidase (MAO-B) has been associated with susceptibility to various psychiatric disorders, personality traits and behaviors. METHODS: Platelet MAO-B  activity and MAO-B intron 13 polymorphism (a G/A substitution) were determined in male war veterans (n=106) with DSM-IV diagnosed current and chronic PTSD, divided into subgroups of PTSD patients with (n=28) or without (n=78) psychotic features, combat exposed veterans (n=41) who did not develop PTSD, and healthy control men  (n=242). RESULTS: Two-way ANOVAs revealed a significant effect of diagnosis and smoking, a significant effect of smoking, no significant effect of genotype, and  no significant interaction between genotype, smoking or diagnosis, on platelet MAO-B activity. One-way ANOVAs showed significantly lower platelet MAO-B activity in smokers than in nonsmokers. After controlling for smoking, veterans with psychotic PTSD had significantly higher platelet MAO-B activity than veterans with or without PTSD, or healthy subjects. LIMITATIONS: The results were obtained on peripheral biochemical marker, i.e. platelet MAO activity. CONCLUSIONS: The MAO-B intron 13 polymorphism was not functional, and did not affect platelet MAO-B activity. The allele frequencies of the MAO-B genotype were similarly distributed among healthy controls and veterans with or without PTSD and/or psychotic symptoms. The results suggest that platelet MAO-B activity, controlled  for smoking status, might be used as a peripheral marker of the psychotic symptoms in PTSD.

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

PMID: 17289152 [PubMed - in process]

 

J Clin Psychiatry. 2007 Nov;68(11):1639-47.

Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001.

Difede J, Cukor J, Jayasinghe N, Patt I, Jedel S, Spielman L, Giosan C, Hoffman HG.

Department of Psychiatry, Weill Medical College of Cornell University, New York,  NY 10021, USA. jdifede@med.cornell.edu

OBJECTIVE: This preliminary study endeavored to evaluate the use of virtual reality (VR) enhanced exposure therapy for the treatment of posttraumatic stress  disorder (PTSD) consequent to the World Trade Center attacks of September 11, 2001. METHOD: Participants were assigned to a VR treatment (N = 13) or a waitlist control (N = 8) group and were mostly middle-aged, male disaster workers. All participants were diagnosed with PTSD according to DSM-IV-TR criteria using the Clinician-Administered PTSD Scale (CAPS). The study was conducted between February 2002 and August 2005 in offices located in outpatient buildings of a hospital campus. RESULTS: Analysis of variance showed a significant interaction of time by group (p < .01) on CAPS scores, with a between-groups posttreatment effect size of 1.54. The VR group showed a significant decline in CAPS scores compared with the waitlist group (p < .01). CONCLUSIONS: Our preliminary data suggest that VR is an effective treatment tool for enhancing exposure therapy for both civilians and disaster workers with PTSD and may be especially useful for those patients who cannot engage in imaginal exposure therapy.

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

PMID: 18052556 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2007 Nov;22(11):1471-8.

Structural validity of the posttraumatic stress disorder checklist among college  students with a trauma history.

Elhai JD, Gray MJ, Docherty AR, Kashdan TB, Kose S.

The University of South Dakota, Vermillion 57069-2390, USA. jelhai@usd.edu

The authors conducted confirmatory factor analyses to test three-factor and four-factor models of posttraumatic stress disorder (PTSD) using the PTSD Checklist with college students reporting a traumatic event history. The authors  found support for the three-factor DSM-IV-based PTSD diagnostic model including reexperiencing, avoidance/numbing, and hyperarousal symptom factors, with slightly better support for a four-factor model separating the avoidance and numbing factors. Results further attest to the PTSD Checklist's construct validity, and to research finding that PTSD avoidance and numbing constructs are  distinct.

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

PMID: 17925293 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Nov;195(11):955-8.

The validity of screening instruments for posttraumatic stress disorder, depression, and other anxiety symptoms in Tajikistan.

Hollander AC, Ekblad S, Mukhamadiev D, Muminova R.

Department of Clinical Neuroscience, Psychiatry-HS, Karolinska Institutet, Stockholm, Sweden.

Armed conflicts and violations of human rights have a large and long-lasting impact on the mental health of affected individuals. In Tajikistan's civil war, 1992-1997, out of a total population of 6.5 million, about 60,000 were killed and 700,000 became refugees. Little has been done to explore the mental health consequences of this war. The purpose of the present pilot study was to validate  1 screening instrument for PTSD and 1 for depression and anxiety symptoms in a Tajik outpatient population. The sample for the study totaled 75. The appropriate cutoff values were determined empirically. The validity of the instruments was high. In conclusion, the use of validated screening instruments was a feasible way to explore the prevalence of PTSD, depression, and other anxiety symptoms in  a Tajikistan context.

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

PMID: 18000460 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Nov;195(11):952-4.

Peritraumatic psychological and somatoform dissociation in predicting PTSD symptoms: a prospective study.

Hagenaars MA, van Minnen A, Hoogduin KA.

Department of Psychology, Leiden University, Leiden, The Netherlands. m.hagenaars@fsw.leidenuniv.nl

The present prospective study evaluates the predictive value of 2 different types of dissociation (psychological and somatoform peritraumatic dissociation), and dysfunctional cognitions on symptoms of posttraumatic stress disorder (PTSD) at 6 months. Assessment of dissociation, PTSD symptoms, and dysfunctional cognitions took place in 49 participants approximately 3 weeks after a traumatic event. Six  months later PTSD symptoms were assessed again. The effect of both psychological  and somatoform peritraumatic dissociation disappeared after controlling for initial PTSD numbing symptoms. Dysfunctional cognitions predicted PTSD at 6 months after controlling for initial numbing symptoms. The present study indicates that peritraumatic dissociation may not be a predictor of PTSD. In contrast, maladaptive posttraumatic coping behavior like persistent dissociation  and dysfunctional cognitions may be predictors.

PMID: 18000459 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Nov;195(11):919-27.

Cortisol, dehydroepiandrosterone, and estradiol measured over 24 hours in women with childhood sexual abuse-related posttraumatic stress disorder.

Bremner D, Vermetten E, Kelley ME.

Departments of Psychiatry and Behavioral Sciences and Radiology, Emory Center for Positron Emission Tomography, Emory University School of Medicine, Atlanta, Georgia, USA. jdbremn@emory.edu

Preclinical studies have shown long-term alterations in several hormonal systems  including cortisol, dehydroepiandrosterone (DHEA) and DHEA-Sulfate, and estradiol. The purpose of this study was to assess cortisol, DHEA, and estradiol  over a 24-hour period in women with early childhood sexual abuse and posttraumatic stress disorder (PTSD); with early abuse and without PTSD; and women without early abuse or PTSD. Forty-three women with early childhood sexual  abuse and PTSD, early abuse without PTSD, and without abuse or PTSD, underwent a  comprehensive assessment of hormones in plasma at multiple time points over a 24-hour period. Abused women with PTSD had lower concentrations of cortisol during the afternoon hours (12-8 p.m.) compared with women with abuse without PTSD and women without abuse or PTSD. DHEA-Sulfate was elevated throughout the 24-hour period in PTSD women, although this was of marginal statistical significance. There were no differences between groups in DHEA or estradiol. PTSD women also had increased cortisol pulsatility compared with the other groups. These findings suggest that a resting hypocortisolemia in the afternoon hours with increased cortisol pulsatility is associated with childhood abuse-related PTSD in women.

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

PMID: 18000454 [PubMed - indexed for MEDLINE]

 

J Occup Environ Med. 2007 Nov;49(11):1197-205.

Health effects in New York State personnel who responded to the World Trade Center disaster.

Mauer MP, Cummings KR, Carlson GA.

Bureau of Occupational Health, New York State Department of Health, Troy, NY, USA. mpm08@health.state.ny.us

OBJECTIVE: To conduct an evaluation of health effects in New York State personnel who responded to the World Trade Center disaster. METHODS: Data from a medical monitoring program, including questionnaire data, physical examination results, and clinical and laboratory test results were evaluated for 1423 participants. Descriptive statistics were reviewed and data were analyzed using logistic regression. RESULTS: Lower and upper respiratory symptoms were reported by nearly half of the study participants. One third reported a psychological symptom. Some  health effects, including respiratory symptoms and symptoms suggestive of posttraumatic stress disorder, were associated with having been caught in the cloud of dust on September 11, 2001. CONCLUSIONS: This cohort probably experienced less overall exposure than other World Trade Center responder cohorts did. Results suggest that being present when the buildings collapsed was associated with reported symptoms.

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

PMID: 17993923 [PubMed - indexed for MEDLINE]

 

J Pediatr Psychol. 2007 Nov-Dec;32(10):1272-7. Epub 2007 Aug 2.

Brief report: pediatric cancer, parental coping style, and risk for depressive, posttraumatic stress, and anxiety symptoms.

Greening L, Stoppelbein L.

Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, 2500 North State Street, Jackson MS 39216. greening@psychiatry.umsmed.edu.

OBJECTIVE: According to the stress and coping goodness of fit model, parents' risk for psychological symptoms was hypothesized to decrease as a function of using emotional regulation and problem appraisal strategies more frequently, and  to increase as a function of using problem-solving and avoidant behaviors more frequently to cope with an uncontrollable stressor-pediatric cancer diagnosis. METHODS: Parents (N = 150) completed measures of depression, PTSD, anxiety, and coping style. RESULTS: Regression analyses revealed that symptoms decreased as a  function of using problem appraisal and an emotional regulation strategy (social  support) more frequently; and increased as a function of using problem-solving strategies, avoidant coping (substance use), and another emotional regulation strategy (negative self-blame) more frequently. CONCLUSIONS: The findings provide some support for the model but suggest that the method of coping (e.g., social support) might be considered in addition to the focus of the coping strategy (e.g., emotional regulation).

PMID: 17675304 [PubMed - in process]

 

J Psychiatr Res. 2007 Nov;41(10):848-60. Epub 2006 Oct 5.

A mouse model of posttraumatic stress disorder that distinguishes between conditioned and sensitised fear.

Siegmund A, Wotjak CT.

Max-Planck-Institut für Psychiatrie, AG Neuronale Plastizität, Kraepelinstr. 2, D-80804 Munich, Germany.

The pathomechanisms of posttraumatic stress disorder (PTSD) are still unknown, but both fear conditioning and stress sensitisation are supposed to play a crucial role. Hence, valid animal models that model both associative and non-associative components of fear will facilitate elucidation of the biological  substrates of the illness, and to develop novel and specific approaches for its prevention and therapy. Here we applied a single electric footshock to C57BL/6N (B6N) and C57BL/6JOla (B6JOla) mice and recorded the conditioned response to contextual trauma reminders (associative fear), the sensitised reaction to a neutral tone in a novel environment (non-associative fear, hyperarousal), social  interaction and various emotional behaviours using Modified Holeboard, Test for Novelty-Induced Suppression of Feeding and Forced Swimming Test, after different  incubation times (1, 14, 28 days). Freezing generally increased as a function of  shock intensity. In B6N mice, sensitised fear was maximal 28 days after trauma and was accompanied by signs of emotional blunting and social withdrawal. B6JOla  mice, in contrast, were less susceptible to develop PTSD-like symptoms. The phenotype of B6N exhibited high behavioural variance, allowing distinction between vulnerable and resilient individuals. Only in vulnerable B6N mice, chronic fluoxetine treatment - initiated after an incubation period of 28 days -  ameliorated sensitised fear. This new mouse model fulfils common criteria for face and predictive validity and can be used to investigate the biological correlates of individual fear susceptibility, as well as the impact and interrelationship of associative and non-associative fear components in the development and maintenance of PTSD.

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

PMID: 17027033 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2007 Nov;41(9):744-52. Epub 2006 Aug 9.

Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder.

von Känel R, Hepp U, Kraemer B, Traber R, Keel M, Mica L, Schnyder U.

Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital/INSELSPITAL, Freiburgstrasse 4, CH-3010 Berne, Switzerland. roland.vonkaenel@insel.ch

Posttraumatic stress disorder (PTSD) may increase cardiovascular risk but the psychophysiological mechanisms involved are elusive. We hypothesized that proinflammatory activity is elevated in patients with PTSD as diagnosed by the Clinician Administered PTSD Scale (CAPS) interview. Plasma levels of proinflammatory C-reactive protein (CRP), interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha, and of anti-inflammatory IL-4 and IL-10 were measured in 14 otherwise healthy PTSD patients and in 14 age- and gender-matched  healthy non-PTSD controls. Levels of TNF-alpha (p=0.038; effect size Cohen's d=0.58) and of IL-1beta (p=0.075, d=0.68) were higher in patients than in controls. CRP (d=0.10), IL-6 (d=0.18), IL-4 (d=0.42), and IL-10 (d=0.37) were not significantly different between groups. Controlling for traditional cardiovascular risk factors, mood, and time since trauma revealed lower IL-4 in patients than in controls (p=0.029) and rendered group differences in TNF-alpha and IL-1beta insignificant. In all subjects, TNF-alpha correlated with total (frequency and intensity) PTSD symptom cluster of re-experiencing (r=0.49, p=0.008), avoidance (r=0.37, p=0.050), and hyperarousal (r=0.42, p=0.026), and with PTSD total symptom score (r=0.37, p=0.054). Controlling for time since trauma attenuated these associations. The correlation between IL-1beta and total  avoidance symptoms (r=0.42, p=0.028) became insignificant when controlling for anxiety and depression. IL-4 correlated with total hyperarousal symptoms (r=-0.38, p=0.047), and after controlling for systolic blood pressure and smoking status, with PTSD total symptom score (r=-0.41, p=0.035). PTSD patients showed a  low-grade systemic proinflammatory state, which, moreover, was related to PTSD symptom levels suggesting one mechanism by which PTSD could contribute to atherosclerotic disease.

PMID: 16901505 [PubMed - indexed for MEDLINE]

 

J Womens Health (Larchmt). 2007 Nov;16(9):1291-9.

Impact of clinician gender on examination anxiety among female veterans with sexual trauma: a pilot study.

Lee TT, Westrup DA, Ruzek JI, Keller J, Weitlauf JC.

Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.

BACKGROUND: The sequelae of sexual trauma, including symptoms or diagnosis of posttraumatic stress disorder (PTSD), may impact women's anxiety and avoidance of preventive healthcare measures such as breast, pelvic, and rectal examinations. As sexual trauma is unfortunately a common occurrence among female patients, particularly veterans, understanding how it influences examination-related distress may improve provision of care to this population. We explored the impact of clinician gender and examination type (breast, pelvic, rectal, and dental) on  anticipated examination-related anxiety among women veterans with a history of sexual trauma. METHODS: We present a cross-sectional pilot study that examines anticipated examination-related distress among 31 female veterans with a history  of sexual trauma. Sexual trauma history was verified by chart review. Self-report instruments assessed patient demographics and patients' anticipated anxiety during breast, pelvic, rectal, and dental examinations (stratified by gender of clinician). The PTSD Checklist-Civilian Version (PCL-C) assessed symptom severity. RESULTS: The women reported significantly more anticipated anxiety during breast, pelvic, and rectal examinations, (p < 0.05) when clinician gender  was male. Severity of PTSD symptoms was generally unrelated to anticipated examination-related anxiety. CONCLUSION: Anticipated anxiety was found to be a function of both examination type and clinician gender but not of PTSD symptom severity. These findings emphasize the importance of screening for sexual trauma  and the careful consideration of female veterans' unique needs during sensitive medical procedures.

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

PMID: 18001185 [PubMed - in process]

 

Neuroimaging Clin N Am. 2007 Nov;17(4):523-38, ix.

Neuroimaging in posttraumatic stress disorder and other stress-related disorders.

Bremner JD.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Room 308e, Mailstop 1256/001/AT, Atlanta GA 30306, USA. jdbremn@emory.edu

Traumatic stress has a broad range of effects on the brain. Brain areas implicated in the stress response include the amygdala, the hippocampus, and the  prefrontal cortex. Studies in patients who have posttraumatic stress disorder (PTSD) and other psychiatric disorders related to stress have replicated findings in animal studies by finding alterations in these brain areas. Brain regions implicated in PTSD also play an important role in memory function, highlighting the important interplay between memory and the traumatic stress response. Abnormalities in these brain areas are hypothesized to underlie symptoms of PTSD  and other stress-related psychiatric disorders.

PMID: 17983968 [PubMed - in process]

 

Psychiatry Res. 2007 Oct 31;153(2):171-7. Epub 2007 Apr 23.

Symptoms of neurasthenia following earthquake trauma: re-examination of a discarded syndrome.

Zhang W, Lee LC, Connor KM, Chang CM, Lai TJ, Davidson JR.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. wei.zhang@duke.edu

The authors examined symptoms of neurasthenia in the context of trauma through a  survey conducted 10 months post-earthquake, among a sample of earthquake survivors in rural Taiwan. An algorithm closely resembling neurasthenia as defined in ICD-10 was designed a priori. Three diagnostic groups were identified, including those with "pure" neurasthenia (n=27) who did not exhibit any Axis I disorder, those with an Axis I disorder but without neurasthenia (n=46) and controls who were without neurasthenia or an Axis I disorder (n=152). Those with  neurasthenia were demographically similar to non-psychiatrically disordered controls and did not differ with respect to impact of trauma. Greater severity of intrusive and avoidant/numbing posttraumatic stress disorder (PTSD) symptoms and  less resilience characterized neurasthenia relative to controls. Morbidity was similar for neurasthenia and Axis I disorders, except for the presence of less resilience in the neurasthenia group. Thus, "pure" neurasthenia appears to be independent from other psychopathology in a significant number of earthquake survivors, and was not closely related to the impact of earthquake trauma. The meaningful number of subjects meeting criteria for our algorithm of neurasthenia  suggests that further study of this syndrome employing exact ICD-10 diagnostic criteria is warranted.

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

PMID: 17451809 [PubMed - in process]

 

Prog Neuropsychopharmacol Biol Psychiatry. 2007 Oct 30 [Epub ahead of print]

Platelet serotonin concentration and suicidal behavior in combat related posttraumatic stress disorder.

Kovacic Z, Henigsberg N, Pivac N, Nedic G, Borovecki A.

Department of Psychopharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Psychiatric Hospital Vrapce, University Department of General and Forensic Psychiatry and Clinical Psychophysiology, Zagreb, Croatia.

Posttraumatic stress disorder (PTSD) is a serious and global problem, a psychiatric disorder that frequently occurs with different comorbidities, and is  associated with a high suicide rate. Pathophysiologically, both PTSD and suicidal behavior are related to disturbances in the central serotonergic system. Serotonin (5-hydroxytryptamine, 5-HT) controls emotional behavior, anxiety, impulsivity and aggression, and nearly all known antidepressants and antianxiety  drugs affect 5-HT transmission. Platelet 5-HT can be used as a limited peripheral marker of the central serotonergic synaptosomes, since it is related to particular basic psychopathological characteristics of several psychiatric disorders. Platelet 5-HT concentration has been reported to be similar in PTSD subjects and healthy controls, but suicidal patients across different psychiatric diagnoses have reduced platelet 5-HT concentration. This study examined platelet  5-HT concentration by the spectrofluorimetric method in male subjects: 73 suicidal and 47 non-suicidal veterans with current and chronic combat related PTSD, 45 suicidal and 30 non-suicidal comparative non-PTSD subjects and 147 healthy men. The presence of suicidal behavior (score=0, non-suicidal; scores >/=1, suicidal) was assessed with the Hamilton Depression Rating Scale-17 (HDRS). Platelet 5-HT concentration was significantly lower in suicidal PTSD and non-PTSD patients compared to non-suicidal patients or healthy controls. Since the majority of patients scored very low on item 3 of HDRS, no significant correlation between suicidal scores and platelet 5-HT concentration was found. These results show that reduced platelet 5-HT concentration is related to suicidal behavior in PTSD, and suggest that platelet 5-HT concentration might be  used as a peripheral marker to predict suicidal behavior across psychiatric diagnoses.

PMID: 18055084 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Oct 29 [Epub ahead of print]

Symptoms of depression and posttraumatic stress disorder in an outpatient population before and after Hurricane Katrina.

McLeish AC, Del Ben KS.

Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi.

The aim of the present investigation was to evaluate symptoms of depression and posttraumatic stress disorder (PTSD) in an outpatient psychiatric population before and after Hurricane Katrina. The sample consisted of 156 patients (110 females; M(age)=41.2 years, SD=10.9) at an outpatient psychiatric clinic who completed measures of psychological symptoms as part of their regular clinical care in the month before (n=76; 49%) and the 1 month after (n=80; 51%) Hurricane  Katrina made landfall. Partially consistent with prediction, depression scores were significantly higher in the month following the hurricane, but PTSD scores were not significantly different. Depressive symptoms after the hurricane were predicted by watching television coverage of the looting that occurred in New Orleans and by the amount of time the participant was without electricity. Symptoms of PTSD after the hurricane were predicted by the participants' use of general television viewing as a coping strategy, the amount of time they spent watching television coverage of the looting in New Orleans, and the use of prayer as a coping behavior. Of these variables, only prayer was associated with a decrease in PTSD symptoms. Findings are discussed in relation to the need for collaborative efforts between clinically oriented and research-oriented institutions to study the impact of large-scale disasters on a variety of populations. Depression and Anxiety 0:1-6, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17969132 [PubMed - as supplied by publisher]

 

Neuropsychopharmacology. 2007 Oct 24 [Epub ahead of print]

Effects of Single Prolonged Stress and D-Cycloserine on Contextual Fear Extinction and Hippocampal NMDA Receptor Expression in a Rat Model of PTSD.

Yamamoto S, Morinobu S, Fuchikami M, Kurata A, Kozuru T, Yamawaki S.

1Department of psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan.

Although the impaired extinction of traumatic memory is one of the hallmark symptoms of posttraumatic stress disorder (PTSD), the underlying mechanisms of impaired extinction are unclear and effective pharmacological interventions have  not yet been developed. Single prolonged stress (SPS) has been proposed as an animal model of PTSD, since rats subjected to SPS (SPS rats) show enhanced negative feedback of the HPA axis and increased contextual fear, which are characteristics similar to those observed in patients with PTSD. In this study, using SPS rats, we examined (a) the ability of SPS to impair fear extinction, (b) whether D-cycloserine (DCS) can alleviate impaired fear extinction in SPS rats, and (c) the effect of SPS and/or DCS on the levels of N-methyl-D-aspartate (NMDA) receptor subunit mRNAs in the rat hippocampus during extinction training. SPS rats exhibited impaired fear extinction in the contextual fear test, which was alleviated by the repeated administration of DCS. The effect of enhanced extinction, induced by the administration of DCS to SPS rats, was maintained for  one week following extinction training. SPS induced significant upregulation of the levels of NMDA receptor subunit mRNAs before and during the period of extinction training, while repeated administration of DCS eliminated the enhanced mRNA levels of NMDARs. Behavioral analyses indicated that SPS is an appropriate animal model of PTSD and that DCS may be effective in the treatment of PTSD. These findings suggest that DCS, irrespective of its mechanistic involvement in the enhancement of fear extinction, may help to reverse hippocampal plasticity, and thus reverse the NMDA compensatory alterations.Neuropsychopharmacology advance online publication, 24 October 2007; doi:10.1038/sj.npp.1301605.

PMID: 17957211 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Oct 23 [Epub ahead of print]

Prevalence and correlates of posttraumatic stress disorder among Kuwaiti military men according to level of involvement in the first Gulf War.

Al-Turkait FA, Ohaeri JU.

Department of Psychology, College of Education, Public Authority for Applied Education and Training, Safat, Kuwait.

First, to compare the prevalence and intensity of posttraumatic stress disorder (PTSD) among Kuwaiti military men, divided into four groups (50 subjects each) according to degree of exposure to war trauma: (1) the retired (retired before the invasion); (2) an active-in-the-army group (AIA) (involved in duties at the rear only); (3) an in-battle (IB) group (involved in combat); and (4) prisoners of war (POWs-captured during combat). Second, to compare the severity of impact of event, comorbid depression, and anxiety among the groups. Third, to evaluate the contribution of self-esteem and locus of control (LOC). Subjects were interviewed once, 6 years after the war, using: the Clinician Administered PTSD Scale; the Impact of Event Scale (IES); the Hopkins Symptom Checklist-25; the Internal-External LOC; and The Self-Esteem Scale. Subjects were aged 24-71 years  (mean 37.9). Sixty-three subjects (31.5%) fulfilled criteria for PTSD, with the rate significantly higher among the POWs (48%) than the retired (24%) and IB (22%), reflecting the severity of IES. Avoidance symptoms were the most pronounced. Self-esteem was significantly lowest among the POWs and those with PTSD. External LOC was associated with PTSD, anxiety, and depression. Self-esteem was the only covariate of PTSD scores. LOC was a significant covariate for anxiety. The characteristics of PTSD in these veterans showed similarity with those from elsewhere. The prominence of self-esteem and avoidance symptoms implies that they should be part of focus for interventions. Focus on LOC should  be from the perspective of anxiety. Depression and Anxiety 0:1-10, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17957807 [PubMed - as supplied by publisher]

 

Child Psychiatry Hum Dev. 2007 Oct 20 [Epub ahead of print]

Repressive Adaptive Style and Self-Reported Psychological Functioning in Adolescent Cancer Survivors.

Erickson SJ, Gerstle M, Montague EQ.

Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA, erickson@unm.edu.

Low levels of posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), and psychosocial distress have been reported in pediatric cancer survivors. One explanation is the relatively high prevalence of the repressive adaptive style (low distress, high restraint) in this population. We investigated the relationship between this adaptive style and PTSD, PTSS, and psychosocial functioning in 29 adolescent cancer survivors (12 through 18 years). Adolescents  categorized as repressors (n = 14) reported moderate/large effect size differences in PTSD, PTSS, and psychosocial distress (lower) as well as QOL (better) compared to non-repressors. Furthermore, repressors reported less PTSD and QOL variability. Thus, the repressive adaptive style, pronounced in this population, may obscure systematic and clinically meaningful adaptive style group differences across psychological measures.

PMID: 17952587 [PubMed - as supplied by publisher]

 

BMC Psychiatry. 2007 Oct 17;7:56.

Altered oscillatory brain dynamics after repeated traumatic stress.

Kolassa IT, Wienbruch C, Neuner F, Schauer M, Ruf M, Odenwald M, Elbert T.

Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany. Iris.Kolassa@uni-konstanz.de

BACKGROUND: Repeated traumatic experiences, e.g. torture and war, lead to functional and structural cerebral changes, which should be detectable in cortical dynamics. Abnormal slow waves produced within circumscribed brain regions during a resting state have been associated with lesioned neural circuitry in neurological disorders and more recently also in mental illness. METHODS: Using magnetoencephalographic (MEG-based) source imaging, we mapped abnormal distributions of generators of slow waves in 97 survivors of torture and war with posttraumatic stress disorder (PTSD) in comparison to 97 controls. RESULTS: PTSD patients showed elevated production of focally generated slow waves (1-4 Hz), particularly in left temporal brain regions, with peak activities in the region of the insula. Furthermore, differential slow wave activity in right frontal areas was found in PTSD patients compared to controls. CONCLUSION: The insula, as a site of multimodal convergence, could play a key role in understanding the pathophysiology of PTSD, possibly accounting for what has been  called posttraumatic alexithymia, i.e., reduced ability to identify, express and  regulate emotional responses to reminders of traumatic events. Differences in activity in right frontal areas may indicate a dysfunctional PFC, which may lead  to diminished extinction of conditioned fear and reduced inhibition of the amygdala.

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

PMID: 17941996 [PubMed - in process]

 

Behav Res Ther. 2007 Oct 13 [Epub ahead of print]

Social problem solving and autobiographical memory in posttraumatic stress disorder.

Sutherland K, Bryant RA.

School of Psychology, University of New South Wales, NSW 2052, Australia.

This study investigated the relationship between overgeneral autobiographical memory and social problem solving in posttraumatic stress disorder (PTSD). Civilian trauma survivors with and without PTSD (N=41) provided autobiographical  memories of events in response to positive and negative cue words. Participants also completed the means-end problem-solving (MEPS) procedure. PTSD participants  reported more overgeneral memories, regardless of cue valence, than non-PTSD participants. Individuals with PTSD also displayed poorer problem solving than those without PTSD. Overgeneral autobiographical memory was strongly associated with deficits in problem solving. This study suggests that deficient problem solving in PTSD is associated with impaired retrieval of specific autobiographical memories.

PMID: 18022601 [PubMed - as supplied by publisher]

 

Behav Res Ther. 2007 Oct 13 [Epub ahead of print]

Cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder symptoms following stroke.

Field EL, Norman P, Barton J.

Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2TP, UK.

This study examined cross-sectional and prospective associations between cognitive appraisals and posttraumatic stress disorder (PTSD) symptoms following  stroke. While in hospital, stroke patients (n=81) completed questionnaires assessing cognitive appraisals (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms. PTSD symptoms were assessed again 3 months later when all patients had been discharged from hospital (n=70). Significant correlations were found between the time 1 measures of negative cognitions about the self and the world, but not self-blame, and the severity of PTSD symptoms measured at time 1 and at time 2. Regression analyses revealed that cognitive appraisals explained a significant amount of variance in the severity of PTSD symptoms at time 1, with negative cognitions about the self-emerging as a significant predictor. In contrast, time 1 cognitive appraisals were unable to explain additional variance in time 2 PTSD severity over and above that explained by time 1 PTSD severity. The findings therefore provide only weak support for Ehlers and Clark's cognitive model of PTSD.

PMID: 18005937 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Oct 12 [Epub ahead of print]

Nicotine dependence mediates the relations between insomnia and both panic and posttraumatic stress disorder in the NCS-R sample.

Babson KA, Feldner MT, Sachs-Ericsson N, Schmidt NB, Zvolensky MJ.

Department of Psychology, Intervention Science Laboratory, University of Arkansas, Fayetteville, Arkansas.

Although a growing literature has demonstrated elevations in insomnia symptoms among persons with either panic disorder (PD) or posttraumatic stress disorder (PTSD) relative to people without psychopathology, comparably little is known about processes underlying these associations. In recognition of this important gap in the literature, this study tested nicotine dependence as a partial mediator of the relations between insomnia symptoms and both PD and PTSD among a  nationally representative sample of 5,692 (3,311 females; M(age)=43.33, SD=16.55) adults from the National Comorbidity Survey-Replication. Consistent with hypotheses, nicotine dependence partially mediated the relations between insomnia and both PD and PTSD after controlling for variance accounted for by diagnoses of major depressive episodes, drug and alcohol dependence, and gender. Overall, results suggest nicotine dependence may be a possible mechanism that underlies insomnia among those with PD and PTSD. Depression and Anxiety 0:1-10, 2007. Published 2007 Wiley-Liss, Inc.

PMID: 17935215 [PubMed - as supplied by publisher]

 

BMC Psychiatry. 2007 Oct 4;7:54.

Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview.

Kolassa IT, Eckart C, Ruf M, Neuner F, de Quervain DJ, Elbert T.

Clinical & Neuropsychology, University of Konstanz, Universitätsstr, 10, 78457 Konstanz, Germany. Iris.Kolassa@uni-konstanz.de

BACKGROUND: According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol  response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences. METHODS: Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the Vivo Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and  arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time. RESULTS: Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms  did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in the DMS task, which  is consistent with memory and concentration problems demonstrated in patients with PTSD. CONCLUSION: A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.

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

PMID: 17916253 [PubMed - in process]

 

Neuron. 2007 Oct 4;56(1):19-32.

Response variation following trauma: a translational neuroscience approach to understanding PTSD.

Yehuda R, LeDoux J.

Division of Traumatic Stress Studies, Mount Sinai School of Medicine, James J Peters Veteran Affairs, New York, NY 10468, USA. rachel.yehuda@med.va.gov

Exposure to traumatic stress is a requirement for the development of posttraumatic stress disorder (PTSD). However, because the majority of trauma-exposed persons do not develop PTSD, examination of the typical effects of a stressor will not identify the critical components of PTSD risk or pathogenesis. Rather, PTSD represents a specific phenotype associated with a failure to recover from the normal effects of trauma. Thus, research must focus on identifying pre- and posttraumatic risk factors that explain the development of the disorder and the failure to reinstate physiological homeostasis. In this review, we summarize what is known about the clinical and biological characteristics of PTSD and articulate some of the gaps in knowledge that can be  addressed by basic neuroscience research. We emphasize how knowledge about individual differences related to genetic and epigenetic factors in behavioral and brain responses to stress offers the hope of a deeper understanding of PTSD.

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

PMID: 17920012 [PubMed - indexed for MEDLINE]

 

AAOHN J. 2007 Oct;55(10):432.

Traumatic incidents and emotional health.

Tompkins OS.

Ms. Tompkins is Manager Occupational Health, Occidental Oil and Gas Corporation,  Houston, TX, USA.

The role of the occupational health nurse in recognizing the potential for posttraumatic stress disorder is discussed.

Publication Types:      Case Reports

PMID: 17969541 [PubMed - indexed for MEDLINE]

 

Am J Kidney Dis. 2007 Oct;50(4):594-601.

Posttraumatic stress disorder in hemodialysis patients.

Tagay S, Kribben A, Hohenstein A, Mewes R, Senf W.

Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany. sefik.tagay@uni-due.de

BACKGROUND: We aim to assess the prevalence and severity of posttraumatic stress  disorder (PTSD) in patients who receive long-term hemodialysis (HD) and investigate its correlation with depression, anxiety, health-related quality of life, and service utilization. STUDY DESIGN, SETTING & PARTICIPANTS: In a cross-sectional study, we recruited 144 HD patients (age, 63.1 +/- 14.2 years; 50.7% men) from 5 dialysis units. FACTOR: PTSD, defined in accordance with criteria of the Impact of Event Scale-Revised and Posttraumatic Stress Diagnostic Scale. OUTCOMES: Physical health, mental health, depression, anxiety, life satisfaction, service utilization. MEASUREMENTS: Impact of Event Scale-Revised, Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey. RESULTS: 77.8% of HD patients reported at least 1 traumatic event. The lifetime prevalence for PTSD, independent from trauma type,  was 17%. PTSD prevalence only with regard to HD as a potential traumatic event was 10.4%. Women reported more helplessness and more intensive experiences of fear or horror than men with respect to the stressor A criterion. Patients with PTSD showed substantial decreases in mental health in comparison to patients without PTSD (P < 0.01). Additionally, greater depression, anxiety, less life satisfaction, and more service utilization were associated with greater posttraumatic symptoms. There was no correlation of physical health with posttraumatic symptoms. In partial correlation analyses adjusting for depression, associations between posttraumatic symptoms, mental health, and anxiety remained  robust. LIMITATIONS: Generalizability to other settings, absence of control group, study power. CONCLUSIONS: PTSD is common in HD patients, but little work has been done to explore the variables associated with PTSD. Data suggest that PTSD is underdiagnosed and undertreated in HD patients. Interventions should target these patients with the goal to improve well-being and quality of life.

Publication Types:      Comparative Study     Multicenter Study

PMID: 17900459 [PubMed - indexed for MEDLINE]

 

Am J Kidney Dis. 2007 Oct;50(4):585-93.

Prevalence and predictors of posttraumatic stress disorder among hemodialysis patients following Hurricane Katrina.

Hyre AD, Cohen AJ, Kutner N, Alper AB, Muntner P.

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

BACKGROUND: Patients with end-stage renal disease reliant on maintenance hemodialysis therapy may be particularly susceptible to developing post-traumatic stress disorder (PTSD) after natural disasters. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: Patients who received treatment at 9 New Orleans,  LA, metropolitan area hemodialysis units before Hurricane Katrina made landfall on August 29, 2005, were recruited for the study. Overall, 391 patients completed the interview between April and October 2006 (participation rate, 85.6%). PREDICTORS: Demographic, dialysis-related, and evacuation characteristics. OUTCOMES & MEASUREMENTS: PTSD was assessed by using the 17-item PTSD Checklist and defined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. RESULTS: Overall, 23.8% of hemodialysis patients reported symptoms consistent with PTSD. After adjustment for age and sex, black patients were 1.92 (95% confidence interval, 1.31 to 2.83) times more likely than whites to have PTSD. After age, race, and sex adjustment, PTSD was more common in hemodialysis patients who were in their first 2 years of treatment, were evacuated fewer than 2 days before the hurricane made landfall, were evacuated initially to a shelter, and missed 3 or more dialysis treatments because of Hurricane Katrina and its aftermath. Additionally, patients who remained displaced for 3 or more months were more likely to have PTSD. LIMITATIONS: Data were not available to distinguish between the presence of acute, chronic, or delayed-onset PTSD. CONCLUSIONS: A substantial proportion of hemodialysis patients had PTSD symptoms approximately 1 year after Hurricane Katrina. Emergency planning for hemodialysis patients should include the identification and treatment of PTSD after future disasters.

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

PMID: 17900458 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Oct;164(10):1476-88.

Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia.

Etkin A, Wager TD.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305, USA. amitetkin@stanford.edu

OBJECTIVE: The study of human anxiety disorders has benefited greatly from functional neuroimaging approaches. Individual studies, however, vary greatly in  their findings. The authors searched for common and disorder-specific functional  neurobiological deficits in several anxiety disorders. The authors also compared  these deficits to the neural systems engaged during anticipatory anxiety in healthy subjects. METHOD: Functional magnetic resonance imaging and positron emission tomography studies of posttraumatic stress disorder (PTSD), social anxiety disorder, specific phobia, and fear conditioning in healthy individuals were compared by quantitative meta-analysis. Included studies compared negative emotional processing to baseline, neutral, or positive emotion conditions. RESULTS: Patients with any of the three disorders consistently showed greater activity than matched comparison subjects in the amygdala and insula, structures  linked to negative emotional responses. A similar pattern was observed during fear conditioning in healthy subjects. Hyperactivation in the amygdala and insula were, of interest, more frequently observed in social anxiety disorder and specific phobia than in PTSD. By contrast, only patients with PTSD showed hypoactivation in the dorsal and rostral anterior cingulate cortices and the ventromedial prefrontal cortex-structures linked to the experience and regulation of emotion. CONCLUSIONS: This meta-analysis allowed us to synthesize often disparate findings from individual studies and thereby provide neuroimaging evidence for common brain mechanisms in anxiety disorders and normal fear. Effects unique to PTSD furthermore suggested a mechanism for the emotional dysregulation symptoms in PTSD that extend beyond an exaggerated fear response. Therefore, these findings help refine our understanding of anxiety disorders and  their interrelationships.

Publication Types:      Comparative Study     Meta-Analysis

PMID: 17898336 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2007 Oct;97(10):1852-8. Epub 2007 Aug 29.

Exposure to terrorism and Israeli youths' cigarette, alcohol, and cannabis use.

Schiff M, Zweig HH, Benbenishty R, Hasin DS.

School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel.

OBJECTIVES: We investigated the consequences of exposure to acts of terrorism among Israeli adolescents. We examined whether exposure to terrorism predicted adolescents' use of cigarettes, alcohol (including binge drinking), and cannabis  after we controlled for posttraumatic stress and depressive symptoms and background variables. METHODS: Anonymous self-administered questionnaires were given to a random sample of 960 10th and 11th grade students (51.6% boys, 48.4% girls) in a large city in northern Israel. RESULTS: Close physical exposure to acts of terrorism predicted higher levels of alcohol consumption (including binge drinking among drinkers) and cannabis use. These relationships remained even after we controlled for posttraumatic stress and depressive symptoms. CONCLUSIONS: In addition to posttraumatic stress symptoms, negative consequences  of terrorism exposure among adolescents included substance abuse. The similarity  between our findings among Israeli adolescents and previous findings among US adults suggests cross-cultural generalizability. Given the risks for later problems from early-onset substance abuse, the consequences of terrorism exposure among adolescents merit greater research and clinical attention.

Publication Types:      Multicenter Study     Randomized Controlled Trial     Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 17761574 [PubMed - indexed for MEDLINE]

 

Ann Epidemiol. 2007 Oct;17(10):827-33. Epub 2007 Jul 2.

Social support and posttraumatic stress disorder among flood victims in Hunan, China.

Feng S, Tan H, Benjamin A, Wen S, Liu A, Zhou J, Li S, Yang T, Zhang Y, Li X, Li  G.

School of Public Health, Central South University, Changsha, Hunan, PR China.

PURPOSE: To explore the relationship between social support and posttraumatic stress disorder (PTSD) among flood victims. METHODS: A cross-sectional survey was carried out in 2000 among individuals who had suffered floods in 1998 in Hunan, China. Multistage sampling was used to select the subjects from the flood-affected areas. PTSD was diagnosed according to DSM-IV criteria, and social support was measured according to a social support rating scale. Data were collected through face-to-face interviews using a structured questionnaire. Multiple logistic regression analysis and confirmatory factor analysis was used to examine the relationship between social support and PTSD. RESULTS: Out of a total of 25,478 subjects interviewed, 2336 (9.7%) were diagnosed as having PTSD.  PTSD was significantly associated with total social support (odds ratio [OR] 0.80, 95% confidence interval [CI], 0.78-0.82), subjective support (OR 0.48, 95%CI, 0.44-0.52), and support utilization (OR 0.53, 95%CI, 0.49-0.57). CONCLUSION: PTSD in flood victims is significantly associated with social support; subjective support and support utilization may play more important roles in mitigating the impact of flood than objective support.

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

PMID: 17606382 [PubMed - indexed for MEDLINE]

 

Ann Pharmacother. 2007 Oct;41(10):1744. Epub 2007 Sep 11.

Adjunctive aripiprazole in combat-related posttraumatic stress disorder.

Padala PR, List D, Petty F, Bhatia SC.

Publication Types:      Case Reports     Letter

PMID: 17848426 [PubMed - indexed for MEDLINE]

 

Arch Psychiatr Nurs. 2007 Oct;21(5):249-56.

Clinical presentation and therapeutic interventions for posttraumatic stress disorder post-Katrina.

Rhoads J, Pearman T, Rick S.

Primary Care Community Health Public Health Nursing Program, LSUHSC School of Nursing, New Orleans, LA 70112, USA. jrhoad@lsuhsc.edu

It has been almost 2 years since Hurricane Katrina struck the Gulf Coast. These 2 years can be characterized by constant struggle and pain as the people try to reattain some semblance of life as they knew it before Katrina struck. Some have  chosen to leave their ancestral homes, homes where they were raised and where they, in turn, raised their own families. Those who did leave are able, in some way, to reestablish some semblance of normality, but those who stayed showed manifestations of and dealt with psychological trauma. These manifestations include regression, inattentiveness, aggressiveness, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer lasting effects may include depression, anxiety, adjustment disorders, and interpersonal or academic difficulties. These postdisaster manifestations can linger or remain hidden until well after the traumatic event and could persist for years. This article presents issues about the effects of Katrina on the mental health of the  people of New Orleans. It discusses the profile of posttraumatic stress disorder  and presents evidence-based review of interventions the health care provider can  implement to care for those who continue to suffer the effects of this horrific disaster.

PMID: 17904482 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Oct;45(10):2268-79. Epub 2007 May 3.

Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement.

Salcioğlu E, Başoğlu M, Livanou M.

Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, London SE5 8AF, UK. Ebru.Salcioglu@iop.kcl.ac.uk

Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Başog lu, M., Salciog lu, E., Livanou, M.,  Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized  that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant  between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.

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

PMID: 17570342 [PubMed - in process]

 

Behav Res Ther. 2007 Oct;45(10):2295-306. Epub 2007 May 10.

The psychosocial impact of Hurricane Katrina: contextual differences in psychological symptoms, social support, and discrimination.

Weems CF, Watts SE, Marsee MA, Taylor LK, Costa NM, Cannon MF, Carrion VG, Pina AA.

Department of Psychology, University of New Orleans, New Orleans, LA 70148, USA.  cweems@uno.edu

This study tested a contextual model of disaster reaction by examining regional differences in the psychosocial impact of Hurricane Katrina. A total of 386 individuals participated in this study. All were recruited in the primary areas affected by Hurricane Katrina and included residents of metropolitan New Orleans  (Orleans Parish, Louisiana), Greater New Orleans (i.e., Metairie, Kenner, Gretna), and the Mississippi Gulf Coast (i.e., cities along the coast from Waveland to Ocean Springs, Mississippi). Participants were assessed for posttraumatic stress disorder (PTSD) symptoms, other psychological symptoms, perceptions of discrimination, perceptions of social support, evacuation distance, and the extent to which they experienced hurricane-related stressful events. Results were consistent with previous research on the impact of disasters on mental health symptoms. Findings extended research on individual differences in the response to trauma and indicated that regional context predicted unique variance in the experience of discrimination, social support, and emotional symptoms consistent with the theoretical model presented.

PMID: 17568560 [PubMed - in process]

 

Behav Res Ther. 2007 Oct;45(10):2502-7. Epub 2007 May 4.

A prospective study of appraisals in childhood posttraumatic stress disorder.

Bryant RA, Salmon K, Sinclair E, Davidson P.

University of New South Wales, Sydney, NSW 2052, Australia. R.Bryant@unsw.edu.au

This study investigated the predictors of posttraumatic stress disorder (PTSD) in children following a diagnosis of traumatic injury. Children (N=76) aged between  7 and 13 who were admitted to hospital following injury were assessed within a month of trauma for acute stress disorder (ASD), negative appraisals, as well as  parental stress reactions. Children (N=62) were re-assessed 6-months later for PTSD and negative appraisals. The majority of the variance of chronic posttraumatic stress was accounted for by negative appraisals about future harm.  This study supports cognitive models of PTSD, and suggests that younger children  who exaggerate their vulnerability after trauma exposure are high risk for PTSD after trauma.

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

PMID: 17560541 [PubMed - in process]

 

BMC Psychiatry. 2007 Oct 1;7:51.

Victimization and PTSD-like states in an Icelandic youth probability sample.

Bödvarsdóttir I, Elklit A.

Department of Psychology, University of Aarhus, Jens Chr, Skous Vej 4, DK-8000 Aarhus C, Denmark. iris@hsu.is

BACKGROUND: Although adolescence in many cases is a period of rebellion and experimentation with new behaviors and roles, the exposure of adolescents to life-threatening and violent events has rarely been investigated in national probability studies using a broad range of events. METHODS: In an Icelandic national representative sample of 206 9th-grade students (mean = 14.5 years), the prevalence of 20 potentially traumatic events and negative life events was reported, along with the psychological impact of these events. RESULTS: Seventy-four percent of the girls and 79 percent of the boys were exposed to at least one event. The most common events were the death of a family member, threat of violence, and traffic accidents. The estimated lifetime prevalence of posttraumatic stress disorder-like states (PTSD; DSM-IV, APA, 1994 1) was 16 percent, whereas another 12 percent reached a sub-clinical level of PTSD-like states (missing the full diagnosis with one symptom). Following exposure, girls suffered from PTSD-like states almost twice as often as boys. Gender, mothers' education, and single-parenthood were associated with specific events. The odds ratios and 95% CI for PTSD-like states given a specific event are reported. Being exposed to multiple potentially traumatic events was associated with an increase  in PTSD-like states. CONCLUSION: The findings indicate substantial mental health  problems in adolescents that are associated with various types of potentially traumatic exposure.

PMID: 17908296 [PubMed - in process]

 

Can J Psychiatry. 2007 Oct;52(10):675-83.

Previous trauma exposure and PTSD symptoms as predictors of subjective and biological response to stress.

Regehr C, LeBlanc V, Jelley RB, Barath I, Daciuk J.

Faculty of Social Work, University of Toronto, Ontario. cheryl.regehr@utoronto.ca

OBJECTIVE: The immediate and long-term effects of traumatic exposure and subsequent posttraumatic stress reactions in people in high-risk occupations are  well-documented. What is less evident is the impact of this traumatic exposure and subsequent traumatic stress symptoms on workers' response to acute stress situations. This study aimed to examine the association between prior traumatic exposure related to policing, current posttraumatic stress symptoms and biological markers of stress, and subjective appraisal of stress before, during,  and after exposure to acutely stressful stimuli. METHOD: A stressful policing situation was created through the use of a video simulator room. Participants' responses to the simulated emergency were evaluated by monitoring heart rate, collecting salivatory samples for cortisol analysis, and repeated administration  of a subjective measure of anxiety. RESULTS: Biological indicators of stress, as  measured by cortisol level and heart rate, were not associated with previous trauma exposure or trauma symptoms; however, biological response was associated with subjective anxiety. Vulnerability to psychological stress responses during an acute stress situation was also associated with lower levels of social support, previous traumatic exposures, and preexisting symptoms of traumatic stress. The importance of these factors became more pronounced as time progressed after the event. CONCLUSION: Previous trauma exposure did not put individuals at  increased risk of biological distress during an acute stress situation. However,  previous trauma and reduced social supports were associated with continuing psychological distress, confirming previous research and raising concerns about the cumulative negative effects of traumatic exposure on psychological health in  emergency responders.

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

PMID: 18020115 [PubMed - indexed for MEDLINE]

 

Child Psychiatry Hum Dev. 2007 Oct;38(3):195-202. Epub 2007 Apr 3.

Brief screening instrument of posttraumatic stress disorder for children and adolescents 7-15 years of age.

Liu A, Tan H, Zhou J, Li S, Yang T, Sun Z, Wen SW.

Department of Epidemiology & Health Statistics, School of Public Health, Central  South University, Xiangya Road 110, Changsha, Hunan 410078, PR China.

The objective of this paper is to develop a brief screening instrument of posttraumatic stress disorder (PTSD) for young victims of natural disasters. Data were derived from flood victims in 1998 and 1999 in Hunan, China. A representative population sample of 6,852 subjects 7-15 years of age was selected. Among them, 6,073 (88.6%) were interviewed. Multistage sampling was used to select the subjects and PTSD was ascertained with Diagnostic and Statistical Manual of Mental Disorders: 4th Edition (DSM-IV). We randomly assigned 80% (4,851) of the study subjects to construct the screening instrument  (construct model) and the remaining 20% (1,222) subjects to examine the model (validation model). Logistic regression analysis and receiver operating characteristics curves were utilized to select a subset of symptoms and cutoff point from the pre-structured questionnaires. A seven-symptom instrument for PTSD screening was selected. Scores of 3 or more on this instrument were employed to define positive cases of PTSD with a sensitivity of 96.9%, specificity 99.0%, positive predictive value (PPV) 82.6%, and negative predictive value (NPV) 99.8%. The brief screening instrument developed in this study is highly valid, reliable, and predictable.

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

PMID: 17404830 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2007 Oct;68(10):1593-600.

Suicidality, psychopathology, and gender in incarcerated adolescents in Austria.

Plattner B, The SS, Kraemer HC, Williams RP, Bauer SM, Kindler J, Feucht M, Friedrich MH, Steiner H.

Department of Child and Adolescent Neuropsychiatry, Medical University of Vienna, Vienna, Austria.

OBJECTIVE: Delinquent juveniles are at extreme risk for suicide with death rates  4 times higher than in the general population. Whereas psychopathologic risk factors for suicidal behavior in nonforensic adolescent populations are well defined, psychopathologies associated with suicidality in delinquent juveniles are not yet clear. The objective of this study was to determine gender-specific psychopathologic profiles associated with suicidality in detained juveniles. METHOD: The Massachusetts Youth Screening Instrument-Second Version, the Youth Self-Report, and the Mini-International Neuropsychiatric Interview for children and adolescents were used to investigate juveniles in an Austrian pre-trial detention facility. The study sample consisted of all juveniles entering the system between March 2003 and January 2005. Of the 370 eligible participants, 319 completed the study (53 girls and 266 boys; age range, 14 to 21 years; mean = 16.67, SD = 1.45 years). RESULTS: We found significantly higher prevalence rates  of both current (p < .01) and lifetime (p < .001) suicidality in girls than in boys. Suicidal boys exhibited more psychopathology and a wider range of psychopathology compared to nonsuicidal boys. For suicidal girls, psychopathologies appeared more circumscribed (all relevant p values < .04). Using signal detection methods, major depressive disorder, attention-deficit/hyperactivity disorder, and social phobia identified boys at highest risk of suicidality, while a diagnosis of posttraumatic stress disorder identified girls at highest risk. CONCLUSIONS: Suicidality levels are high in delinquent adolescents, especially in girls. Psychopathologic risk factors seem to be gender specific in this population. Not only depression, but also psychopathologies that usually do not arouse strong suspicion for an association  with suicidal behavior, i.e., social phobia and ADHD in boys and PTSD in girls, might increase suicide risk. Further research in other countries is needed to replicate our results with respect to sociocultural influences.

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

PMID: 17960977 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2007 Oct;75(5):812-5.

Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder.

Bryant RA, Guthrie RM.

School of Psychology, University of New South Wales, Sydney, NSW, Australia. r.bryant@unsw.edu.au

This study tested the proposal that negative appraisals represent a risk factor for developing posttraumatic stress disorder (PTSD) after trauma. Trainee firefighters (N = 68) were assessed during training (before trauma exposure) for  PTSD, history of traumatic events, and tendency to engage in negative appraisals. Firefighters were reassessed 4 years later (N = 52), after commencing firefighter duty (after trauma exposure), for PTSD and depression using the Posttraumatic Stress Disorder Scale (E. B. Foa, L. Cashman, L. Jaycox, & K. Perry, 1997) and the Beck Depression Inventory (Version 2; A. T. Beck, R. A. Steer, & G. K. Brown, 1996). At follow-up, 12% met criteria for PTSD. Pretrauma negative appraisals about oneself accounted for 20% of variance in PTSD severity at follow-up. These  data provide the first evidence that preexisting negative appraisals are a risk factor for PTSD. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

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

PMID: 17907863 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2007 Oct;75(5):683-92.

Predictors of posttraumatic distress 1 year after exposure to community violence: the importance of acute symptom severity.

Denson TF, Marshall GN, Schell TL, Jaycox LH.

School of Psychology, University of New South Wales, Australia. t.denson@unsw.edu.au

In this longitudinal study of 333 primarily male, Hispanic survivors of community violence, the authors investigated the effects of 4 categories of risk factors on posttraumatic stress disorder (PTSD) symptom severity: demographic characteristics, pretraumatic psychological factors, characteristics of the trauma, and reactions to the trauma. Replicating past research, exemplars from all 4 categories predicted PTSD symptom severity at 12-month follow-up. Acute symptom severity, measured approximately 5 days posttrauma, accounted for the largest proportion of variance among all the predictors included. No other predictors remained significant after 5-day distress was included in the model. These findings suggest that the effects of several purported risk factors for chronic posttraumatic distress may already be reflected in acute distress following trauma exposure. These results bear on current conceptions of the fundamental nature of PTSD and suggest that initial distress during the immediate aftermath of the trauma may be an important target for intervention. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

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

PMID: 17907850 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2007 Oct;75(5):671-82.

What predicts psychological resilience after disaster? The role of demographics,  resources, and life stress.

Bonanno GA, Galea S, Bucciarelli A, Vlahov D.

Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY 10027, USA. gab38@columbia.edu.

A growing body of evidence suggests that most adults exposed to potentially traumatic events are resilient. However, research on the factors that may promote or deter adult resilience has been limited. This study examined patterns of association between resilience and various sociocontextual factors. The authors used data from a random-digit-dial phone survey (N = 2,752) conducted in the New  York City area after the September 11, 2001, terrorist attack. Resilience was defined as having 1 or 0 posttraumatic stress disorder symptoms and as being associated with low levels of depression and substance use. Multivariate analyses indicated that the prevalence of resilience was uniquely predicted by participant gender, age, race/ethnicity, education, level of trauma exposure, income change,  social support, frequency of chronic disease, and recent and past life stressors. Implications for future research and intervention are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

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

PMID: 17907849 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2007 Oct;22(10):1305-14.

Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers.

Rosen D, Seng JS, Tolman RM, Mallinger G.

University of Pittsburgh, Pittsburgh, PA, USA.

Estimates of intimate partner violence (IPV) during pregnancy vary by population  being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and  depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women  also experiencing depression and/or posttraumatic stress disorder.

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

PMID: 17766728 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Oct;195(10):830-6.

The development and psychometric evaluation of the emotional reactivity and numbing scale.

Orsillo SM, Theodore-Oklota C, Luterek JA, Plumb J.

Department of Psychology, Suffolk University, Boston, Massachusetts 02114-4280, USA. sorsillo@suffolk.edu

Recent research has highlighted the role of hyperresponsivity and numbing of emotions in posttraumatic stress disorder. Preliminary research suggests that emotional numbing symptoms impact the development, maintenance, and treatment of  posttraumatic stress disorder. However, research in this area has been hindered,  in part, due to the absence of a psychometrically sound, conceptually based measure of emotional numbing. The present study examined the psychometric properties of the Emotional Reactivity and Numbing Scale in a sample of 92 trauma-exposed men and women veterans. Results provide preliminary support for the internal consistency, test-retest reliability, convergent, and discriminant validity of the measure. Implications for future research are discussed.

Publication Types:      Comparative Study

PMID: 18043523 [PubMed - indexed for MEDLINE]

 

J Neuropsychiatry Clin Neurosci. 2007 Fall;19(4):475-6.

Neuroanatomical changes after eye movement desensitization and reprocessing (EMDR) treatment in posttraumatic stress disorder.

Letizia B, Andrea F, Paolo C.

Publication Types:      Case Reports     Letter

PMID: 18070859 [PubMed - indexed for MEDLINE]

 

J Paediatr Child Health. 2007 Oct;43(10):662-6.

Psychiatric morbidity in adolescents operated in childhood for congenital cyanotic heart disease.

Toren P, Horesh N.

Tel Aviv-Brull Community Mental Health Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ptoren@post.tau.ac.il

AIM: The aim of the present study was to assess psychiatric morbidity of adolescents operated in childhood for congenital cyanotic heart disease (CCHD) and their parents. METHODS: Participants were 31 adolescents (19 boys, 12 girls)  aged 10-21 (mean +/- SD, 14.7 +/- 0.3) years, who had undergone cardiac surgery 13.7 +/- 2.48 years before the study assessment period. Twenty-two mothers and nine fathers participated in the study. Assessment tools for adolescents included: the UCLA Post Traumatic Stress Disorder-Reaction Index, The Screen for  Child Anxiety Related Emotional Disorders, and The Beck Depression Inventory; for the parents: The Posttraumatic Stress Diagnostic Scale, The Spielberger State Trait Anxiety Inventory, and The Beck Depression Inventory. RESULTS: Nine out of  31 adolescents (29.03%) were defined as 'full post-traumatic stress disorder (PTSD) likely' with a total post-traumatic stress symptom (PTSS) score significantly higher than that of the non-PTSS subgroup (P < 0.001). A non-significant trend was noted for more adolescents with 'anxiety disorder likely' (P = 0.096, NS) in the PTSS versus the non-PTSS subgroups. A non-significant trend was detected showing that on all symptom domains of PTSD, as well as on anxiety and depressive measures, parents of children with PTSS received higher scores than parents of children without PTSS (P = 0.095, 0.03, 0.04, respectively, NS). CONCLUSION: Children undergoing cardiac surgery for CCHD may be at a high risk for long-term PTSS.

PMID: 17854449 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Oct;20(5):857-67.

The relationship between childhood support and later emergence of PTSD.

Lauterbach D, Koch EI, Porter K.

Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, USA.  dlauterba@emich.edu

The authors examine the relationship between three sources of social support (maternal, paternal, and peer) and the development of posttraumatic stress disorder (PTSD). This study utilized data from the National Comorbidity Survey (NCS), a large (N = 5,877) nationally representative population survey. Persons with and without a lifetime history of PTSD and those with and without a history  of trauma exposure were compared on levels of social support received prior to age 15. Persons with a history of PTSD reported that they received less maternal, paternal, and peer support as children than those without PTSD. Importantly, persons who developed PTSD after the age of 17 reported lower levels of early childhood support from their fathers.

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

PMID: 17955546 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):763-74.

Brain, skull, and cerebrospinal fluid volumes in adult posttraumatic stress disorder.

Woodward SH, Kaloupek DG, Streeter CC, Kimble MO, Reiss AL, Eliez S, Wald LL, Renshaw PF, Frederick BB, Lane B, Sheikh JI, Stegman WK, Kutter CJ, Stewart LP, Prestel RS, Arsenault NJ.

National Center for PTSD, Clinical Laboratory and Education Division and Psychology Service, VA Palo Alto Healthcare System, Palo Alto, CA 94025, USA. Steve.woodward@med.va.gov

Children and adolescents with maltreatment-related posttraumatic stress disorder  (PTSD) exhibit smaller intracranial tissue volume than controls. Linear relationships have also been observed between intracranial tissue volume and the  age of maltreatment onset. The authors explored associations among adult PTSD, early trauma, and cerebral volumes in 99 combat veterans. A bone-based estimate of cranial volume was developed to adjust for variation in body size. Posttraumatic stress disorder was not associated with smaller cerebral tissue volume, but rather with smaller cerebrospinal fluid (CSF) and cranial volumes. These findings co-occurred with expected effects of alcoholism and aging on cerebral tissue and CSF volumes. The results point to early developmental divergences between groups with and without PTSD following adult trauma.

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

PMID: 17955544 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):737-50.

Genetics of posttraumatic stress disorder: Review and recommendations for future  studies.

Koenen KC.

Department of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. kkoenen@hsph.harvard.edu

Posttraumatic stress disorder (PTSD) is common and debilitating. Posttraumatic stress disorder is moderately heritable; however, the role of genetic factors in  PTSD etiology has been largely neglected by trauma researchers. The goal of this  study is to motivate trauma researchers to reflect on the role genetic variation  may play in vulnerability and resilience following trauma exposure. Evidence from family, twin, and molecular genetic studies for genetic influences on PTSD is reviewed. Recommendations for future studies are presented with emphasis on study design and assessment issues particular to the field of trauma and PTSD. Clinical implications of PTSD genetic studies are discussed.

PMID: 17955543 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):667-76.

Baroreceptor sensitivity at rest and during stress in women with posttraumatic stress disorder or major depressive disorder.

Hughes JW, Dennis MF, Beckham JC.

Department of Psychology, Kent State University, Kent, OH 44242, USA. jhughes1@kent.edu

The relationship between posttraumatic stress disorder (PTSD) and parasympathetic nervous system functioning was investigated during a baseline rest period and anger recall speaking task using noninvasive estimates of baroreceptor sensitivity. Participants (N = 124) were women categorized into one of four diagnostic groups: PTSD without major depressive disorder (MDD), PTSD with comorbid MDD, MDD without PTSD, and controls with neither psychiatric diagnosis.  Women with PTSD (with or without MDD) exhibited significantly lower resting baroreceptor sensitivity than women not diagnosed with PTSD. Baroreceptor sensitivity decreased during the anger recall task, and the decrease was less among the psychiatric groups. Taken together, these findings suggest that PTSD is associated with reduced parasympathetic nervous system functioning.

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

PMID: 17955541 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):713-25.

Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery.

Hopper JW, Frewen PA, van der Kolk BA, Lanius RA.

Behavioral Psychopharmacology Research Laboratory, Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA. jhopper@mclean.harvard.edu

Research suggests that responses to script-driven trauma imagery in posttraumatic stress disorder (PTSD) include reexperiencing and dissociative symptom subtypes.  This functional magnetic resonance imaging (fMRI) study employed a dimensional approach to characterizing script-driven imagery responses, using the Responses to Script-Driven Imagery Scale and correlational analyses of relationships between severity of state posttraumatic symptoms and neural activation. As predicted, state reexperiencing severity was associated positively with right anterior insula activity and negatively with right rostral anterior cingulate cortex (rACC). Avoidance correlated negatively with rACC and subcallosal anterior cingulate activity. In addition, as predicted, dissociation correlated positively with activity in the left medial prefrontal and right superior temporal cortices, and negatively with the left superior temporal cortex. Theoretical and clinical implications are discussed, particularly with respect to an emotion-dysregulation account of PTSD.

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

PMID: 17955540 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):909-14.

Long-term, high-dose benzodiazepine prescriptions in veteran patients with PTSD:  influence of preexisting alcoholism and drug-abuse diagnoses.

Hermos JA, Young MM, Lawler EV, Rosenbloom D, Fiore LD.

Pharmacoepidemiology Research Group, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA. john.hermos@med.va.gov

Databases from the New England Veterans Integrated Service Network were analyzed  to determine factors associated with long-term, high-dose anxiolytic benzodiazepine prescriptions dispensed to patients with posttraumatic stress disorder (PTSD) and existing alcoholism and/or drug abuse diagnoses. Among 2,183  PTSD patients, 234 received the highest 10% average daily doses for alprazolam, clonazepam, diazepam, or lorazepam, doses above those typically recommended. Highest doses were more commonly prescribed to patients with existing drug abuse  diagnoses. Among patients with PTSD and alcoholism, younger age, drug abuse, and  concurrent prescriptions for another benzodiazepine and oxycodone/acetaminophen independently predicted high doses. Results indicate that for veteran patients with PTSD, alcoholism alone is not associated with high-dose benzodiazepines, but existing drug abuse diagnoses do increase that risk.

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

PMID: 17955537 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):881-91.

Anxiety, depressive, and posttraumatic stress symptoms in mothers of children with type 1 diabetes.

Horsch A, McManus F, Kennedy P, Edge J.

Oxford Doctoral Course in Clinical Psychology, Isis Education Centre, Warneford Hospital, Oxford, UK. antje.horsch@hmc.ox.ac.uk

This study investigated the prevalence of mothers' anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms triggered by their child's type 1 diabetes and identified individual diabetes-related traumatic stressors. Sixty mothers of children who had been diagnosed with diabetes within the past 5 years  were interviewed using the Structured Clinical Interview (SCID) DSM-IV-PTSD module, and completed the Posttraumatic Stress Diagnostic Scale (PDS) and the Hospital Anxiety and Depression Scale (HADS). Fifteen percent of participants met criteria for partial and 10% for full PTSD. Fifty-five percent of participants identified hearing about their child's diagnosis as the traumatic stressor. Forty percent of participants reported moderate to severe symptoms of state-anxiety and 17% moderate to severe symptoms of depression. This study highlights the significant emotional impact this diagnosis in children can have on mothers, and  identifies a population with clinical needs.

PMID: 17955536 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):821-31.

Psychosocial correlates of PTSD symptom severity in sexual assault survivors.

Ullman SE, Filipas HH, Townsend SM, Starzynski LL.

Criminal Justice Department, University of Illinois at Chicago, Chicago, IL 60607-7140, USA. seullman@uic.edu.

This study's goal was to assess the effects of preassault, assault, and postassault psychosocial factors on current posttraumatic stress disorder (PTSD)  symptoms of sexual assault survivors. An ethnically diverse sample of over 600 female sexual assault survivors was recruited from college, community, and mental health agency sources (response rate = 90%). Regression analyses tested the hypothesis that postassault psychosocial variables, including survivors' responses to rape and social reactions from support providers, would be stronger  correlates of PTSD symptom severity than preassault or assault characteristics. As expected, few demographic or assault characteristics predicted symptoms, whereas trauma histories, perceived life threat during the assault, postassault characterological self-blame, avoidance coping, and negative social reactions from others were all related to greater PTSD symptom severity. The only protective factor was survivors' perception that they had greater control over their recovery process in the present, which predicted fewer symptoms. Recommendations for intervention and treatment with sexual assault survivors are  discussed.

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

PMID: 17955534 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):689-99.

Salivary cortisol levels and mood vary by lifetime trauma exposure in a sample of healthy women.

Ganzel BL, Eckenrode JJ, Kim P, Wethington E, Horowitz E, Temple E.

Department of Human Development, Cornell University, Ithaca, NY 14853, USA. blg4@cornell.edu

The authors examined the effects of lifetime trauma exposure on salivary cortisol and mood in a sample of women (N = 37) over 25 days before and after a stressful  event. The sample excluded posttraumatic stress disorder (PTSD) and major depression and was divided into three groups: (a) no trauma, (b) prior trauma with no peritraumatic symptoms of acute distress, and (c) prior trauma with peritraumatic symptoms. Because results indicated no significant differences between groups one and two, they were combined for analysis. Women reporting prior trauma with symptoms had lower afternoon cortisol levels across time, with  sustained negative mood relative to the comparison group. These data suggest the  presence of long-term psychophysiological effects of trauma exposure in healthy women.

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

PMID: 17955533 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):657-66.

Physiologic reactivity to startling tones in female Vietnam nurse veterans with PTSD.

Carson MA, Metzger LJ, Lasko NB, Paulus LA, Morse AE, Pitman RK, Orr SP.

Department of Nursing, Saint Anselm College, Manchester, NH 03102-1310, USA. mcarson@anselm.edu

Posttraumatic stress disorder (PTSD) is associated with larger heart rate (HR), skin conductance (SC), and eyeblink responses to sudden, loud tones. The present  study tested this association in female nurse veterans with PTSD related to witnessing patients' death, severe injury and/or suffering during their Vietnam service. Nurses with current, past but not current, or who never had PTSD listened to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with sudden onsets, while HR, SC, and eyeblink responses were measured. Nurses with current PTSD produced significantly larger averaged HR, but not SC or eyeblink responses across tone trials. A larger HR response to loud tones is one of the most robust physiologic  findings in PTSD and may reflect increased defensive responding.

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

PMID: 17955532 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):917-9.

The crucial role of criterion A: A response to Maier's commentary.

Weathers FW, Keane TM.

Department of Psychology, Auburn University, Auburn, Alabama.

We thank Maier for his thoughtful comments (this issue, pp. 925-926) and appreciate the opportunity to further explicate our views regarding the Criterion A problem. According to Maier, the obvious conclusion to be drawn from our article (Weathers & Keane, 2007) is that Criterion A should be eliminated. We believe the opposite, given the current conceptual and empirical status of the posttraumatic stress disorder (PTSD) construct.

PMID: 17955530 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):793-805.

Considerations in treatment integrity: implications and recommendations for PTSD  research.

Barber JP, Triffleman E, Marmar C.

Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA. Barberj@mail.med.upenn.edu

In this article, the authors address the rationale for and uses of treatment integrity measurement in psychotherapy research, focusing on therapists' adherence and competence in trauma and posttraumatic stress disorder treatment research. The following issues are examined: (a) distinctions between adherence monitoring, performed contemporaneously with ongoing study treatments, and adherence evaluation, and the implications for outcomes analysis; (b) simultaneous measurement of adherence and competence; (c) selection of sessions for adherence/competence assessment and the need for concurrent outcome measurement, and (d) the association between therapist adherence, competence, alliance and treatment outcome. Recommendations regarding common problems in the  implementation of adherence and competence measurement are made throughout. The article concludes with a summary of steps and considerations in decision-making with regard to treatment integrity.

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

PMID: 17955529 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):903-7.

The association between PTSD symptoms and salivary cortisol in youth: the role of time since the trauma.

Weems CF, Carrion VG.

Department of Psychology, University of New Orleans, New Orleans, LA 70148, USA.  cweems@uno.edu

This study examined the direction of association between symptoms of posttraumatic stress disorder (PTSD) and cortisol levels among youth with recent  and distal traumas (N = 50; mean age = 10.7 years). Each had a clinical interview for PTSD symptoms, a cortisol assessment, and the time since the child's most recent trauma was assessed. Results indicated that the time since the most recent trauma moderated the association between cortisol and PTSD symptoms and comparisons indicated that there were significant differences in the size of the  correlations across the recent and distal trauma groups. The results point to a potentially important role of the time since trauma in understanding the relationship between PTSD symptoms and cortisol.

PMID: 17955527 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):893-901.

Relationships between REM sleep findings and PTSD symptoms during the early aftermath of trauma.

Mellman TA, Pigeon WR, Nowell PD, Nolan B.

Department of Psychiatry, Howard University, Washington, DC 20059, USA. TMellman@Howard.edu

Laboratory sleep findings in posttraumatic stress disorder (PTSD) have been characterized as incongruent with subjective complaints. Most findings relate to  rapid eye movement (REM) sleep. Chronicity confounds relationships between objective sleep and PTSD. The authors report relationships between PTSD symptoms  and objective sleep measures from the early aftermath of trauma. Thirty-five patients received polsomnography and PTSD assessment within a month of traumatic  injury. Posttraumatic stress disorder status was established at 2 months. The REM segment duration correlated negatively with initial PTSD and insomnia severity, which also correlated with total sleep time. Relative beta frequency during REM sleep from a subset of cases correlated negatively with PTSD and nightmare severity. These findings suggest a link between subjective symptoms and REM sleep phenomena acutely following trauma.

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

PMID: 17955526 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):869-79.

Risk factors for suicidal behavior among a national sample of adolescents: implications for prevention.

Waldrop AE, Hanson RF, Resnick HS, Kilpatrick DG, Naugle AE, Saunders BE.

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA. waldrop@musc.edu

Factors associated with suicidal ideation and attempts were examined among a national probability sample of adolescents. Sample prevalences of suicidal ideation and attempts were 24.3% and 3.3%, respectively, yielding weighted population prevalence estimates of 23.3% and 3.1%. Suicidal ideation was positively associated with female gender, age, family alcohol and drug problems,  violence exposure, lifetime depression, and posttraumatic stress disorder (PTSD). Suicide attempts were associated with female gender, age, sexual and physical assault, lifetime substance abuse or dependence, PTSD, and depression. Implications for intervention and prevention are discussed.

PMID: 17955525 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):757-61.

Ten-year follow-up study of cortisol levels in aging holocaust survivors with and without PTSD.

Yehuda R, Morris A, Labinsky E, Zemelman S, Schmeidler J.

Division of Traumatic Stress Studies, Department of Psychiatry, Mount Sinai School of Medicine, Bronx NY, USA. rachel.yehuda@med.va.gov

To investigate the longitudinal course of mean 24-hour urinary cortisol excretion in posttraumatic stress disorder (PTSD), the authors evaluated 24-hour cortisol excretion in 28 Holocaust survivors 10 years after obtaining an initial estimate. Cortisol levels increased in participants whose PTSD had remitted (n = 3) but declined in participants who developed PTSD (n = 3) or whose PTSD status did not  change over time (PTSD+: n = 14, PTSD-: n = 8). Cortisol levels at Time 1 predicted diagnostic status change better than psychological variables, including exposure to traumatic events between assessments. The authors conclude that cortisol levels are affected by change in PTSD status and age.

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

PMID: 17955524 [PubMed - in process]

 

J Trauma Stress. 2007 Oct;20(5):751-6.

Elevated heart rate as a predictor of PTSD six months following accidental pediatric injury.

De Young AC, Kenardy JA, Spence SH.

Centre of National Research on Disability and Rehabilitation Medicine, University of Queensland, Australia.

The present study investigated the relationship between elevated heart rate (HR)  and posttraumatic stress disorder (PTSD) 6 months following accidental pediatric  injury. The HR was taken in 101 children, aged 7 to 16 years, upon arrival at the hospital and again 24 hours following admission. Posttraumatic stress disorder was assessed 6 months later using the Anxiety Disorders Interview Schedule for DSM-IV (W. K. Silverman & A. M. Albano, 1996). Children who had an elevated HR (defined as greater than/equal to one standard deviation above the age and sex mean) at admission or 24 hours later were more likely to experience traumatic stress symptoms at 6 months. These findings suggest elevated HR could be used to  aid in the early identification of children at risk of developing PTSD following  a traumatic accident.

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

PMID: 17955523 [PubMed - in process]

 

Mil Med. 2007 Oct;172(10):1039-45.

Does compensation status influence treatment participation and course of recovery from post-traumatic stress disorder?

Laffaye C, Rosen CS, Schnurr PP, Friedman MJ.

VA HSR&D, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.

We reviewed the empirical literature to examine how seeking compensation and/or being awarded compensation for posttraumatic stress disorder-related disability are associated with participation in mental health treatment and course of recovery. The search for relevant literature was conducted using the PubMed, PsycINFO, Medline, and PILOTS databases and yielded seven studies on veterans and five on motor vehicle accident survivors. The literature indicates that veterans  who are seeking or have been awarded compensation participate in treatment at similar or higher rates than do their non-compensation-seeking counterparts. Veteran treatment outcome studies produced either null or mixed findings, with no consistent evidence that compensation-seeking predicts worse outcomes. Studies of motor vehicle accident survivors found no association between compensation status and course of recovery. Recommendations to strengthen future research in this area are provided, including using clear and consistent definitions of compensation status that differentiate compensation-seeking status from award status.

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

PMID: 17985763 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2007 Oct;58(10):1311-6.

Posttraumatic stress disorder and psychiatric comorbidity among detained youths.

Abram KM, Washburn JJ, Teplin LA, Emanuel KM, Romero EG, McClelland GM.

Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Dr., Suite 900, Chicago, IL 60611, USA. psycho-legal@northwestern.edu

OBJECTIVE: This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. METHODS: The  sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. RESULTS: Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without  PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the  participants with PTSD had two or more types of comorbid disorders--that is, affective, anxiety, behavioral, or substance use disorders--and 11% had all four  types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol  use disorder and both alcohol and drug use disorders significantly increased the  odds of having PTSD. No significant difference in prevalence rates of PTSD was found between males and females with specific psychiatric disorders. The prevalence of any comorbid psychiatric disorder was significantly greater for males with PTSD than that for females with PTSD (OR=3.4, CI=1.1-10.6, p<.05). CONCLUSIONS: Detection of comorbid PTSD among detained youths must be improved. PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients. When planning treatment, clinicians  must consider ramifications of comorbid PTSD.

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

PMID: 17914008 [PubMed - indexed for MEDLINE]

 

Psychiatry. 2007 Fall;70(3):260-73.

Strengthening the patient-provider relationship in the aftermath of physical trauma through an understanding of the nature and severity of posttraumatic concerns.

Zatzick DF, Russo J, Rajotte E, Uehara E, Roy-Byrne P, Ghesquiere A, Jurkovich G, Rivara F.

Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, HMC 325 Ninth Ave., Seattle, WA 98104, USA. dzatzick@u.washington.edu

Few investigations have focused on patients' concerns in the immediate aftermath  of physical trauma. A population-based sample of 120 hospitalized injury survivors was recruited and followed over the course of the year after injury. Open-ended, semi-structured items were developed to elicit up to three concerns related to the injury from each hospitalized inpatient. Concern narratives were coded into content domains, and concern severity was assessed. Patients most frequently expressed physical health concerns (68%), followed by work and finance (59%), social (44%), psychological (25%), medical (8%), and legal (5%) concerns.  The expression of three severe concerns immediately after the trauma was associated with higher PTSD symptoms levels over the course of the year. Greater  initial concern severity independently predicted persistent PTSD symptoms 12 months after the injury (Adjusted Relative Risk = 1.71, 95% Confidence Interval = 1.05, 2.78). Early posttraumatic concerns can be readily elicited and reliably interpreted. Psychological concerns constitute a minority of total concerns after physical trauma, and the presence of greater numbers of severe concerns predicts  worsening symptomatic course. Incorporation of posttraumatic concern assessments  has the potential to simultaneously strengthen the posttraumatic patient-provider relationship and to link patient-centered evaluation with individual and community-level PTSD and functional outcome evaluations.

Publication Types:      Randomized Controlled Trial     Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, P.H.S.

PMID: 17937531 [PubMed - indexed for MEDLINE]

 

Qual Life Res. 2007 Oct;16(8):1289-97. Epub 2007 Aug 1.

The relationship between quality of life and posttraumatic stress disorder or major depression for firefighters in Kaohsiung, Taiwan.

Chen YS, Chen MC, Chou FH, Sun FC, Chen PC, Tsai KY, Chao SS.

Department of Community Psychiatry, Kai-Suan Psychiatric Hospital, 130 Kai-Suan 2nd Rd, Kaohsiung, Taiwan.

OBJECTIVE: The work of firefighters involves the risk of exposure to the harmful  effects of toxic substances as well as the possibility of enormous emotional shock from disasters, which may result in psychiatric impairments and a lower quality of life. Therefore, we examined quality of life, prevalence of posttraumatic stress disorder (PTSD) and major depression, and the related risk factors for firefighters in Kaohsiung, Taiwan. METHODS: This is a two-stage survey study. During the first stage, we used the 36-item Short-Form Health Survey (SF-36) and the Disaster-Related Psychological Screening Test (DRPST) to assess quality of life, probable PTSD, probable major depression, and the related risk factors for 410 firefighters. During the second stage, psychiatrists categorized these probable cases according to self-reported questionnaires against DSM-IV into PTSD or major depression group, subclinical group, and health group. All the data were analyzed with SPSS 10.0 Chinese version. RESULTS: The estimated current prevalence rates for major depression and PTSD were 5.4% (22/410) and 10.5% (43/410), respectively. The firefighters with estimated PTSD or major depression scored significantly lower on quality of life measures than subclinical PTSD/major depression and mentally healthy groups, which was evident  in eight concepts and two domains of the SF-36. The major predictors of poor quality of life and PTSD/major depression were mental status, psychosocial stressors, or perceived physical condition. CONCLUSION: Firefighters have a higher estimated rate of PTSD, and the risk factors that affect quality of life and PTSD/major depression should encourage intervention from mental health professionals.

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

PMID: 17668289 [PubMed - indexed for MEDLINE]

 

Rev Bras Psiquiatr. 2007 Oct;29 Suppl 2:S61-5.

[Antipsychotics, anticonvulsants, antiadrenergics and other drugs: what to do when posttraumatic stress disorder does not respond to selective serotonin reuptake inhibitors?]

[Article in Portuguese]

Berger W, Portella CM, Fontenelle LF, Kinrys G, Mendlowicz MV.

Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. wberger@globo.com

OBJECTIVES: In this narrative review, we aimed to describe different pharmacological strategies for the treatment of patients with post-traumatic stress disorder who display different levels of intolerance, resistance, refractoriness, or who are unable to take to antidepressants, especially serotonin reuptake inhibitors. METHOD: We searched the ISI web of science and the PubMed for original studies focusing in the treatment of PTSD in different clinical scenarios. RESULTS: Preliminary evidence pointed towards the efficacy of drugs such as risperidone, olanzapine, lamotrigine and prazosin as strategies to  be employed in the above mentioned clinical scenarios. The choice of a specific "second line" drug should take into account not only symptoms, but also pattern of comorbidities, previous response to other treatments, pharmacological interactions, side-effects, and patient's physical conditions. CONCLUSIONS: Future randomized controlled trials should be performed in order to unveil which  drugs should be prescribed in the absence of adequate treatment and response to serotonin reuptake inhibitors.

Publication Types:      English Abstract

PMID: 18157435 [PubMed - in process]

 

Trauma Violence Abuse. 2007 Oct;8(4):384-400.

Trauma among female veterans: a critical review.

Zinzow HM, Grubaugh AL, Monnier J, Suffoletta-Maierle S, Frueh BC.

National Crime Victims Research and Treatment Center, Medical University of South Carolina, SC, USA.

This article reviews the literature documenting the nature and prevalence of traumatic experiences, trauma-related mental and physical health problems, and service use among female veterans. Existing research indicates that female veterans experience higher rates of trauma exposure in comparison to the general  population. Emerging data also suggest that female veterans may be as likely to be exposed to combat as male veterans, although not as directly or as frequently. Female veterans also report high rates of posttraumatic stress disorder, which has been associated with poor psychiatric and physical functioning. Although sexual assault history has been related to increased medical service use, further research is needed to understand relationships between trauma history and patterns of medical and mental health service use. Researchers also are encouraged to employ standardized definitions of trauma and to investigate new areas, such as treatment outcomes and mediators of trauma and health. Policy and  practice implications are discussed.

Publication Types:      Review

PMID: 17846179 [PubMed - indexed for MEDLINE]

 

J Pediatr Psychol. 2007 Sep 21 [Epub ahead of print]

Brief Report: Quality of Life Is Impaired in Pediatric Burn Survivors with Posttraumatic Stress Disorder.

Landolt MA, Buehlmann C, Maag T, Schiestl C.

Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Switzerland, Department of Social and Health Psychology, Institute of Psychology, University of Zurich, Switzerland, and Pediatric Burn Center, Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Switzerland.

OBJECTIVE: This study assessed health-related quality of life (HRQOL) and posttraumatic stress disorder (PTSD) in pediatric burn survivors and examined associations between PTSD and HRQOL. METHODS: Forty-three burn survivors, ages 7-16 years, were interviewed at an average of 4.4 years after their accident using the Clinician-Administered PTSD Scale for Children and Adolescents and the  TNO-AZL Child Quality of Life Questionnaire. RESULTS: Eight children (18.6%) met  DSM-IV criteria for current PTSD. While most dimensions of HRQOL were within normal limits, social functioning was impaired. Severity of PTSD was significantly associated with physical, cognitive, and emotional dimensions of HRQOL. Children with PTSD reported an impaired overall HRQOL and limited physical (e.g., more bodily complaints) and emotional functioning (e.g., more feelings of  sadness). CONCLUSIONS: This study provides tentative evidence for a considerably  high prevalence of PTSD in pediatric burn survivors and for a negative association between PTSD and HRQOL.

PMID: 17890286 [PubMed - as supplied by publisher]

 

J Psychiatr Res. 2007 Sep 18 [Epub ahead of print]

A combined dexamethasone/corticotropin-releasing hormone test in patients with chronic PTSD - First preliminary results.

Muhtz C, Wester M, Yassouridis A, Wiedemann K, Kellner M.

Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.

BACKGROUND: Reports about alterations of hypothalamic-pituitary-adrenocortical (HPA) function in patients with chronic posttraumatic stress disorder (PTSD) are  inconsistent and controversial. More refined laboratory tests and subgrouping of  PTSD patients might help to decrease variance of findings. METHODS: 14 subjects with chronic PTSD and 14 healthy controls were examined between 13:00 and 17:00 using a modified combined dexamethasone/CRH test (0.5mg dexamethasone at 23:00, 100mug CRH at 15:00). Plasma adenocorticotropic hormone (ACTH), cortisol and blood pressure were measured every 15min from 14:45 until 17:00. RESULTS: No significant differences between patients and controls were found in the analyses  of ACTH and cortisol levels, but a significantly elevated systolic and diastolic  blood pressure in PTSD. Severity of depressive symptoms had no influence. However, explorative analyses showed that patients with a history of childhood traumatization had significantly higher post-dexamethasone-ACTH levels and a significantly lower diastolic blood pressure in comparison to patients without early trauma. CONCLUSIONS: In this first pilot study in a typical clinical sample of patients with chronic PTSD we found effects of severe adverse events in childhood on HPA axis regulation. Maybe, childhood traumatization could influence HPA axis findings in PTSD. Further research is needed, especially dose-response studies with different doses of dexamethasone in dexamethasone/CRH tests in PTSD.

PMID: 17884095 [PubMed - as supplied by publisher]

 

Acta Oncol. 2007 Sep 12;:1-8 [Epub ahead of print]

Parent distress in childhood cancer: A comparative evaluation of posttraumatic stress symptoms, depression and anxiety.

Norberg AL, Boman KK.

Department of Woman and Child Health, Childhood Cancer Research Unit, Karolinska  Institutet, Stockholm, Sweden.

The aim was to assess symptoms consistent with posttraumatic stress (PTS; cognitive intrusions, avoidance, arousal) related to the child's illness, and generic distress (anxiety, depression) in parents of childhood cancer patients. Outcomes were compared to normative and relevant reference data, and analysed for their dependence on time passed since diagnosis. Swedish parents (266 mothers, 208 fathers) were recruited at two centres. Data from a clinical sample of posttraumatic stress disorder (PTSD) patients and parents of healthy children were used for comparison. The Impact of Events Scale (IES-R) was used for assessing PTS symptoms, and self-report scales for anxiety and depression. Elevated stress and generic distress varied as a function of time from diagnosis. Up to 12% of parents for whom>5 years had passed since diagnosis still reported equally, or more intrusive thoughts, avoidance and arousal when contrasted to patients suffering from PTSD. Parents of recently diagnosed children had more cancer-related intrusive thoughts than those of long-term survivors. Heightened anxiety and depression was most prominent in mothers and fathers up to 2.5 years  after diagnosis. In conclusion, severe generic distress characterises the first years after diagnosis, and initially common PTS symptoms are found in a considerable portion of parents years after diagnosis. Clinically, attention should be paid to continuous parent support needs. Individual variation vis-ŕ-vis distress vulnerability should be acknowledged, and presupposed gender differences avoided. When treatment situation asks the most of parents' collaboration, many are under pressure of severe stress.

PMID: 17851875 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2007 Sep 12 [Epub ahead of print]

Prazosin Effects on Objective Sleep Measures and Clinical Symptoms in Civilian Trauma Posttraumatic Stress Disorder: A Placebo-Controlled Study.

Taylor FB, Martin P, Thompson C, Williams J, Mellman TA, Gross C, Peskind ER, Raskind MA.

Northwest Network VISN 20 Mental Illness Research, Education and Clinical Center, Seattle, Washington, USA; Rainier Associates Tacoma; Department of Psychiatry and Behavioral Sciences University of Washington, Seattle, Washington.

BACKGROUND: Prazosin, a central nervous system (CNS) active alpha-1 adrenoreceptor antagonist, has reduced nightmares and sleep disturbance in placebo-controlled studies of combat-related posttraumatic stress disorder (PTSD). We evaluated objective sleep parameters and PTSD symptoms in a placebo-controlled prazosin trial for civilian trauma-related PTSD. METHODS: Thirteen outpatients with chronic civilian trauma PTSD, frequent nightmares, and  sleep disturbance participated in a randomized placebo-controlled crossover trial of prazosin. Sleep parameters were quantified at home with the REMView (Respironics, Pittsburgh, Pennsylvania). The PTSD symptoms were quantified with the Clinician Administered PTSD Scale (CAPS) "recurrent distressing dreams" and "disturbed sleep" items, a non-nightmare distressed awakenings scale, the PTSD Dream Rating Scale (PDRS), the PTSD Checklist-Civilian (PCL-C), and the Clinical  Global Impression of Improvement (CGI-I). RESULTS: Prazosin compared with placebo significantly increased total sleep time by 94 min; increased rapid eye movement  (REM) sleep time and mean REM period duration without altering sleep onset latency; significantly reduced trauma-related nightmares, distressed awakenings,  and total PCL scores; significantly improved CGI-I scores; and changed PDRS scores toward normal dreaming. CONCLUSIONS: Prazosin reductions of nighttime PTSD symptoms in civilian trauma PTSD are accompanied by increased total sleep time, REM sleep time, and mean REM period duration in the absence of a sedative-like effect on sleep onset latency.

PMID: 17868655 [PubMed - as supplied by publisher]

 

Psychooncology. 2007 Sep 11 [Epub ahead of print]

Posttraumatic stress disorder among parents of children on cancer treatment: a longitudinal study.

Pöder U, Ljungman G, von Essen L.

Department of Public Health and Caring Sciences, Psychosocial Oncology, Uppsala University, Uppsala, Sweden.

The main aim of this study was to investigate the occurrence of cancer-related posttraumatic stress disorder (PTSD) among parents of children on cancer treatment. A longitudinal design with assessments at one week (T1), two (T2), and four (T3) months after the child's diagnosis was used. Two hundred and fourteen parents (107 mothers, 107 fathers) participated at T1-T3. The PTSD Checklist Civilian (PCL-C), a self-report screening instrument for PTSD, was answered by parents over the telephone. According to the PCL-C symptom criteria method 33%, more mothers than fathers, score as potential cases of acute stress disorder (ASD) at T1, whereas 28% as potential cases of PTSD at T2 and 22% at T3. The levels of acute- and posttraumatic stress symptoms show a linear, descending pattern, and mothers report higher levels than fathers. Half of the parents who score as potential cases of ASD a week after the child's diagnosis score as potential cases of PTSD four months later. The findings illustrate that a group of parents of children with cancer experience serious psychological distress related to their child's disease. A traumatic stress perspective on childhood cancer should be applied to paediatric oncology care and appropriate psychosocial interventions should be offered to parents when needed. Copyright (c) 2007 John Wiley & Sons, Ltd.

PMID: 17847123 [PubMed - as supplied by publisher]

 

J Pediatr Psychol. 2007 Sep 10 [Epub ahead of print]

Brief Report: Children's Responses to Trauma- and Nontrauma-related Hospital Admission: A Comparison Study.

Murray BL, Kenardy JA, Spence SH.

Centre of National Research on Disability and Rehabilitation Medicine, School of  Psychology, University of Queensland, and Division of Linguistics and Psychology, Macquarie University, Australia.

OBJECTIVE: This study aims to investigate and compare psychological responses in  children and parents 1 month after trauma- and nontrauma-related hospital admission. METHODS: Two hundred and five children aged 7-16 years (and their parents) were assessed for posttraumatic stress disorder (PTSD), other psychopathology, and distress 1 month after trauma-related (Trauma Group; n = 101) and nontrauma-related hospital admission (Non-Trauma Group; n = 104). RESULTS: Clinically elevated PTSD symptom levels were more prevalent in children  admitted for trauma-related (18%) than nontrauma-related reasons (4%). Parents also experienced posttraumatic distress, although rates of clinically elevated symptom levels did not differ between the Trauma (11%) and Non-Trauma (8%) groups. Other pathology and distress in children and parents were comparable across groups. CONCLUSIONS: Children experienced greater posttraumatic distress following trauma-related hospital admission, while parents' experience of their child's hospitalization is equally distressing regardless of the reason for admission.

PMID: 17846041 [PubMed - as supplied by publisher]

 

Psychother Psychosom Med Psychol. 2007 Sep 10 [Epub ahead of print]

[Assessment of Complex PTSD - Internal and External Validity of a Diagnostic Interview.]

[Article in German]

Boroske-Leiner K, Hofmann A, Sack M.

Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie.

BACKGROUND The diagnostic construct of complex posttraumatic stress disorder (complex PTSD) describes the consequences of early onset and long-term persisting psychological traumatizations. The interview for complex PTSD (I-kPTBS) - is the  German adaptation of the structured interview for disorders of extreme stress (SIDES). The present study reports first data regarding the internal validity of  the I-kPTBS as well as on the external validity of the diagnosis of complex PTSD. METHOD The I-kPTBS was applied in 72 consecutive patients of a specialized outpatient clinic. 31 patients fulfilled the criteria of the diagnosis complex PTSD. 25 suffered from a PTSD but did not fulfil the diagnostic criteria of complex PTSD. Both groups where compared regarding their symptoms, resources and  reports of childhood events. RESULTS Internal consistence of the I-kPTBS regarding the sample was good to excellent (alpha = 0.88). As expected, patients  with the diagnosis of complex PTSD showed more severe dissociative, depressive and general anxiety symptoms than patients with PTSD alone. Patients fulfilling the criteria of complex PTSD reported a lower age at their first traumatic event, more multiple traumatizations and more often a dissociative disorder as comorbid  diagnosis. Patients with complex PTSD show a higher traumaload in childhood and a lower level of compensatory resources. DISCUSSION The interview for complex PTSD  (I-kPTBS) describes a consistent diagnostic construct. The results demonstrate that the diagnosis of complex PTSD selects a specific group of patients with early childhood trauma and high symptom level. Specific criteria can differentiate this patient group well from patients that suffer from PTSD alone.

PMID: 17828686 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2007 Sep 6 [Epub ahead of print]

Evidence for Acquired Pregenual Anterior Cingulate Gray Matter Loss from a Twin Study of Combat-Related Posttraumatic Stress Disorder.

Kasai K, Yamasue H, Gilbertson MW, Shenton ME, Rauch SL, Pitman RK.

Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo,  Tokyo, Japan.

BACKGROUND: Controversy exists over the nature and origin of reduced regional brain volumes in posttraumatic stress disorder (PTSD). At issue is whether these  reductions represent preexisting vulnerability factors for developing PTSD upon traumatic exposure or acquired PTSD signs due to the traumatic stress that caused the PTSD or the chronic stress of having the disorder (or both). We employed a case-control design in monozygotic twin pairs discordant for combat exposure to address the preexisting versus acquired origin of brain morphometric abnormalities in PTSD. METHODS: We used voxel-based morphometry to search for gray matter density reductions in magnetic resonance imaging (MRI) data obtained  in a previous study of combat-exposed Vietnam veteran twins with (n = 18) versus  without (n = 23) PTSD and their "high-risk" versus "low-risk" (respectively) identical combat-unexposed cotwins. RESULTS: Compared with the combat-exposed twins without PTSD, the combat-exposed twins with PTSD showed significant gray matter density reductions in four predicted brain regions: right hippocampus, pregenual anterior cingulate cortex (ACC), and left and right insulae. There was  a significant PTSD Diagnosis x Combat Exposure interaction in pregenual ACC in which combat-exposed PTSD twins had lower gray matter density than their own combat-unexposed cotwins as well as than the combat-exposed twins without PTSD and their cotwins. CONCLUSIONS: The results point to gray matter volume diminutions in limbic and paralimbic structures in PTSD. The pattern of results obtained for pregenual ACC suggests that gray matter reduction in this region represents an acquired sign of PTSD consistent with stress-induced loss.

PMID: 17825801 [PubMed - as supplied by publisher]

 

Confl Health. 2007 Sep 6;1:10.

Screening for Posttraumatic Stress Disorder among Somali ex-combatants: A validation study.

Odenwald M, Lingenfelder B, Schauer M, Neuner F, Rockstroh B, Hinkel H, Elbert T.

University of Konstanz, Department of Psychology, Fach D25, 78457 Konstanz, Germany. michael.odenwald@uni-konstanz.de.

ABSTRACT: BACKGROUND: In Somalia, a large number of active and former combatants  are affected by psychological problems such as Posttraumatic Stress Disorder (PTSD). This disorder impairs their ability to re-integrate into civilian life. However, many screening instruments for Posttraumatic Stress Disorder used in post-conflict settings have limited validity. Here we report on development and validation of a screening tool for PTSD in Somali language with a sample of ex-combatants. METHODS: We adapted the Posttraumatic Diagnostic Scale (PDS) to reflect linguistic and cultural differences within the Somali community so that local interviewers could be trained to administer the scale. For validation purposes, a randomly selected group of 135 Somali ex-combatants was screened by trained local interviewers; 64 of them were then re-assessed by trained clinical  psychologists using the Composite International Diagnostic Interview (CIDI) and the Self-Report Questionnaire (SRQ-20). RESULTS: The screening instrument showed  good internal consistency (Cronbach's alpha = .86), convergent validity with the  CIDI (sensitivity = .90; specificity = .90) as well as concurrent validity: positive cases showed higher SRQ-20 scores, higher prevalence of psychotic symptoms, and higher levels of intake of the local stimulant drug khat. Compared  to a single cut-off score, the multi-criteria scoring, in keeping with the DSM-IV, produced more diagnostic specificity. CONCLUSION: The results provide evidence that our screening instrument is a reliable and valid method to detect PTSD among Somali ex-combatants. A future Disarmament, Demobilization and Reintegration Program in Somalia is recommended to screen for PTSD in order to identify ex-combatants with special psycho-social needs.

PMID: 17822562 [PubMed - in process]

 

Am J Psychiatry. 2007 Sep;164(9):1385-94.

Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers.

Perrin MA, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R.

Cognitive Neurophysiology Laboratory, Nathan S. Kline Institute for Psychiatric Research, Bldg. 35, 140 Old Orangeburg Rd., Orangeburg, NY 10962, USA. mperrin@nki.rfmh.org

OBJECTIVE: This study compared the prevalence and risk factors of current probable posttraumatic stress disorder (PTSD) across different occupations involved in rescue/recovery work at the World Trade Center site. METHOD: Rescue and recovery workers enrolled in the World Trade Center Health Registry who reported working at the World Trade Center site (N=28,962) were included in the analysis. Interviews conducted 2-3 years after the disaster included assessments  of demographic characteristics, within-disaster and work experiences related to the World Trade Center, and current probable PTSD. RESULTS: The overall prevalence of PTSD among rescue/recovery workers was 12.4%, ranging from 6.2% for police to 21.2% for unaffiliated volunteers. After adjustments, the greatest risk of developing PTSD was seen among construction/engineering workers, sanitation workers, and unaffiliated volunteers. Earlier start date and longer duration of time worked at the World Trade Center site were significant risk factors for current probable PTSD for all occupations except police, and the association between duration of time worked and current probable PTSD was strongest for those who started earlier. The prevalence of PTSD was significantly higher among those  who performed tasks not common for their occupation. CONCLUSIONS: Workers and volunteers in occupations least likely to have had prior disaster training or experience were at greatest risk of PTSD. Disaster preparedness training and shift rotations to enable shorter duration of service at the site may reduce PTSD among workers and volunteers in future disasters.

PMID: 17728424 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Sep;164(9):1319-26.

Delayed-onset posttraumatic stress disorder: a systematic review of the evidence.

Andrews B, Brewin CR, Philpott R, Stewart L.

Department of Psychology, Royal Holloway University of London, Egham, Surrey TW20 OEX, UK. b.andrews@rhul.ac.uk

OBJECTIVE: Since the diagnosis of delayed-onset posttraumatic stress disorder (PTSD) was introduced in DSM-III, there has been controversy over its prevalence  and even its existence. The authors sought to resolve discrepant findings concerning the prevalence of delayed-onset PTSD by conducting a systematic review of the evidence. METHOD: A literature search was conducted for case reports and group studies with adequate measurement of delayed-onset PTSD according to DSM criteria. Studies that met inclusion criteria were examined for the defined length of delay for delayed-onset PTSD, presence of symptoms before full diagnostic criteria were met, length of follow-up, prevalence estimates, and other variables. Studies were also examined for differences between immediate-onset PTSD, delayed-onset PTSD, and no-PTSD cases. RESULTS: Ten case studies and 19 group studies met criteria for inclusion in the review. Studies consistently showed that delayed-onset PTSD in the absence of any prior symptoms  was rare, whereas delayed onsets that represented exacerbations or reactivations  of prior symptoms accounted on average for 38.2% and 15.3%, respectively, of military and civilian cases of PTSD. CONCLUSIONS: The discrepant findings in the  literature concerning prevalence can be largely, but not completely, explained as being due to definitional issues. Little is known about what distinguishes the delayed-onset and immediate-onset forms of the disorder. Continuing scientific study of delayed-onset PTSD would benefit if future editions of DSM were to adopt a definition that explicitly accepts the likelihood of at least some prior symptoms.

Publication Types:      Case Reports     Review

PMID: 17728415 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 Sep;64(9):1040-8.

Parental posttraumatic stress disorder as a vulnerability factor for low cortisol trait in offspring of holocaust survivors.

Yehuda R, Teicher MH, Seckl JR, Grossman RA, Morris A, Bierer LM.

Traumatic Stress Studies Program, Department of Psychiatry, Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA. rachel.yehuda@va.gov

CONTEXT: Lower cortisol levels in posttraumatic stress disorder (PTSD) may reflect a preexisting vulnerability associated with developing the disorder after trauma exposure. Because offspring of trauma survivors with PTSD have a greater prevalence of PTSD after their own life events than offspring of trauma survivors without PTSD and offspring of nonexposed persons, examination of patterns of basal cortisol secretion in such offspring provides an opportunity to test this hypothesis. OBJECTIVE: To characterize the patterns of basal cortisol secretion in offspring of Holocaust survivors with and without parental PTSD and children of nonexposed parents. DESIGN: Cortisol secretion was measured every 30 minutes for 24 hours. The raw hormonal data were subjected to a chronobiological analysis by applying single-oscillator and multioscillator cosinor analyses, a nonlinear least squares curve-fitting program, to determine circadian and ultradian regulatory dynamics. SETTING: The study was conducted under controlled conditions at the General Clinical Research Center at the Mount Sinai School of Medicine. PARTICIPANTS: Twenty-three Holocaust offspring with parental PTSD and 10 without  parental PTSD were compared with 16 children of nonexposed parents. No participant had PTSD. MAIN OUTCOME MEASURES: Mean cortisol levels during the 24-hour cycle and other chronobiological parameters (amplitude, acrophase, circadian quotient, and goodness-of-fit coefficient) derived from single-oscillator and multioscillator models. RESULTS: Offspring with parental PTSD displayed lower mean cortisol levels, reflected by the circadian mesor and reduced cortisol amplitude, compared with offspring without parental PTSD and children of nonexposed parents. This effect seemed to be specifically related to  the presence of maternal PTSD. CONCLUSIONS: Low cortisol levels and other chronobiological alterations in offspring are associated with the risk factor of  maternal PTSD, raising the possibility that these alterations are acquired via glucocorticoid programming either from in utero exposures or in response to maternal behaviors early in life.

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

PMID: 17768269 [PubMed - indexed for MEDLINE]

 

Assessment. 2007 Sep;14(3):223-30.

Validation of a Tibetan translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire.

Lhewa D, Banu S, Rosenfeld B, Keller A.

Boston University, Boston, MA, USA.

This study sought to translate and validate the Hopkins Symptom Checklist-25 (HSCL) and the Harvard Trauma Questionnaire (HTQ) in a Tibetan population. Translated questionnaires were administered to 57 Tibetan survivors of torture/human rights abuses living in the United States and receiving services in a torture treatment program. Participants were evaluated to determine if they met criteria for major depressive episode, generalized anxiety disorder, or posttraumatic stress disorder (PTSD). Coefficient alpha for the HSCL Anxiety subscale (.89), Depression subscale (.92), and the HTQ (.89) were high. Diagnostic accuracy using receiver operating characteristic curve analysis generated good classification accuracy for anxiety (.89), depression (.92), and PTSD (.83). However, although sensitivity and specificity for HSCL subscales were quite high, the HTQ generated low sensitivity (.33), partly because of a low rate of PTSD. Results support the reliability and validity of the HSCL but suggest further study of the HTQ with this population is required.

Publication Types:      Validation Studies

PMID: 17690379 [PubMed - indexed for MEDLINE]

 

Attach Hum Dev. 2007 Sep;9(3):187-205.

Caregiver traumatization adversely impacts young children's mental representations on the MacArthur Story Stem Battery.

Schechter DS, Zygmunt A, Coates SW, Davies M, Trabka K, McCaw J, Kolodji A, Robinson J.

Columbia University, USA.

The aim of our study was to investigate the impact of maternal exposure to family violence, maltreatment, and related posttraumatic stress disorder (PTSD) on young children's mental representations of self and caregivers. Participant mothers (n=24) and children (n=25) were recruited from a referred sample when they were 4-7 years old. Maternal report and child story stem narratives were used. Mother's experience of domestic violence and severity of violence-related PTSD symptoms robustly predicted more dysregulated aggression, attentional bias to danger and distress, as well as more avoidance of and withdrawal from conflicts presented in the children's story stems. Less narrative coherence was also noted. Traumatized mothers experience and symptoms prior to their child's turning 4 years old adversely affected their child's mental representations from 4-7 years.

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

PMID: 18007959 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Sep;45(9):2019-33. Epub 2007 Mar 12.

Fear conditioning in posttraumatic stress disorder: evidence for delayed extinction of autonomic, experiential, and behavioural responses.

Blechert J, Michael T, Vriends N, Margraf J, Wilhelm FH.

Department of Clinical Psychology and Psychotherapy, Institute for Psychology, University of Basel, Missionsstrasse 60/62, CH-4055 Basel, Switzerland. jens.blechert@unibas.ch

Aversive conditioning has been proposed as an important factor involved in the etiology of posttraumatic stress disorder (PTSD). However, it is not yet fully understood exactly which learning mechanisms are characteristic for PTSD. PTSD patients (n=36), and healthy individuals with and without trauma exposure (TE group, n=21; nTE group, n=34), underwent a differential fear conditioning experiment consisting of habituation, acquisition, and extinction phases. An electrical stimulus served as the unconditioned stimulus (US), and two neutral pictures as conditioned stimuli (CS+, paired; CS-, unpaired). Conditioned responses were quantified by skin conductance responses (SCRs), subjective ratings of CS valence and US-expectancy, and a behavioural test. In contrast to the nTE group, PTSD patients showed delayed extinction of SCRs to the CS+. Online ratings of valence and US-expectancy as well as the behavioural test confirmed this pattern. These findings point to a deficit in extinction learning and highlight the role of affective valence appraisals and cognitive biases in PTSD.  In addition, there was some evidence that a subgroup of PTSD patients had difficulties in learning the CS-US contingency, thereby providing preliminary evidence of reduced discrimination learning.

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

PMID: 17442266 [PubMed - in process]

 

Behav Res Ther. 2007 Sep;45(9):2212-20. Epub 2007 Jan 5.

Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression.

Bichescu D, Neuner F, Schauer M, Elbert T.

Department of Psychology, University of Konstanz, Fach D-25, 78457 Konstanz, Germany. Dana-Maria.Bichescu@uni-konstanz.de

The psychological consequences of traumatic stress may last even into old age. In persons in their 60s and 70s who had been victims of political detention and torture four decades ago, we compared the outcome of narrative exposure therapy (NET) to that of psychoeducation (PED) only. From a group of 59 former political  detainees, 18 who fulfilled the full PTSD criteria according to the Composite International Diagnostic Interview (CIDI) were offered and accepted participation in the treatment study. The participants were randomly assigned to either one session of PED (n=9) or five sessions of NET (n=9). Symptoms of PTSD (CIDI) and depression (Beck Depression Inventory, BDI) were assessed prior to treatment and  after a 6-month follow-up. NET but not PED produced a significant reduction in post-traumatic symptoms and depression scores. Four out of 9 of those who completed NET, compared to 8/9 of those within the PED group, still had PTSD 6 months after the treatment had ended. These results indicate that NET may lead to the alleviation of post-traumatic and depression symptoms even when the conditions persist for excessive time periods.

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

PMID: 17288990 [PubMed - in process]

 

Behav Ther. 2007 Sep;38(3):303-13. Epub 2007 May 17.

A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms.

Tull MT, Barrett HM, McMillan ES, Roemer L.

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

This study examined the relationship between posttraumatic stress (PTS) symptoms  and particular aspects of emotion regulation difficulties among trauma-exposed individuals. Participants were an ethnically diverse sample of 108 undergraduates from an urban university. PTS symptom severity was found to be associated with lack of emotional acceptance, difficulty engaging in goal-directed behavior when  upset, impulse-control difficulties, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall difficulties in emotion regulation were associated with PTS symptom severity, controlling for negative affect. Finally, individuals exhibiting PTS symptoms indicative of a PTSD diagnosis reported greater difficulties with emotion regulation than those reporting PTS symptoms at a subthreshold level. The implications of these findings for research and treatment are discussed.

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

PMID: 17697854 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2007 Sep 1;62(5):513-20. Epub 2007 May 23.

Configural cue performance in identical twins discordant for posttraumatic stress disorder: theoretical implications for the role of hippocampal function.

Gilbertson MW, Williston SK, Paulus LA, Lasko NB, Gurvits TV, Shenton ME, Pitman  RK, Orr SP.

Manchester VA Medical Center, Manchester, New Hampshire 03104, USA. mark.gilbertson@med.va.gov

BACKGROUND: A significant subgroup of individuals with posttraumatic stress disorder (PTSD) exhibits chronic, unremitting symptomatology that has also been associated with smaller hippocampal volume. The hippocampus plays a significant role in configural processing of contextual cues that facilitates context-appropriate extinction of conditioned fear. We test the hypothesis that hippocampus-based configural processing deficits are a pre-existing vulnerability factor for unremitting forms of PTSD. METHODS: Participants included male monozygotic twin pairs who were discordant for combat trauma. In 18 twin pairs the combat-exposed brother developed unremitting PTSD, whereas in 23 pairs the combat-exposed brother never developed PTSD. Participants were compared in the capacity to solve allocentric spatial processing tasks, and this performance was  examined for its relationship to the severity of PTSD symptomatology and hippocampal volume. RESULTS: Although not completely differentiated from overall  IQ, PTSD combat veterans demonstrated significantly impaired performance in configural processing relative to non-PTSD combat veterans. Despite having neither combat-exposure nor PTSD, the unexposed co-twins of combat veterans with  PTSD displayed the same decrements as their brothers. Deficits were significantly related to PTSD severity and hippocampal volume. CONCLUSIONS: The current study provides the first evidence that the relevance of the hippocampus in PTSD might be related to pre-existing configural cue processing deficits that predispose individuals to develop unremitting forms of the disorder.

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

PMID: 17509537 [PubMed - indexed for MEDLINE]

 

Birth. 2007 Sep;34(3):253-63.

Thoughts and emotions during traumatic birth: a qualitative study.

Ayers S.

Psychology Department, University of Sussex, Brighton, Sussex, United Kingdom.

BACKGROUND: Previous research shows that 1 to 6 percent of women will develop symptoms of posttraumatic stress disorder after childbirth. The objective of this study was to examine thoughts and emotions during birth, cognitive processing after birth, and memories of birth that might be important in the development of  postnatal posttraumatic stress symptoms. METHODS: In a qualitative study, women with posttraumatic stress symptoms (n= 25) and without (n = 25) were matched for  obstetric events to examine the nonmedical aspects of birth that made it traumatic. Women were interviewed 3 months after birth. RESULTS: The following themes emerged for all women: thoughts during birth included mental coping strategies, wanting labor to end, poor understanding of what was going on, and mental defeat. More negative than positive emotions were described during birth,  primarily feeling scared, frightened, and upset. Postnatal cognitive processing included retrospective appraisal of birth, such as taking a fatalistic view and focusing on the present, for example, concentrating on the baby. Memories of birth included not remembering parts of the birth and forgetting how bad it was.  Women with posttraumatic stress symptoms reported more panic, anger, thoughts of  death, mental defeat, and dissociation during birth; after birth, they reported fewer strategies that focused on the present, more painful memories, intrusive memories, and rumination, than women without symptoms. CONCLUSIONS: The results provide a useful first step toward identifying aspects of birth and postnatal processing that might determine whether women develop postnatal posttraumatic stress symptoms. Further research is needed to broaden knowledge of posttraumatic stress disorder before drawing definite conclusions.

PMID: 17718876 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2007 Sep;12(9):690-5.

Prolonged exposure therapy for chronic combat-related PTSD: a case report of five veterans.

Nacasch N, Foa EB, Fostick L, Polliack M, Dinstein Y, Tzur D, Levy P, Zohar J.

Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Prolonged exposure (PE) therapy has been found efficient in reducing posttraumatic stress disorder (PTSD) symptoms mostly among rape victims, but has  not been explored in combat-related PTSD. Five patients with severe chronic PTSD, unresponsive to previous treatment (medication and supportive therapy) are described. Patients were evaluated with the PTSD Symptom Scale-Interview, and Beck Depression Inventory, before and after 10-15 sessions of PE therapy. All five patients showed marked improvement with PE, with a mean decrease of 48% in PTSD Symptom Scale-Interview score and 69% in Beck Depression Inventory score. Moreover, four patients maintained treatment gains or kept improving 6-18 months  after the treatment. The results suggest that PE was effective in reducing combat-related chronic PTSD symptoms.

Publication Types:      Case Reports

PMID: 17805215 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2007 Sep;12(9):675-80.

Findings with 0.25 mg dexamethasone suppression test in eating disorders: association with childhood trauma.

Díaz-Marsá M, Carrasco JL, Basurte E, Pastrana JI, Sáiz-Ruiz J, López-Ibor JJ.

Department of Psychiatry, Hospital Clínico San Carlos, Madrid, Spain. mdiazm.hcsc@salud.madrid.org

INTRODUCTION: While both blunted and enhanced cortisol suppression following a dexamethasone suppression test (DST) are described in eating disorders, some evidence suggests that enhanced cortisol suppression might be associated with the presence of trauma history. The objective of this study is to investigate hypothalamic-pituitary-adrenal axis response to a modified DST in eating disorders and its relationship with childhood trauma. METHODS: Fifty-two patients with eating disorders were studied with a 0.25 mg DST and with measures of childhood trauma. CONCLUSION: Patients with bulimia symptoms had significantly greater cortisol suppression than controls and restrictive anorexia patients (F=8.2, P<.05). Cortisol suppression was significantly correlated with intensity  of childhood traumatic events (F=0.32, P<.05). Hypersensitive hypothalamic-pituitary-adrenal axis response to DST in eating disorders may be related with a history of childhood trauma and suggests some biological similarities with posttraumatic syndromes that should be further explored.

PMID: 17805213 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2007 Sep-Oct;48(5):395-9. Epub 2007 Jul 5.

The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief.

Simon NM, Shear KM, Thompson EH, Zalta AK, Perlman C, Reynolds CF, Frank E, Melhem NM, Silowash R.

Massachusetts General Hospital and Harvard Medical School, MA, USA. nsimon@partners.org

BACKGROUND: Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists.  METHODS: Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were  used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could  be explained by grief. RESULTS: Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment. LIMITATIONS: It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into  consideration. CONCLUSIONS: Our data provide further support for the need to identify CG as a psychiatric disorder.

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

PMID: 17707245 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2007 Sep;20(5):491-6.

Torture.

Wenzel T.

Medical University of Vienna, Vienna, Austria. drthomaswenzel@web.de

PURPOSE OF REVIEW: Torture has become a key theme in healthcare and a rising number of publications, especially over the last years, confirm its relevance also in regard to mental health. RECENT FINDINGS: Torture survivors appear to be  a frequent but also underdetected group in clinical and general populations. Exposure to further stressful and traumatic events is common. Sequelae include posttraumatic stress disorder, chronic pain, depressive disorders, and more, but  so far insufficiently explored and partly culture-based, reactive symptoms. Symptoms are frequently chronic and can be hard to treat even in cost-intensive treatment settings. Medical ethics are challenged in several situations, including documentation, in speaking up against and reporting of torture, and in  the refusal to participate in or condone any form of torture. SUMMARY: Torture prevention and interdisciplinary rehabilitation of survivors must receive more attention, and healthcare professionals have an obligation to take a substantial  role in this effort.

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

PMID: 17762594 [PubMed - indexed for MEDLINE]

 

Dig Dis Sci. 2007 Sep;52(9):2452-9. Epub 2007 Apr 7.

Posttraumatic growth, immunity and survival in patients with hepatoma.

Dunigan JT, Carr BI, Steel JL.

Department of Medicine, Division of Rheumatology and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

This study was designed to assess the relationship between posttraumatic growth (PTG), immunity, and survival in patients with biopsy-proven hepatocellular carcinoma (HCC). Forty-one patients with HCC were administered the Posttraumatic  Growth Inventory. Total and differential peripheral blood leukocytes (PBL) counts were measured at baseline, 3-, and 6-month follow-up. Survival also was measured  from the data of diagnosis to death. Participants who scored above the median for the PTGI total scale score (423 days) survived 186 days longer than participants  who scored below the median PTGI total score (237 days). Patients with PTG scores above the median had higher PBL counts. The results of this study suggest that patients with greater PTG scores recover more rapidly from chemotherapy in regards to their white blood cell counts. Further research is warranted regarding the possible immune mediation between PTG and survival.

PMID: 17417728 [PubMed - indexed for MEDLINE]

 

Int J Soc Psychiatry. 2007 Sep;53(5):447-63.

The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees.

Shoeb M, Weinstein H, Mollica R.

University of California, San Francisco School of Medicine, 94143, USA. marwa.shoeb@ucsf.edu

BACKGROUND: Mental health assessments in post-conflict zones have relied heavily  on Western psychiatric scales. Yet, a strict dependence on the paradigms of Western psychiatry risks inappropriately prioritizing syndromes, such as PTSD, which, however important, are eclipsed by local concerns. MATERIAL AND DISCUSSION: In Dearborn, Michigan, home to the largest population of Iraqi refugees in the United States, 60 Iraqi refugee life stories were collected in order to adapt the Harvard Trauma Questionnaire (HTQ) to the Iraqi context. CONCLUSION: The methodology described proved to be a useful approach to developing a trauma measure that is culturally grounded in a multi-dimensional model of mental health.

PMID: 18018666 [PubMed - in process]

 

J Affect Disord. 2007 Sep;102(1-3):137-43. Epub 2007 Feb 8.

Effects of posttraumatic stress disorder on pregnancy outcomes.

Rogal SS, Poschman K, Belanger K, Howell HB, Smith MV, Medina J, Yonkers KA.

Yale University Department of Psychiatry, USA.

BACKGROUND: The purpose of this study was to determine the association between posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, and the risk of delivering a low birth weight (<2500 g) or preterm (<37 weeks gestational age) infant. METHODS: Pregnant women were recruited from obstetrics clinics and screened for major and minor depressive disorder, panic disorder, PTSD, and substance use. Current episodes of PTSD were diagnosed according to the MINI International Neuropsychiatric Interview, and pregnancy outcomes were abstracted from hospital records. RESULTS: Among the 1100 women included in analysis, 31 (3%) were in episode for PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorder, and prior preterm delivery were significantly associated with a diagnosis of PTSD. Preterm delivery was non-significantly higher in pregnant women with (16.1%) compared to those without (7.0%) PTSD (OR=2.82, 95% C.I. 0.95, 8.38). Low birth weight (LBW) was present in 6.5% of women and was not significantly associated with a diagnosis of PTSD in pregnancy after adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder (OR=1.82, 95% C.I. 1.01,  3.29). LIMITATIONS: There was a low prevalence of PTSD in this cohort, resulting  in limited power. CONCLUSIONS: These data suggest a possible association between  PTSD and preterm delivery. Coupled with the association found between LBW and a depressive disorder, these results support the utility of screening for mental health disorders in pregnancy.

PMID: 17291588 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2007 Sep;63(9):843-50.

Stability of the dexamethasone suppression test in borderline personality disorder with and without comorbid PTSD: a one-year follow-up study.

Wingenfeld K, Lange W, Wulff H, Berea C, Beblo T, Saavedra AS, Mensebach C, Driessen M.

Department of Psychiatry and Psychotherapy Bether, Ev. Hospital Bielefeld, Bielefeld, Germany. katja.wingenfeld@evkb.de

Alterations in hypothalamic-pituitary-adrenal axis feedback regulation have been  repeatedly reported in patients with borderline personality disorder (BPD). Due to the cross-sectional design of these studies, little is known about the longitudinal course of HPA axis functioning. In a sample of 13 patients with BPD, the dexamethasone suppression test (DST) has been used in a one-year follow-up study. There were no changes of cortisol concentrations before or after dexamethasone intake between baseline and follow-up examination. Patients with comorbid posttraumatic stress disorder (PTSD) showed more pronounced cortisol suppression compared to those without PTSD. The DST seems to be a stable marker of alterations in HPA axis feedback regulation in BPD, which is also reflected by substantial correlations between percentage of cortisol suppression at baseline and follow-up examination. (c) 2007 Wiley Periodicals, Inc.

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

PMID: 17674401 [PubMed - indexed for MEDLINE]

 

J Fam Psychol. 2007 Sep;21(3):354-62.

Posttraumatic stress disorder and physical health symptoms among women seeking help for relationship aggression.

Taft CT, Vogt DS, Mechanic MB, Resick PA.

National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. casey.taft@med.va.gov

This study examined associations between intimate partner aggression and physical health symptoms among a sample of help-seeking women experiencing relationship aggression (N = 388). Using a structural equation modeling framework, the authors found posttraumatic stress disorder (PTSD) symptoms to fully mediate the associations of both physical and psychological aggression with physical health symptoms. The influence of PTSD symptoms on physical health symptoms was partially mediated by anger/irritability. Results were consistent with studies from other trauma groups suggesting that PTSD is pivotal with respect to explaining the effects of trauma on health. PsycINFO Database Record (c) 2007 APA, all rights reserved

PMID: 17874920 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2007 Sep;22(9):1321-4. Epub 2007 Jul 17.

Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms.

Gerrity MS, Corson K, Dobscha SK.

Division of Hospital and Specialty Medicine, Portland VA Medical Center, Portland, OR, USA.

BACKGROUND: Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD  have not been evaluated for patients with depression. OBJECTIVE: The objective was to evaluate a 4-item screen for PTSD in patients with depression. DESIGN: Baseline data from a depression study were used to evaluate sensitivity, specificity, and likelihood ratios (LRs) using the PTSD checklist (PCL-17) as the reference standard. SUBJECTS: Subjects are 398 depressed patients seen in Veterans Affairs (VA) primary care clinics. MEASURES: The Patient Health Questionnaire (PHQ) for depression, PCL-17, and 4-item screen for PTSD were used. RESULTS: Patients had a mean PHQ score of 14.8 (SD 3.7). Using a conservative PCL-17 cut point "(>50)", the prevalence of PTSD was 37%. PCL-17 scores were strongly associated with PHQ scores (r = 0.59, P < 0.001). Among the 342 (86%) patients endorsing trauma, a score of 0 on the remaining 3 symptom items had a LR = 0.21, score of 1 a LR = .62, score of 2 a LR = 1.36, and score of 3 a LR = 4.38. CONCLUSIONS: Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.

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

PMID: 17634781 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Sep;195(9):785-8.

Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: implications for EMDR therapy.

Propper RE, Pierce J, Geisler MW, Christman SD, Bellorado N.

Psychology Department, Merrimack College, North Andover, Massachusetts 01845, USA. ruth.propper@merrimack.edu

The use of bilateral eye movements (EMs) is an important component of Eye Movement Desensitization and Reprocessing (EMDR) therapy for posttraumatic stress disorder. The neural mechanisms underlying EMDR remain unclear. However, prior behavioral work looking at the effects of bilateral EMs on the retrieval of episodic memories suggests that the EMs enhance interhemispheric interaction. The present study examined the effects of the EMs used in EMDR on interhemispheric electroencephalogram coherence. Relative to noneye-movement controls, engaging in bilateral EMs led to decreased interhemispheric gamma electroencephalogram coherence. Implications for future work on EMDR and episodic memory are discussed.

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

PMID: 17984782 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Sep;195(9):723-8.

Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees.

Eytan A, Durieux-Paillard S, Whitaker-Clinch B, Loutan L, Bovier PA.

Adult Psychiatry Service, Department of Psychiatry, Geneva University Hospitals,  Chęne-Bourg, Switzerland. Ariel.Eytan@hcuge.ch

Refugees and asylum seekers have a high risk of developing mental health problems and appropriate screening in people from diverse origins remains a challenge. The aim of this study was to validate a structured diagnostic interview, adapted from the Major Depressive Episode (MDE) and Posttraumatic Stress Disorder (PTSD) sections of the Mini International Neuropsychiatric Interview, to detect these disorders among newly arrived asylum seekers. The adapted questionnaire was administered by nurses in a primary care context and its performance was judged against the expert opinion of a mental health specialist. One hundred one subjects were included in the study (mean age: 30; origin: Africa 58%, Europe: 37%, Asia: 5%). MDE and PTSD were diagnosed among 33% and 30% of them respectively. The questionnaire demonstrated moderate sensitivity (MDE: 79%; PTSD: 69%), but high specificity (MDE: 95%; PTSD: 94%). These characteristics remained stable despite cultural differences and use of interpreters. This instrument could be used for systematic screening of MDE and PTSD in refugees from various origins.

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

PMID: 17984771 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Sep;195(9):715-22.

Asylum seekers seeking mental health services in the United States: clinical and  legal implications.

Piwowarczyk L.

Boston University School of Medicine, Department of Psychiatry, Boston Center for Refugee Health and Human Rights, Boston Medical Center, Boston, Massachusetts 02118, USA. piwo@bu.edu

Asylum seekers flee their countries in search of safety due to persecution at home. Characteristics were assessed of 134 consecutive asylum seekers who sought  mental health services at a program caring for survivors of torture and refugee trauma, using a chart review of patients seen between January 1999 and December 2002. Two-thirds of the sample were female, and 82% came from Africa. Eighty-four percent of the sample reported a history of torture, and one-half experienced rape or attempted rape. Most common diagnoses included posttraumatic stress disorder and depression. Predictors of torture included: posttraumatic stress disorder [odds ratio (OR) = 4.93, p = 0.03], rape (OR = 4.23, p = 0.035), and political persecution (OR = 9.28, p = 0.006). Most common self-reported health problems were headaches (29.9%), sexual dysfunction (26.1%), chronic pain (12.7%), and gastrointestinal symptoms (11.2%).

Publication Types:      Comparative Study

PMID: 17984770 [PubMed - indexed for MEDLINE]

 

J Psychosom Res. 2007 Sep;63(3):233-9. Epub 2007 Aug 2.

Stress history and breast cancer recurrence.

Palesh O, Butler LD, Koopman C, Giese-Davis J, Carlson R, Spiegel D.

University of Rochester, Rochester, NY 14642, USA. oxana_palesh@urmc.rochester.edu

BACKGROUND: There is mixed evidence regarding the possible association between a  history of stressful or traumatic life events and more rapid breast cancer progression. METHOD: Retrospective reports of past experiences of traumatic life  events were assessed among 94 women with metastatic or recurrent breast cancer. A traumatic event assessment was conducted using the event-screening question from  the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for the DSM-IV-TR (SCID; 2002). Each reported event was judged by two independent raters to determine whether it met DSM-IV-TR PTSD A1 criteria for a traumatic event. Those events that did not meet such criteria were designated "stressful events." RESULTS: Nearly 42% of the women in the sample were judged to have experienced one or more traumatic events; 28.7% reported only stressful events. A Kruskal-Wallis test found significant differences in disease-free interval among the three groups [chi2 (2, N=94)=6.09, P<.05]. Planned comparisons revealed a significantly longer disease-free interval among women who had reported no traumatic or stressful life events (median=62 months) compared to those who had experienced one or more stressful or traumatic life events (combined median=31 months). CONCLUSIONS: A history of stressful or traumatic life events may reduce host resistance to tumor growth. These findings are consistent with a possible long-lasting effect of previous life stress on stress  response systems such as the hypothalamic-pituitary-adrenal (HPA) axis.

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

PMID: 17719359 [PubMed - indexed for MEDLINE]

 

Psychol Bull. 2007 Sep;133(5):725-46.

The psychophysiology of posttraumatic stress disorder: a meta-analysis.

Pole N.

Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1109, USA.  nnamdi@umich.edu

This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes. PsycINFO Database Record (c) 2007 APA, all rights reserved

Publication Types:      Meta-Analysis

PMID: 17723027 [PubMed - indexed for MEDLINE]

 

Psychoneuroendocrinology. 2007 Sep-Nov;32(8-10):991-9. Epub 2007 Sep 7.

Elevated morning serum interleukin (IL)-6 or evening salivary cortisol concentrations predict posttraumatic stress disorder in children and adolescents  six months after a motor vehicle accident.

Pervanidou P, Kolaitis G, Charitaki S, Margeli A, Ferentinos S, Bakoula C, Lazaropoulou C, Papassotiriou I, Tsiantis J, Chrousos GP.

First Department of Pediatrics, Athens University Medical School, "Aghia Sophia"  Children's Hospital, Thivon and Levadias Str, Athens, Greece.

BACKGROUND: This study examined prospectively the activity of the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system and inflammatory factors in children shortly after a motor vehicle accident (MVA) in  relation to later posttraumatic stress disorder (PTSD) development. PATIENTS AND  METHODS: Fifty six children, aged 7-18, were studied after an MVA and 1 and 6 months later; 40 subjects served as controls. Morning serum cortisol and interleukin (IL)-6 and plasma catecholamine concentrations were measured within 24h after the event. Salivary cortisol was measured 5 times at defined time points during the same day. PTSD diagnoses 1 and 6 months later were based on K-SADS interview. RESULTS: Morning serum IL-6 concentrations, measured within the first 24h after the accident, were higher in children that developed PTSD 6 months later than those who did not and those of the control group. Longitudinal  IL-6 measurements revealed normalization of IL-6 in the PTSD group, while no differences between the three groups were detected 1 and 6 months later. Evening  salivary cortisol and morning serum IL-6 after the accident were positively inter-related (r=0.54, p<0.001) and in separate regression analyses both predicted PTSD development 6 months later. In contrast, morning serum IL-6 did nor correlate with morning serum or salivary cortisol concentrations. CONCLUSIONS: Immediate posttraumatic alterations in neuroendocrine or inflammatory factors-increased evening salivary cortisol and/or increased morning serum IL-6 concentrations-are involved in subsequent PTSD development in children and adolescents.

PMID: 17825995 [PubMed - in process]

 

Psychosomatics. 2007 Sep-Oct;48(5):436-9.

Posttraumatic stress disorder caused by hallucinations and delusions experienced  in delirium.

DiMartini A, Dew MA, Kormos R, McCurry K, Fontes P.

Publication Types:      Case Reports

PMID: 17878504 [PubMed - indexed for MEDLINE]

 

Psychother Psychosom Med Psychol. 2007 Sep-Oct;57(9-10):364-72.

[Outpatient group therapy for emotion management in complex posttraumatic disorders]

[Article in German]

Müller C, Teschner M, Assaloni H, Kraemer B, Schnyder U, Rufer M.

Psychiatrische Poliklinik, UniversitätsSpital Zürich, Schweiz. christoph.mueller2@usz.ch

Insufficient regulation of intense emotions and impulses is frequently seen in patients suffering from complex mental disorders following childhood trauma. Therefore, phase-oriented trauma therapy first aims at stabilization and arousal  control. Group therapy for the improvement of emotion regulation skills has increasingly been implemented in inpatient treatment settings. However, despite their economic and therapeutic advantages, "stabilization groups" are scarcely offered in outpatient facilities. We introduce a novel outpatient group treatment protocol for the enhancement of self-regulatory capabilities. The protocol focuses primarily on the application of a hierarchically structured model of affect regulation strategies including body-oriented, hypnotherapeutic and guided imagery interventions. This is complemented by psychoeducation and resource activation based on recent neurobiological findings in traumatic stress research. Data from the first completed program is presented and discussed.

Publication Types:      English Abstract

PMID: 17590835 [PubMed - indexed for MEDLINE]

 

Psychother Psychosom Med Psychol. 2007 Sep-Oct;57(9-10):373-8.

[Psychological strain following foreign assignment - results of an investigation  among German soldiers serving in ISAF VII]

[Article in German]

Hauffa R, Brähler E, Biesold KH, Tagay S.

Selbstständige Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig. robinhauffa@hotmail.com

We present results of an investigation dealing with psychological strain in soldiers following a foreign assignment. There are few studies in German-speaking countries concerned with prevalence of traumatic events and posttraumatic stress  disorder in soldiers. A total of 118 soldiers were questioned (age: 20 - 46; 2,6  % female). The following questionnaires were used in the survey: Essener Trauma Inventory (ETI), Posttraumatic Symptom Scale (PTSS-10), Impact of Event Scale-Revised (IES-R), Symptom Check List 27 (SCL-27), Patient Health Questionnaire (PHQ-D) and Breslau's short screening scale for PTSD. Prevalence of Posttraumatic Stress Disorder (PTSD) in soldiers following foreign assignment ranged from 0.8 % to 2.5 % depending on the Scale used. 19.5 % had symptoms of depression or dysthymia. 15 % had an alcohol syndrome according to den PHQ-D. Contrary to our expectations the PTSD prevalence was lower than in the general population or other military samples.

Publication Types:      English Abstract

PMID: 17564945 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2007 Aug 30 [Epub ahead of print]

Discriminative delay Pavlovian eyeblink conditioning in veterans with and without posttraumatic stress disorder.

Ginsberg JP, Ayers E, Burriss L, Powell DA.

Dorn VA Medical Center, Columbia, SC 29209-1639, United States; University of South Carolina, Columbia, SC 29208, United States.

BACKGROUND: Impaired eyeblink (EB) classical conditioning using a delay paradigm  has previously been shown in combat veterans, as well as in a group of depressed  adults, compared to normal individuals. Significant deficits in immediate memory  (IM) in combat PTSD+ veterans, compared to normal controls, have also been previously shown, but these differences became non-significant after controlling  for level of self-reported depression. Furthermore, EB conditioning has been shown to be significantly correlated with heart rate variability (HRV) in normal  adults. The present study examined how depression (self-reported), IM, and resting HRV are related to discriminative delay classical EB conditioning in veterans with and without PTSD. METHOD: Three groups of subjects (combat PTSD+, combat PTSD-, and non-combat PTSD-) were assessed for self-report of depression and anxiety, as well as IM and HRV. Subjects received a single session of discriminative EB classical conditioning in which the conditioned stimulus (CS) was a light signal (either red or green) compounded with a tone. On CS+ trials, the light-tone compound stimulus co-terminated with a corneal airpuff (unconditioned stimulus, US), thus producing a delay paradigm. On CS- trials the  appropriate light-tone stimulus was presented but not followed by the airpuff US. EB amplitude and frequency were recorded. RESULTS: PTSD+ subjects had greater self-reported depression and anxiety scores than the two control groups, as well  as lower scores on a measure of IM. However, the IM difference was not significant after the effects of self-reported depression and anxiety were controlled. EB CR amplitude was significantly greater to CS+ than CS- for all three groups. EB amplitude to both the US (airpuff) and the CS+ declined over trials, but was significantly lower in the combat PTSD+ group compared to the combined PTSD- groups. Subjects who reached an EB CR acquisition criterion had significantly greater scores on IM than those who did not reach criterion. Factor analysis of the entire data set revealed four factors corresponding to (1) self-reported depression and anxiety, (2) IM, (3) HRV, and (4) EB amplitude. EB frequency was significantly predicted by IM and HRV. CONCLUSIONS: These data extend our previous results by showing deficits in EB conditioning among combat PTSD+ veterans that were associated with lower IM and resting HRV, but were not associated with self-report of depression.

PMID: 17913453 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2007 Aug 30;152(2-3):253-60. Epub 2007 Jul 12.

Locus of control among spinal cord injury patients with different levels of posttraumatic stress disorder.

Chung MC, Preveza E, Papandreou K, Prevezas N.

University of Plymouth, Clinical Psychology Teaching Unit, Peninsula Allied Health Centre, Derriford Road, Plymouth, PL6 8BH, UK. m.chung@plymouth.ac.uk

Two hypotheses were investigated in the present study: 1) Patients with full posttraumatic stress symptoms following spinal cord injury (SCI) would experience more general health problems than those with partial posttraumatic stress disorder (PTSD), with no-PTSD and the control group; 2) Patients with full PTSD would endorse the external locus of control more than those with partial PTSD, no-PTSD and the control group. Sixty-two patients were recruited from a specialized rehabilitation clinic for spinal cord injury. The control group comprised 60 participants without SCI. Patients with SCI were assessed using the  Posttraumatic Stress Disorder Checklist, the General Health Questionnaire-28 (GHQ-28) and the Multidimensional Health Locus of Control (MHLC). The control group was assessed using the GHQ-28 and the MHLC. The full PTSD group experienced more somatic problems, anxiety, social dysfunction and depression than the partial PTSD, the no-PTSD and the control groups. The results also showed that the full PTSD group endorsed significantly more external health locus of control  than the control group. However, no significant differences were found between the three patient groups in health locus of control. The three PTSD sub-scales were positively correlated with general health problems. Further analyses showed  that partial PTSD patients with paraplegia and partial PTSD patients whose SCI had a medically related cause were more likely to report less internal locus of control than other patients. Patients who suffered from full PTSD experienced more general health problems than those with fewer PTSD symptoms and those without SCI. External locus of control was a distinctive strategy that SCI-PTSD patients used in coping with the effects of SCI-PTSD.

PMID: 17628694 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2007 Aug 30;152(2-3):243-52. Epub 2007 Jul 2.

Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction.

Chung MC, Berger Z, Rudd H.

University of Plymouth, Clinical Psychology Teaching Unit, Peninsula Allied Health Centre, College of St Mark & St John, Derriford Road, Plymouth, PL6 8BH, UK. M.Chung@plymouth.ac.uk

More research is needed to further our understanding of posttraumatic stress responses and comorbidity following myocardial infarction (MI), and to help us identify more clearly the personality traits which indicate that a person is more prone to developing post-MI posttraumatic stress disorder (PTSD). This study aimed to 1) investigate the comorbidity of patients who suffered from different levels of posttraumatic stress disorder following myocardial infarction (i.e. post-MI PTSD), and 2) investigate to what extent patients with different levels of post-MI PTSD differed in their personality traits. One hundred and twenty MI patients from two general practices were recruited for the study. They were asked to complete the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). They were  divided into a no-PTSD group, a partial-PTSD group and a full-PTSD group, according to the scores of the PDS. One hundred and sixteen members of the general public were also recruited for comparison purposes. They were asked to complete the GHQ-28. The results showed that patients with full-PTSD reported significantly more somatic problems, anxiety, social dysfunction and depression than the other two patient groups and the control group. When age, bypass surgery, mental health problems before MI and angioplasty were controlled for, patients with full-PTSD also reported greater symptom severity of the four GHQ subscales than the other two patient groups. Patients with full-PTSD were significantly more neurotic than those with no-PTSD and partial-PTSD. Patients with full-PTSD were less agreeable than patients with no-PTSD. Regression analyses showed that personality did not moderate the relationship between PTSD and comorbidity. To conclude, following MI, those with full-PTSD tend to report more severe comorbidity than those who have not developed PTSD fully. The former  can also be distinguished from the latter by virtue of their specific personality traits.

PMID: 17604843 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2007 Aug 15;155(3):265-9. Epub 2007 Jun 14.

Influence of comorbid depression on fear in posttraumatic stress disorder: an fMRI study.

Kemp AH, Felmingham K, Das P, Hughes G, Peduto AS, Bryant RA, Williams LM.

Brain Dynamics Centre, Westmead Hospital and Western Clinical, School University  of Sydney, Sydney, NSW, Australia. kempa@psych.usyd.edu.au

Posttraumatic Stress Disorder (PTSD) is thought to involve a dysregulation of medial prefrontal-amygdala activity in response to fear. PTSD studies, however, have been confounded by comorbid depression, which shows similar dysregulation. Amygdala and medial prefrontal activity was reduced in PTSD-depression compared to PTSD-alone samples, highlighting the need to account for comorbidity.

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

PMID: 17572075 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2007 Aug 13 [Epub ahead of print]

Neural correlates of associative learning and memory in veterans with posttraumatic stress disorder.

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

Research Centre – Military Mental Health, Ministry of Defense, PO Box 90.000, 3509AA Utrecht, The Netherlands; Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, Utrecht University Medical Center, Utrecht, The Netherlands.

Impaired attention and memory are symptoms frequently associated with posttraumatic stress disorder (PTSD). Although patients with PTSD frequently report memory difficulties and empirical research provides support for a memory deficit in PTSD, as of yet, no fMRI study has adequately investigated the neural  correlates of learning and memory of neutral (i.e. not trauma related) material in patients with PTSD compared to controls. Twelve male veterans with PTSD, and twelve male veterans without PTSD, were recruited, and matched for age, region and year of deployment. Encoding and retrieval of 12 word-pair associates was assessed during fMRI in both experimental groups. Compared to controls veterans with PTSD revealed underactivation of the frontal cortex, and overactivation of the temporal cortex during the encoding phase. Retrieval of the paired associates resulted in underactivation of right frontal cortex, bilateral middle temporal gyri, and the left posterior hippocampus/parahippocampal gyrus in patients with PTSD. Deficits in memory performance in PTSD appear to be related to altered activity in fronto-temporal areas during both the encoding and retrieval phase of memory processing.

PMID: 17698081 [PubMed - as supplied by publisher]

 

Addict Behav. 2007 Aug;32(8):1719-27. Epub 2006 Dec 22.

Precipitants of first substance use in recently abstinent substance use disorder  patients with PTSD.

Ouimette P, Coolhart D, Funderburk JS, Wade M, Brown PJ.

Center for Integrated Healthcare, Syracuse VA Medical Center, and SUNY Upstate Medical University, Syracuse, NY, United States. paigec.ouimette@med.va.gov

Patients with substance use (SUD) and posttraumatic stress disorders (PTSD) are at high risk for relapse. This study examined the reasons patients identify for their first substance use following discharge from SUD treatment. A total of 65 patients with and without PTSD completed clinical interviews, including an adapted version of the Relapse Interview [RI; Miller, W.R., & Marlatt, G.A. (1996). Appendix A: Relapse Interview. Addiction, 91(Suppl), 231-240.] at a 6-month follow-up. Qualitative data from the RI was consensus coded using Marlatt's taxonomy of relapse situations. Results indicated that patients with PTSD were less likely to report first substance use triggered by cue-based urges  and more likely to report use in response to negative emotions of an interpersonal nature than those patients without PTSD. Other characteristics of first use associated with PTSD included greater subjective urges right before using, greater efforts to obtain substances and more likelihood to use to intoxication. Patients with unremitted PTSD reported poorer outcome and self-efficacy expectations than those without PTSD or with remitted PTSD. Implications for self-medication theory and clinical practice are discussed.

PMID: 17188816 [PubMed - indexed for MEDLINE]

 

Am J Geriatr Psychiatry. 2007 Aug;15(8):660-72.

Age differences in posttraumatic stress disorder, psychiatric disorders, and healthcare service use among veterans in Veterans Affairs primary care clinics.

Frueh BC, Grubaugh AL, Acierno R, Elhai JD, Cain G, Magruder KM.

Department of Psychology, University of Hawaii at Hilo, Hilo, HI 96720, USA. frueh@hawaii.edu

OBJECTIVE: To expand our understanding of posttraumatic stress disorder (PTSD) prevalence, its psychiatric characteristics, and service use among elderly veterans in Veterans Affairs (VA) primary care clinics. METHODS: A cross-sectional, epidemiological design (N = 745) incorporating self-report measures, structured interviews, and chart reviews was used to obtain relevant information for analyses. RESULTS: The oldest group of veterans (>or=65 years; N  = 318) had lower prevalence of most psychiatric diagnoses than the youngest (18-44 years; N = 69) and middle-aged (45-64 years; N = 358) groups. Despite having higher rates of combat exposure, veterans in the oldest group (6.3%) had one-third the prevalence of PTSD than those in the middle-aged group (18.6%). A similar pattern was found across other psychiatric diagnoses. For example, those  in the oldest group (7.5%) had one-third the prevalence of major depression as those in the two younger groups (21.7% and 22.9%). These differences were maintained after controlling for relevant demographic covariates (race, sex). Results from examination of VA health care service use across the three groups were consistent with the findings that the oldest veteran group is functioning significantly better across mental health domains. CONCLUSION: Elderly veterans who use VA primary care services evidence lower rates of PTSD and other psychiatric disorders, and they use significantly less VA mental health services. They also do not appear to show evidence of worse physical health functioning or  use VA health care services or disability benefits at a meaningfully higher rate  than their younger counterparts.

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

PMID: 17670996 [PubMed - indexed for MEDLINE]

 

Am J Geriatr Psychiatry. 2007 Aug;15(8):652-9. Epub 2007 May 15.

Lifetime and 12-month prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders among older African Americans: findings from  the National Survey of American Life.

Ford BC, Bullard KM, Taylor RJ, Toler AK, Neighbors HW, Jackson JS.

School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA. bcford@umich.edu

OBJECTIVE: The purpose of this study was to estimate lifetime and 12-month prevalence of 13 psychiatric disorders for older African Americans. METHODS: Data are from the older African American subsample of the National Survey of American  Life. Selected measures of lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder (PTSD), major depressive disorder, dysthymia, bipolar I and II disorders, alcohol abuse/dependence, and drug abuse/dependence). RESULTS: Twenty-three percent of older African Americans reported at least one lifetime disorder and 8.54% reported at least one 12-month disorder. Alcohol abuse, PTSD, and major depression were the most prevalent lifetime disorders. The most prevalent 12-month disorders were PTSD, major depression, and social phobia. Age, sex, education, and region were significantly associated with the odds of having a lifetime disorder. CONCLUSION: This is the first study of prevalence rates of serious mental disorders for older African Americans based on a national sample.  Demographic correlates of the prevalence of disorders are discussed with an emphasis on age and regional differences.

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

PMID: 17504908 [PubMed - indexed for MEDLINE]

 

Am J Hosp Palliat Care. 2007 Aug-Sep;24(4):270-6.

Traumatic distress and positive changes in advanced cancer patients.

Mystakidou K, Parpa E, Tsilika E, Pathiaki M, Galanos A, Vlahos L.

Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, 27 Korinthias Street, 15 26 Athens, Greece. mistakidou@yahoo.com

This study investigated the traumatic distress and posttraumatic growth in 58 advanced cancer patients receiving palliative treatment in a Pain Relief and Palliative Care Unit. The patients completed the Greek version of the Impact of Events Scale-Revised and the Posttraumatic Growth Inventory. Statistically significant associations were found among Impact of Events Scale-Revised-Greek "Relating to Others" (r = 0.311, P = .017), "New Possibilities" ( r = 0.248, P =  .050), and "Appreciation of Life" ( r = 0.419, P = .001), and the Posttraumatic Growth Inventory scores (r = 0.323, P = .013). Similarly, "Appreciation of Life"  correlated significantly with "Avoidance" (r = 0.318, P = .015), "Intrusion" (r = 0.365, P = .005), and "Hyperarousal" (r = 0.398, P = .002). Statistically significant associations were also found between "Relating to Others" and "Intrusion" (r = 0.414, P = .001). The study concluded that in advanced cancer patients, the higher the impact event, the more improvement in their relationships with others, enhanced life appreciation, and more positive consequences after trauma.

PMID: 17895492 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Aug;164(8):1250-8.

Paralimbic and medial prefrontal cortical involvement in neuroendocrine responses to traumatic stimuli.

Liberzon I, King AP, Britton JC, Phan KL, Abelson JL, Taylor SF.

Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. liberzon@umich.edu

OBJECTIVE: Hypothalamic-pituitary-adrenal axis activity and cortisol release are  consequences of central stress system activation, but they may also influence cognitive and emotional processes within the brain. Despite the importance of central stress response systems, little is known about the specific brain circuits through which psychosocial stimuli activate the hypothalamic-pituitary-adrenal axis and through which cortisol feedback modulates central processing. The authors used [(15)O]H(2)O positron emission tomography (PET) on subjects with posttraumatic stress disorder (PTSD) to study these circuits. METHOD: Participants were combat-PTSD patients, combat-exposed healthy  comparison subjects, and noncombat-exposed healthy comparison subjects. Participants were scanned using [(15)O]H(2)O PET while they experienced a series  of emotional-induction conditions, which included aversive pictures and autobiographic narratives. Blood samples were obtained 2 minutes before and 5 minutes after each activation scan in order to measure the subjects' plasma adrenocorticotropic hormone and cortisol levels. RESULTS: In voxel-wise analyses, the authors found that adrenocorticotropic hormone responses were covaried with regional cerebral blood flow (rCBF) in the dorsal medial prefrontal cortex, rostral anterior cingulate cortex, and right insula, with some differences between PTSD patients and comparison subjects. Prestimulus cortisol levels covaried with rCBF responses in the rostral anterior cingulate cortex. In combat-PTSD patients only, prestimulus cortisol levels covaried with rCBF in the  subgenual anterior cingulate cortex. CONCLUSIONS: These findings provide evidence of cortical involvement in hypothalamic-pituitary-adrenal responses to psychological stimuli, specifically implicating the insula, dorsal medial prefrontal cortex, and rostral anterior cingulate cortex. These findings also show, for the first time, that cortisol may modulate activity in specific brain areas such as the rostral and subgenual anterior cingulate cortices. Differential patterns of covariation between combat veterans with and without PTSD potentially implicate the dorsal medial prefrontal cortex and subgenual anterior cingulate cortex as areas of dysregulation in PTSD.

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

PMID: 17671289 [PubMed - indexed for MEDLINE]

 

Aust N Z J Psychiatry. 2007 Aug;41(8):637-48.

Australian guidelines for the treatment of adults with acute stress disorder and  post-traumatic stress disorder.

Forbes D, Creamer M, Phelps A, Bryant R, McFarlane A, Devilly GJ, Matthews L, Raphael B, Doran C, Merlin T, Newton S.

Australian Centre for Posttraumatic Mental Health, West Heidelberg, Vic, Australia.

Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in  consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.

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

PMID: 17620160 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Aug;45(8):1903-13. Epub 2006 Oct 16.

The role of attentional biases in PTSD: is it interference or facilitation?

Pineles SL, Shipherd JC, Welch LP, Yovel I.

VA Boston Healthcare System, National Center for PTSD, Women's Health Sciences Division (116B-3), Boston, MA, USA. suzanne.pineles@va.gov

Although attentional biases have been demonstrated in individuals with posttraumatic stress disorder (PTSD), the cognitive methodologies used have not allowed for disambiguation of two types of attentional biases. It remains unclear if PTSD involves difficulty disengaging attention from threatening stimuli (interference) or facilitated detection. To differentiate between attentional interference and facilitation, 57 male Vietnam-era veterans (30 High PTSD and 27  Low PTSD) completed a visual search task with a lexical decision component. High  PTSD veterans who engaged in the interference task first showed increased interference to threat-relevant words relative to Low PTSD veterans. However, no  evidence was found for facilitated detection of threatening stimuli in PTSD.

PMID: 17049337 [PubMed - indexed for MEDLINE]

 

Can J Psychiatry. 2007 Aug;52(8):510-8.

Posttraumatic stress disorder and associated risk factors in Canadian peacekeeping veterans with health-related disabilities.

Richardson JD, Naifeh JA, Elhai JD.

Operational Stress Injury Clinic, Parkwood Hospital, St Joseph's Health Care London, Ontario. Don.Richardson@sjhc.london.on.ca

OBJECTIVES: This study investigates posttraumatic stress disorder (PTSD) and its  associated risk factors in a random, national, Canadian sample of United Nations  peacekeeping veterans with service-related disabilities. METHODS: Participants included 1016 male veterans (age < 65 years) who served in the Canadian Forces from 1990 to 1999 and were selected from a larger random sample of 1968 veterans  who voluntarily and anonymously completed a general health survey conducted by Veterans Affairs Canada in 1999. Survey instruments included the PTSD Checklist-Military Version (PCL-M), Center for Epidemiological Studies-Depression Scale (CES-D), and questionnaires regarding life events during the past year, current stressors, sociodemographic characteristics, and military history. RESULTS: We found that rates of probable PTSD (PCL-M score > 50) among veterans were 10.92% for veterans deployed once and 14.84% for those deployed more than once. The rates of probable clinical depression (CES-D score > 16) were 30.35% for veterans deployed once and 32.62% for those deployed more than once. We found that, in multivariate analyses, probable PTSD rates and PTSD severity were associated with younger age, single marital status, and deployment frequency. CONCLUSIONS: PTSD is an important health concern in the veteran population. Understanding such risk factors as younger age and unmarried status can help predict morbidity among trauma-exposed veterans.

PMID: 17955914 [PubMed - indexed for MEDLINE]

 

Can J Psychiatry. 2007 Aug;52(8):505-9.

Preexisting neuroticism, subjective stressor severity, and posttraumatic stress in soldiers deployed to Iraq.

Engelhard IM, van den Hout MA.

Clinical and Health Psychology, Utrecht University, The Netherlands. I.M.Engelhard@uu.nl

OBJECTIVE: To investigate the extent to which preexisting neuroticism confounds the relation between appraisals of the severity of major and minor stressors and  posttraumatic stress disorder (PTSD) symptoms. METHOD: A sample of 383 Dutch army soldiers completed a neuroticism scale before their 4-month tour of duty in Iraq. About 5 months after deployment, most of them rated the severity of stressors on  deployment. PTSD symptoms were also assessed. RESULTS: Appraisal of major stressors in Iraq was significantly related to PTSD symptoms and was, for the most part, independent of neuroticism. However, the strength of the association between minor stressors and PTSD symptoms dropped by 31% after statistical control for neuroticism. CONCLUSION: Neuroticism may partly compromise the relation between perceived minor stressors and PTSD symptoms.

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

PMID: 17955913 [PubMed - indexed for MEDLINE]

 

Can J Psychiatry. 2007 Aug;52(8):499-500; discussion 504.

Posttraumatic stress disorder is overloaded.

Merskey H, Piper A.

University of Western Ontario, London. harold.merskey@sympatico.ca

PMID: 17955911 [PubMed - indexed for MEDLINE]

 

Harv Ment Health Lett. 2007 Aug;24(2):1-4.

Rethinking posttraumatic stress disorder. What is a traumatic event, and how does it produce symptoms?

[No authors listed]

PMID: 17715544 [PubMed - indexed for MEDLINE]

 

Health Soc Work. 2007 Aug;32(3):169-76.

The sun always comes out after it rains: understanding posttraumatic growth in HIV caregivers.

Cadell S.

Lyle S Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener, Ontario, Canada. scadell@wlu.ca

Coping theory and research have long focused on negative outcomes. However, a growing body of literature has indicated that individuals may experience certain  benefits from stressful life events. This research explored the positive and negative changes in caregivers' lives after caring for someone who had died of complications related to HIV/AIDS. Fifteen participants with either high or low scores of posttraumatic growth were interviewed. Data were analyzed from a grounded theory standpoint using open, axial, and selective coding. All of the individuals interviewed were undergoing or had undergone a process of finding meaning in their bereavement, in HIV disease in general, or both. Themes of distress, growth, humor, support, spirituality, fear of death, and the intertwining of support and spirituality emerged from the data. This research contributes to the growing areas of concentration on strengths and positive outcomes in coping. In addition, the results echo the re-emergence of interest in spirituality and social work.

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

PMID: 17896673 [PubMed - indexed for MEDLINE]

 

Intensive Crit Care Nurs. 2007 Aug;23(4):206-15. Epub 2007 Apr 20.

The meaning of posttraumatic stress-reactions following critical illness or injury and intensive care treatment.

Corrigan I, Samuelson KA, Fridlund B, Thomé B.

Intensive Care Unit, Division of Anaesthesiology and Intensive Care, Lund University Hospital, SE-221 85 Lund, Sweden. ingrid.corrigan@lsn.se

Traumatic events connected with a critical condition and treatment in the intensive care unit (ICU) may result in subsequent posttraumatic stress-reactions. The aim of this phenomenological study was to describe the meaning of posttraumatic stress-reactions as experienced by individuals following a critical illness or injury and intensive care. Fourteen informants, testing positive for posttraumatic stress-reactions as a clinical concern, were interviewed. The data was analysed following the principles indicated by Giorgi [Giorgi A. The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure. J Phenomenol Psychol 1997;28:235-61]. The essence of the phenomenon of posttraumatic stress-reactions was understood as a transition to a life-situation beyond control, where the traumatic experiences have a profound impact and are ever-present. The variations of the phenomenon presented themselves as a need to make sense of the traumatic memories, which live on; being haunted by the trauma; a need to escape; distress and strain in the life-situation; transformation of self and, finally, interactions with others affected. The need for caring strategies and support is emphasised, both in the ICU and afterwards, thus preventing or alleviating some of the suffering.

PMID: 17449252 [PubMed - indexed for MEDLINE]

 

J Abnorm Child Psychol. 2007 Aug;35(4):578-93. Epub 2007 Feb 27.

Violence exposure and psychopathology in urban youth: the mediating role of posttraumatic stress.

Ruchkin V, Henrich CC, Jones SM, Vermeiren R, Schwab-Stone M.

Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520-7900, USA. vladislav.ruchkin@yale.edu

Understanding the mechanisms underlying the development of violence exposure sequelae is essential to providing effective treatments for traumatized youth. This longitudinal study examined the mediating role of posttraumatic stress in the relationship between violence exposure and psychopathology, and compared the  mediated models by gender. Urban adolescents (n=1,358) were surveyed using the Social and Health Assessment. The proposed relationships were examined using Structural Equation Modeling. Posttraumatic stress fully mediated the relationships between victimization and depression and anxiety in girls, and partially so in boys. In addition, posttraumatic stress partially mediated the relationships between violence exposure and commission of violence in boys. Current findings support the longitudinal effects of violence exposure on adolescent mental health. Posttraumatic stress represents a unique mechanism for  the development of psychopathology in girls and is also related to negative outcomes in boys. These findings have direct implications for prevention and rehabilitation efforts among violence exposed youth.

PMID: 17333360 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 Aug;116(3):607-11.

Gender differences in the sensitivity to posttraumatic stress disorder: An epidemiological study of urban young adults.

Breslau N, Anthony JC.

Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA. Breslau@epi.msu.edu

The authors examine the relationship between 2 separate but interrelated findings in the epidemiology of posttraumatic stress disorder (PTSD): women's greater PTSD risk following traumatic events and the sensitizing effects of a prior trauma on  the PTSD response to a subsequent trauma. Data come from a representative sample  of 1,698 young adults from a large U.S. city. Analysis was conducted on the subset exposed to traumatic events. Women's risk for PTSD following assaultive violence was higher than men's. When assaultive violence preceded a later nonassaultive trauma in women, there was an increased risk (relative risk = 4.9)  for PTSD, which was not observed in men. The relative risk estimate in women was  significantly higher than in men. These findings suggest that assaultive violence elicits women's PTSD response directly and by sensitizing them to the effects of  subsequent traumatic events of lesser magnitude.

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

PMID: 17696716 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 Aug;116(3):498-507.

Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.

Taft CT, Kaloupek DG, Schumm JA, Marshall AD, Panuzio J, King DW, Keane TM.

National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. casey.taft@va.gov

This study examined the association between posttraumatic stress disorder (PTSD)  symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced  the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association. (c) 2007 APA, all rights reserved

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

PMID: 17696706 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 Aug;116(3):448-63.

Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation.

Brewin CR, Kleiner JS, Vasterling JJ, Field AP.

Subdepartment of Clinical Health Psychology, University College London, London, United Kingdom. c.brewin@ucl.ac.uk

Studies have come to conflicting conclusions about whether posttraumatic stress disorder (PTSD) is associated with poorer memory for emotionally neutral information. The authors report a meta-analysis of 27 studies that investigated verbal and/or visual memory in samples with PTSD and healthy controls. The results indicated that the association between PTSD and memory impairment appears to be robust, small to moderate in size, and stronger for verbal than for visual  memory. Effect sizes did not vary according to whether recall was immediate or delayed. The association is found in both civilian and military samples and cannot be readily explained as being due to the use of nontraumatized healthy control groups or concurrent head injury. The findings are placed in the context  of recent neurobiological and experimental cognitive research. (c) 2007 APA, all  rights reserved

Publication Types:      Meta-Analysis

PMID: 17696700 [PubMed - indexed for MEDLINE]

 

J Am Acad Child Adolesc Psychiatry. 2007 Aug;46(8):1051-61.

Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary  randomized controlled trial.

Smith P, Yule W, Perrin S, Tranah T, Dalgleish T, Clark DM.

Kings College London, Institute of Psychiatry, UK. patrick.smith@iop.kcl.ac.uk

OBJECTIVE: To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people. METHOD: Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full DSM-IV PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing  violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks. RESULTS: Compared to the WL group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of  participants no longer met criteria. CBT gains were maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of PTSD. CONCLUSIONS: Individual trauma-focused CBT is an effective treatment for PTSD in children and young people.

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

PMID: 17667483 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2007 Aug;68(8):1257-70.

Sleep disturbance in adults with posttraumatic stress disorder: a review.

Lamarche LJ, De Koninck J.

School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.

OBJECTIVE: To present a critical review of the literature and research on sleep difficulties in adults with posttraumatic stress disorder (PTSD), more specifically the existing treatment options, and to formulate recommendations regarding future treatment approaches and research related to sleep and PTSD. DATA SOURCES: The following databases were consulted: PsycInfo (1872-2006) and MEDLINE (1966-2006). The search was conducted using the following key terms: PTSD and sleep, PTSD and nightmares, PTSD and dreams, PTSD and insomnia, PTSD and periodic limb movement disorder, and PTSD and sleep disordered breathing. Only studies examining sleep disturbance among adults with PTSD were included, and only articles written in English were consulted. STUDY SELECTION: Studies and reviews related to the prevalence, causes, and treatments of sleep disturbance among adults with PTSD, as well as those examining the relationship between sleep and PTSD, were selected. CONCLUSIONS: Promising treatment options are available for treating sleep difficulties among adults with PTSD. In particular, cognitive-behavioral therapy including a component for nightmares (imagery rehearsal therapy) and insomnia has been found to significantly improve sleep disturbance among these individuals. It is proposed that with the inclusion of other components, such as a screening for other sleep disorders, relaxation exercises, positive self-talk, imagery rehearsal related to recurring images before bed, and a daytime nap, sleep-related symptoms may improve to a greater degree, which may then lead to a significant decrease in other PTSD symptoms and  overall PTSD severity. The inclusion of sleep medicine specialists should also be considered for sleep medicine treatment of individuals with PTSD. Collaboration between mental health professionals and sleep medicine specialists is therefore recommended for treatment of sleep-related difficulties among individuals with PTSD.

Publication Types:      Review

PMID: 17854251 [PubMed - indexed for MEDLINE]

 

J Fam Nurs. 2007 Aug;13(3):370-84.

The effects of guided written disclosure on psychological symptoms among parents  of children with cancer.

Duncan E, Gidron Y, Rabin E, Gouchberg L, Moser AM, Kapelushnik J.

Division of Psychology, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, UK. edu@gcal.ac.uk

This study examines whether structured writing about receiving a diagnosis and treatment for pediatric cancer reduces distress among highly distressed parents of children with cancer (PCWC). Eight PCWC completed measures of posttraumatic stress symptoms (PTSS) and depressive symptoms at two baselines, and again after  writing, with 1-month gaps between assessments. Using a guided disclosure protocol (GDP), parents were asked to write about receiving the diagnosis first in a chronological manner, then to explicitly label their emotions at the time of diagnosis and explain the impact of the child's illness on their life. Finally, they were asked to reflect on current feelings, future coping ability, and personal growth. Although symptoms of distress did not change between baselines,  significant reductions were found in PTSS from the first baseline to postwriting, but not in depression. This preliminary study suggests that the GDP may reduce PTSS in distressed PCWC.

PMID: 17641114 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Aug;195(8):701-4.

Does posttraumatic stress disorder (PTSD) affect performance?

LeBlanc VR, Regehr C, Jelley RB, Barath I.

Orange Transport Medicine, Toronto, Ontario, Canada. vicki.leblanc@utoronto.ca

Research has increasingly identified alarming levels of traumatic stress symptoms in individuals working in emergency services and other high stress jobs. This study examined the effects of prior critical incident exposure and current posttraumatic symptoms on the performance of a nonpatient population, police recruits, during an acutely stressful event. A stressful policing situation was created through the use of a video simulator room that was responsive to actions  of participants. The performance of participants to the simulated emergency was evaluated by 3 independent blinded raters. Prior exposure to critical incidents was measured using the Critical Incident History Questionnaire and current level  of traumatic stress symptoms was measured using the Impact of Events Scale-Revised. Neither previous exposure to critical incidents nor trauma symptoms correlated with performance level. Recruits with high or severe levels of trauma symptoms did not demonstrate impairments in judgment, communication, or situation control compared with their colleagues with lesser or no trauma symptoms. On the basis of these findings, there is no reason to believe that police recruits with PTSD are prone to making errors of communication or judgment that would place them or others at increased risk.

Publication Types:      Comparative Study

PMID: 17700305 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Aug;195(8):655-61.

Severity of combat-related posttraumatic stress disorder versus noncombat-related posttraumatic stress disorder: a community-based study in American Indian and Hispanic veterans.

Brinker M, Westermeyer J, Thuras P, Canive J.

Mental Health Services, Minneapolis Veterans Affairs Medical Center, Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota 55417, USA.

The goal of the study was to compare severity of combat-related posttraumatic stress disorder (PTSD) versus noncombat-related PTSD in a group known to have high rates of combat-related PTSD. Sample consisted of 255 male American Indian and Hispanic veterans with lifetime PTSD who were contacted in communities in 2 regions of the country. Measures of PTSD severity included current posttraumatic  symptoms, remission from lifetime PTSD, lifetime severity of alcohol-drug related problems, and mental health treatment history. Our findings revealed that veterans with combat-related PTSD had more severe posttraumatic symptoms, were less apt to have remitted from PTSD during the last year, and-contrary to expectation-were less apt to have sought mental health treatment since military duty. In conclusion, combat-related PTSD was more severe, as compared with noncombat-related PTSD, in this group, on 2 out of 5 measures. A low rate of mental health treatment since military duty may have contributed to increased symptoms and a lower remission rate.

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

PMID: 17700297 [PubMed - indexed for MEDLINE]

 

J Pediatr Psychol. 2007 Aug;32(7):771-82. Epub 2007 Apr 2.

Trajectories of adjustment in mothers of children with newly diagnosed cancer: a  natural history investigation.

Dolgin MJ, Phipps S, Fairclough DL, Sahler OJ, Askins M, Noll RB, Butler RW, Varni JW, Katz ER.

Schneider Children's Medical Center, Israel. mdolgin@netvision.net.il

OBJECTIVES: The objectives of this study were (a) to assess negative affectivity  and posttraumatic symptomatology in mothers following the diagnosis of cancer in  their children; (b) to examine sociodemographic and psychosocial variables associated with change in distress over time; and (c) to identify distinct subgroups of mothers whose patterns and trajectories of adjustment can be distinguished according to available predictor data. METHODS: Two hundred and twelve mothers at seven sites were assessed just following their child's diagnosis, and again 3 months and 6 months later. Primary outcomes included measures of mood disturbance, depressive symptoms, and symptoms of posttraumatic  stress. RESULTS: Overall, mothers demonstrated a pattern of mildly elevated negative affectivity and posttraumatic symptomatology initially, with steady improvements evident at 3- and 6-month follow-up. Distinct adjustment trajectories were evident within the sample as a whole, indicating subgroups of mothers with high-declining, moderate-stable, and low-stable distress levels. CONCLUSIONS: These findings highlight considerable resilience among mothers facing the stress of childhood cancer. Intervention efforts aimed at reducing maternal distress might best be targeted towards the subgroup of mothers who may  be predicted to exhibit the highest level of distress.

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

PMID: 17403910 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):631-6.

Feasibility and effectiveness of cognitive-behavioral therapy for posttraumatic stress disorder in preschool children: two case reports.

Scheeringa MS, Salloum A, Arnberger RA, Weems CF, Amaya-Jackson L, Cohen JA.

Department of Psychiatry and Neurology, Tulane University, New Orleans, LA, USA.  mscheer@tulane.edu

New evidence raises concerns that posttraumatic stress disorder (PTSD) in preschool children is unremitting over years even with unstructured community treatment. This report presents proof of concept of the feasibility and effectiveness of a structured therapy, cognitive-behavioral therapy (CBT), for preschool PTSD that follows a range of different traumatic events. Two cases are  presented, including transcribed dialogue, from a motor vehicle accident and Hurricane Katrina, respectively. Three key CBT feasibility questions were examined; it was concluded that (a) young children can cooperate meaningfully in  structured, trauma-related exposure exercises; (b) they can utilize relaxation techniques successfully; and (c) highly anxious parents do not inhibit their children's improvement per se as long as they can facilitate the manual techniques. Clinicians need to be aware of emerging evidence-based treatment for  preschool children.

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

PMID: 17721975 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):611-7.

Adult sexual abuse is associated with elevated neurohormone levels among women with PTSD due to childhood sexual abuse.

Friedman MJ, Jalowiec J, McHugo G, Wang S, McDonagh A.

National Center for PTSD, VA Medical Center, White River Junction, VT and Department of Psychiatry, Dartmouth Medical School, Lebanon, NH, USA. Matthew.Friedman@Dartmouth.edu

Posttraumatic stress disorder (PTSD) has been associated with reduced, similar, or increased urinary cortisol levels. The authors identified a factor that might  contribute to such variability when they obtained 24-hour urinary neurohormone profiles on 69 women with PTSD due to childhood sexual abuse. Half (n = 35) had subsequently experienced adult sexual abuse (ASA) while the other half (n = 34) had not. The ASA group had significantly elevated urinary cortisol, norepinephrine and dopamine levels in comparison to the non-ASA group. Neither a  history of childhood or adult physical abuse nor other variables contributed to this finding. The results suggest that the psychobiological consequences of exposure to the same traumatic event may differ as a result of an interaction between age and the composite history of trauma exposure.

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

PMID: 17721974 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):553-63.

Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors.

Thompson SJ, Maccio EM, Desselle SK, Zittel-Palamara K.

University of Texas at Austin, School of Social Work, Austin, TX 78703, USA. SannaThompson@mail.utexas.edu

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or  juvenile detention. Findings demonstrated high levels of trauma-related symptoms  for both groups. Worry about family, greater runaway episodes, and living with a  father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships  predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

PMID: 17721973 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):467-79.

Comment on:     J Trauma Stress. 2007 Aug;20(4):449-65.    J Trauma Stress. 2007 Aug;20(4):481-6.

The psychological risks of Vietnam: the NVVRS perspective.

Schlenger WE, Kulka RA, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS.

Abt Associates Inc., Durham, NC 27703, USA. bill_schlenger@abtassoc.com

In recent years, controversy concerning the psychological consequences of service in the Vietnam war has rearisen. In this article, the Co-Principal Investigators  of the National Vietnam Veterans Readjustment Study (NVVRS) provide a perspective on new findings reported by B. P. Dohrenwend et al. (2006) that addresses criticisms of the NVVRS PTSD (posttraumatic stress disorder) prevalence findings, and on a perspective that was provided by R. J. McNally (2006) in an accompanying commentary. They find that Dohrenwend et al.'s study, which evaluated empirically a variety of the critics' alternative explanations and found little support for any of them, represents a landmark contribution to the trauma field. However, they found that McNally's commentary misrepresented the history and context of the NVVRS, and then misinterpreted Dohrenwend et al.'s findings and their importance.

Publication Types:      Comment

PMID: 17721970 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):637-42.

Partial and full PTSD in Brazilian ambulance workers: prevalence and impact on health and on quality of life.

Berger W, Figueira I, Maurat AM, Bucassio EP, Vieira I, Jardim SR, Coutinho ES, Mari JJ, Mendlowicz MV.

Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio  de Janeiro, Brazil.

A cross-sectional survey for posttraumatic stress disorder (PTSD) was conducted with 234 Brazilian ambulance workers (180 men and 54 women) using a sociodemographic questionnaire, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Short Form Health Survey-36. Current prevalence rates for full and partial PTSD were 5.6% (men = 6.7%, women = 1.9%) and 15% (men = 13.3%, women = 20.4%), respectively. Male workers with full PTSD were more likely to be nonmarried (75% vs. 43%) and those with partial PTSD reported more emotional problems (65.2% vs. 30%) and medical visits (67% vs. 44%) than the controls. Workers with PTSD showed impairment in the physical and mental domains of the SF-36, whereas workers with partial PTSD had only the later compromised. The characteristics and the level of exposure to trauma of the study population may account for the low prevalence of PTSD.

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

PMID: 17721969 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):529-39.

Traumatic events and posttraumatic stress in cross-cultural mission assignments.

Schaefer FC, Blazer DG, Carr KF, Connor KM, Burchett B, Schaefer CA, Davidson JR.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. Frauke.Schaefer@duke.edu

In addition to cross-cultural and environmental stressors, aid workers and missionaries are frequently exposed to trauma. We explored the frequency of traumatic events, their mental health impact, and factors associated with posttraumatic stress in two groups of missionaries, one representing a predominantly stable setting (Europe) and the other an unstable setting (West Africa). The 256 participants completed self-report measures assessing lifetime traumatic events, current posttraumatic stress, depressive and anxiety symptoms,  resilience, and functioning. The rate of traumatic events was significantly higher in the unstable setting. More-frequent traumatic events were associated with higher posttraumatic stress. Factors associated with the severity of posttraumatic stress were depression, functional impairment, subjective severity  and number of traumatic events, and the level of resilience.

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

PMID: 17721967 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):505-15.

Stigma and the military: evaluation of a PTSD psychoeducational program.

Gould M, Greenberg N, Hetherton J.

Department of Clinical Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK.

Trauma risk management (TRiM) is an intensive posttraumatic stress disorder (PTSD) psychoeducational management strategy based on peer-group risk assessment  developed by the UK Royal Navy (RN). TRiM seeks to modify attitudes about PTSD, stress, and help-seeking and trains military personnel to identify at-risk individuals and refer them for early intervention. This quasiexperimental study found that TRiM training significantly improved attitudes about PTSD, stress, and help-seeking from TRiM-trained personnel. There was a nonsignificant effect on attitudes to seeking help from normal military support networks and on general health. Within both the military and civilian populations, stigma is a serious issue preventing help-seeking and reducing quality of life. The results suggest that TRiM is a promising antistigma program within organizational settings.

Publication Types:      Controlled Clinical Trial

PMID: 17721966 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):619-23.

Self-selection bias in sleep and psychophysiological studies of posttraumatic stress disorder.

Woodward SH, Stegman WK, Pavao JR, Arsenault NJ, Hartl TL, Drescher KD, Weaver C.

National Center for PTSD, Clinical Laboratory and Education Division, VA Palo Alto HCS, Menlo Park Division, Menlo Park, CA 94025, USA. Steve.woodward@med.va.gov

Psychobiological studies of posttraumatic stress disorder (PTSD) often challenge  participants to assess the dynamics of systems evolved to organize responses to extreme events. Informed consent insures that volunteers have every opportunity to preevaluate the conditions of the research experience and decline if made uncomfortable by them. Notwithstanding their necessity, these protections set the stage for self-selection phenomena that may bias study outcomes. This study compared prospectively obtained psychometric data from 196 participants and 1229  nonparticipants in sleep and psychophysiological studies of PTSD. Lower subjective nightmare severity was endorsed by persons who later agreed to participate in a study of baseline sleep, an observation consistent with the low  nightmare frequencies observed in most laboratories studies of sleep in PTSD.

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

PMID: 17721964 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):577-86.

Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users.

Bonn-Miller MO, Vujanovic AA, Feldner MT, Bernstein A, Zvolensky MJ.

Department of Psychology, University of Vermont, Burlington, VT 05405-0134, USA.

The present study examines the relation between posttraumatic stress symptom severity and motives for marijuana use among 103 (55 women) young adult marijuana users (current) who reported experiencing at least one traumatic event in their lifetime. As expected, after covarying for the theoretically relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, and volume of alcohol consumed, posttraumatic stress symptom severity was significantly related to marijuana use coping motives, but no other motives for marijuana use. Results are discussed in relation to better understanding the role of coping-motivated marijuana use among young adults experiencing posttraumatic stress.

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

PMID: 17721963 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):541-51.

School-based intervention for prevention and treatment of elementary-students' terror-related distress in Israel: a quasi-randomized controlled trial.

Berger R, Pat-Horenczyk R, Gelkopf M.

Israel Trauma Center for the Victims of Terror and War (NATAL), Tel Aviv, Israel.

A school-based intervention for preventing and reducing children's posttraumatic  stress-related symptoms, somatic complaints, functional impairment, and anxiety due to exposure to terrorism was evaluated. In a quasi-randomized controlled trial, elementary school students were randomly assigned to an eight-session structured program, "Overshadowing the Threat of Terrorism" or to a waiting list  control comparison group. Two months postintervention, the study group reported significant improvement on all measures. The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- (PTSD-) related symptoms in children repeatedly exposed to terrorist attacks and  propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism.

Publication Types:      Randomized Controlled Trial

PMID: 17721962 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):517-27.

Validation of a screening instrument for posttraumatic stress disorder in a community sample of Bedouin men serving in the Israeli Defense Forces.

Caspi Y, Carlson EB, Klein E.

Department of Psychiatry, Rambam Medical Center, Haifa, Israel. y_caspi@rambam.health.gov.il

This study evaluates the performance of the Screen for Posttraumatic Stress Disorder (SPTSS) in the assessment of a high-risk ethnic minority sample. Participants included 317 Bedouin men serving in the Israeli Defense Forces (IDF), who disclosed extensive trauma and loss. The sensitivity and specificity of the SPTSS were calculated using the Structured Clinical Interview for DSM-IV (SCID) as the criterion for posttraumatic stress disorder (PTSD), which was diagnosed in 14.5% of respondents. Receiver operating characteristic (ROC) analysis using the SPTSS total mean scores maximized classification accuracy at a cut point of 5.5, yielding equal sensitivity and specificity rates of 89%. Likelihood ratios indicated that men with positive screens who did not meet criteria for PTSD were likely to report significant emotional distress and functional impairment.

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

PMID: 17721959 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):481-6.

Comment in:     J Trauma Stress. 2007 Aug;20(4):467-79.

Comment on:     J Trauma Stress. 2007 Aug;20(4):449-65.

Revisiting Dohrenwend et al.'s revisit of the National Vietnam Veterans Readjustment Study.

McNally RJ.

Department of Psychology, Harvard University, Cambridge, MA 02138, USA. rjm@wjh.harvard.edu

Critics of the National Vietnam Veterans Readjustment Study (NVVRS) suspect that  the NVVRS overestimated the prevalence of posttraumatic stress disorder (PTSD) among Vietnam veterans. Dohrenwend et al. (2006) confirmed this suspicion. Dohrenwend et al.'s reanalysis of the NVVRS data resulted in a prevalence estimate 40% lower than the original NVVRS estimate. Furthermore, had they required clinically significant functional impairment, the prevalence rate would  have been 65% lower than the original NVVRS rate. That is, the current (late 1980s) prevalence estimates for PTSD are 15.2% (original NVVRS), 9.1% (Dohrenwend et al.), and 5.4% (clinically significant functional impairment). The policy implications of these findings are discussed.

Publication Types:      Comment

PMID: 17721958 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):643-9.

Circumstances of service and gender differences in war-related PTSD: findings from the National Vietnam Veteran Readjustment Study.

Turner JB, Turse NA, Dohrenwend BP.

Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA. jbt12@columbia.edu

Data from the National Vietnam Veteran Readjustment Study (NVVRS) revealed a prevalence of current posttraumatic stress disorder (PTSD) in female Vietnam Theater veterans half the size of the prevalence in their male counterparts. This stands in contrast to the elevated prevalence of PTSD in women obtained in general population surveys. This study undertakes further analyses of gender differences in the NVVRS and how these differences might be specified by the amount and type of exposure to war-zone stress. The findings indicate that male elevations in PTSD are limited to men who served under circumstances of high probable severity of war-zone stress exposure. When prewar demographic differences are controlled, male veterans in low-exposure circumstances display a level of PTSD prevalence substantially lower than female veterans.

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

PMID: 17721956 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):495-503.

PTSD symptoms, life events, and unit cohesion in U.S. soldiers: baseline findings from the neurocognition deployment health study.

Brailey K, Vasterling JJ, Proctor SP, Constans JI, Friedman MJ.

Southeast Louisiana Veterans Health Care System and Tulane University, New Orleans, LA, USA. Kevin.Brailey@va.gov

Relationships among a modifiable situational factor (unit cohesion), prior stressful life events, and posttraumatic stress disorder (PTSD) symptoms were assessed in 1,579 U.S. Army soldiers with no history of contemporary war zone deployment. It was predicted that unit cohesion would attenuate the dose-response relationship between past stressor exposures and PTSD symptoms at relatively moderate levels of exposure. Consistent with this hypothesis, regression analysis revealed that life experiences and unit cohesion strongly and independently predicted PTSD symptoms, and that unit cohesion attenuated the impact of life experiences on PTSD. Some military personnel reported significant predeployment,  stress-related symptoms. These symptoms may serve as vulnerabilities that could potentially be activated by subsequent war-zone deployment. Higher predeployment  unit cohesion levels appear to ameliorate such symptoms, potentially lessening future vulnerability.

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

PMID: 17721953 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Aug;20(4):449-65.

Comment in:     J Trauma Stress. 2007 Aug;20(4):467-79.    J Trauma Stress. 2007 Aug;20(4):481-6.    J Trauma Stress. 2007 Aug;20(4):487-93.

Continuing controversy over the psychological risks of Vietnam for U.S. veterans.

Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R.

Department of Psychiatry, Columbia University, New York, NY 10032, USA. dohrenw@pi.cpmc.columbia.edu

In 1988, the National Vietnam Veterans Readjustment Study (NVVRS) reported 30.9%  lifetime and 15.2% current rates of posttraumatic stress disorder (PTSD), and a strong dose/response relationship with retrospective reports of combat exposure.  Skeptics argued that recall bias and other flaws inflated the results. Using a new record-based exposure measure and diagnoses in an NVVRS subsample, the authors addressed this controversy in a recent issue of Science (B. P. Dohrenwend et al., 2006). They found little evidence of falsification, an even stronger dose/response relationship and, when fully adjusted for impairment and evidence of exposure, 18.7% onset and 9.1% current rates of war-related PTSD. The fact that these rates are lower than the original NVVRS rates has stimulated continuing controversy that has tended to obscure the more important implications of the study's results.

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

PMID: 17721952 [PubMed - indexed for MEDLINE]

 

JAMA. 2007 Aug 1;298(5):588.

JAMA patient page. Posttraumatic stress disorder.

Stevens LM, Burke AE, Glass RM.

Publication Types:      Patient Education Handout

PMID: 17666680 [PubMed - indexed for MEDLINE]

 

JAMA. 2007 Aug 1;298(5):555-9.

Comment in:     JAMA. 2007 Aug 1;298(5):567-8.

Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers.

Bayer CP, Klasen F, Adam H.

Outpatient Clinic for Refugee Children and Their Families, Department of Child and Adolescent Psychiatry, University Clinic Hamburg, Germany.

CONTEXT: Tens of thousands of the estimated 250,000 child soldiers worldwide are  abused or have been abused during the last decade in Africa's Great Lakes Region. In the process of rebuilding the war-torn societies, it is important to understand how psychological trauma may shape the former child soldiers' ability  to reconcile. OBJECTIVE: To investigate the association of posttraumatic stress disorder (PTSD) symptoms and openness to reconciliation and feelings of revenge in former Ugandan and Congolese child soldiers. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional field study of 169 former child soldiers (aged 11-18 years) in rehabilitation centers in Uganda and the Democratic Republic of the Congo, conducted in 2005. MAIN OUTCOME MEASURES: Potentially traumatic war-related experiences assessed via a sample-specific events scale; PTSD symptoms assessed using the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI), with a score of 35 or higher indicating clinically important PTSD symptoms; and openness to reconciliation and feelings of revenge assessed via structured questionnaires. RESULTS: Children participating in this study were a mean of 15.3 years old. These former child soldiers reported that they had been (violently) recruited by armed forces at a young age (mean [SD], 12.1 [2] years), had served a mean of 38 months (SD, 24 months), and had been demobilized a mean of 2.3 months before data collection (SD, 2.4 months). The children were exposed  to a high level of potentially traumatic events (mean [SD], 11.1 [2.99]). The most commonly reported traumatic experiences were having witnessed shooting (92.9%), having witnessed someone wounded (89.9%), and having been seriously beaten (84%). A total of 54.4% reported having killed someone, and 27.8% reported that they were forced to engage in sexual contact. Of the 169 interviewed, 59 (34.9%; 95% confidence interval, 34.4%-35.4%) had a PTSD symptom score higher than 35. Children who showed more PTSD symptoms had significantly less openness to reconciliation (rho= -0.34, P < .001) and more feelings of revenge (rho= 0.29, P < .001). CONCLUSIONS: PTSD symptoms are associated with less openness to reconciliation and more feelings of revenge among former Ugandan and Congolese child soldiers. The effect of psychological trauma should be considered when these children are rehabilitated and reintegrated into civilian society.

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

PMID: 17666676 [PubMed - indexed for MEDLINE]

 

JAMA. 2007 Aug 1;298(5):543-54.

Comment in:     JAMA. 2007 Aug 1;298(5):567-8.

Exposure to war crimes and implications for peace building in northern Uganda.

Vinck P, Pham PN, Stover E, Weinstein HM.

Payson Center for International Development, Tulane University, New Orleans, Louisiana, USA. pvinck@berkeley.edu

CONTEXT: Since the late 1980s, the Lord's Resistance Army has waged war against the Ugandan People's Democratic Army and the people of northern Uganda. Ending the conflict and achieving peace have proven to be challenges. In this context, it is important to examine population-based data on exposure to war crimes to understand how survivors perceive mechanisms aimed at achieving a lasting peace.  OBJECTIVES: To assess the level of exposure to war-related violence and the prevalence of posttraumatic stress disorder (PTSD) and depression symptoms in northern Uganda and to determine how these variables are associated with respondents' views about peace. DESIGN, SETTING, AND PARTICIPANTS: Multistage, stratified, random cluster survey of 2585 adults aged 18 years or older conducted in villages and camps for internally displaced persons in 4 districts of northern Uganda in April and May 2005. MAIN OUTCOME MEASURES: Rates and patterns of exposure to trauma; symptom criteria for PTSD, assessed via the PTSD Checklist-Civilian Version with a total severity score of 44; symptoms of depression, assessed via the Johns Hopkins Depression Symptom Checklist with a cutoff of 42; and opinions and attitudes about peace. RESULTS: Among the respondents, 1774 of 2389 (74.3%) met PTSD symptom criteria and 1151 of 2585 (44.5%) met depression symptom criteria. Four patterns of exposure to trauma were distinguished: those with low exposure (group 1; 21.4%), witnesses to war-related violence (group 2; 17.8%), those threatened with death and/or physically injured  (group 3; 16.4%), and those abducted (group 4; 44.3%). Respondents in groups 3 and 4, who experienced the most traumatic exposures, were more likely to have PTSD symptoms compared with group 1 (group 3 vs group 1: odds ratio [OR], 7.04 [95% confidence interval {CI}, 5.02-9.87]; group 4 vs group 1: OR, 6.07 [95% CI,  4.77-7.71]). Groups 3 and 4 were also more likely to meet depression symptom criteria (group 3 vs group 1: OR, 5.76 [95% CI, 4.34-7.65]; group 4 vs group 1: OR, 4.00 [95% CI, 3.16-5.06]). Respondents who met the PTSD symptom criteria were more likely to identify violence as a means to achieve peace (OR, 1.31; 95% CI, 1.05-1.65). Respondents who met the depression symptom criteria were less likely  to identify nonviolence as a means to achieve peace (OR, 0.77; 95% CI, 0.65-0.93). CONCLUSIONS: Our study found high prevalence rates for symptoms of PTSD and depression in a conflict zone. Respondents reporting symptoms of PTSD and depression were more likely to favor violent over nonviolent means to end the conflict.

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

PMID: 17666675 [PubMed - indexed for MEDLINE]

 

Med Intensiva. 2007 Aug-Sep;31(6):318-25.

[Emotional disorders and psychological needs of patients in an Intensive Care Unit]

[Article in Spanish]

Gómez-Carretero P, Monsalve V, Soriano JF, de Andrés J.

Investigación, Sociedad Valenciana para el Estudio y Tratamiento del Dolor, Avenida De la Plana 20, 46460 Valencia, Spain. Pgomez212f@cv.gva.es

From the time when a disease whose treatment is going to require hospitalization  for a surgical intervention is diagnosed, both the patient and his/her family members or primary caretakers are involved in a process that may involve the experience of several emotional alterations. This work focuses on the description of the different psychological problems and needs manifested by the patients who  require, as part of the treatment process and recovery control, admission to an Intensive Care Unit (ICU). During the patient's stay in the ICU, the emotional alterations mentioned most frequently by them are anxiety, stress, depression or  the so-called intensive care syndrome, during which factors such as excessive noise that may make sleeping and rest difficult, pain, the methods used for ventilation that prevent the patients from communicating adequately, etc. Furthermore, the patients generally develop a feeling of loss of self-control, the main needs described being the sensation of safety and "knowing what is happening". The experiences lived may continue to produce emotional alterations even months after hospital discharge, with the development of a Posttraumatic Stress Disorder. This justifies a follow-up in order to detect them and treat them adequately. It seems to be appropriate for the treatment of these patients to be multidisciplinary, attending to both the physical needs related with the disease as well as the psychological ones.

Publication Types:      English Abstract     Review

PMID: 17663957 [PubMed - indexed for MEDLINE]

 

Mol Neurobiol. 2007 Aug;36(1):92-101. Epub 2007 Aug 17.

The endocannabinoid system and extinction learning.

Lutz B.

Department of Physiological Chemistry, Johannes Gutenberg-University Mainz, Duesbergweg 6, D-55099 Mainz, Germany. blutz@uni-mainz.de

The endocannabinoid system has emerged as a versatile neuromodulatory system, implicated in a plethora of physiological and pathophysiological processes. Cannabinoid receptor type 1 (CB1 receptor) and endocannabinoids are widely distributed in the brain. Their roles in learning and memory have been well documented, using rodents in various memory tests. Depending on the test, the endocannabinoid system is required in the acquisition and/or extinction of memory. In particular, the activation of CB1 receptor-mediated signaling is centrally involved in the facilitation of behavioral adaptation after the acquisition of aversive memories. As several human psychiatric disorders, such as phobia, generalized anxiety disorders, and posttraumatic stress disorder (PTSD) appear to involve aberrant memory processing and impaired adaptation to changed environmental conditions, the hope has been fuelled that the endocannabinoid system might be a valuable therapeutic target for the treatment of these disorders. This review summarizes the current data on the role of the endocannabinoid system in the modulation of extinction learning.

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

PMID: 17952654 [PubMed - indexed for MEDLINE]

 

Neuroimage. 2007 Aug 1;37(1):282-9. Epub 2007 May 18.

Neural responses to auditory stimulus deviance under threat of electric shock revealed by spatially-filtered magnetoencephalography.

Cornwell BR, Baas JM, Johnson L, Holroyd T, Carver FW, Lissek S, Grillon C.

Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Drive, MSC 2670, Bethesda, MD 20892, USA. cornwellb@mail.nih.gov

Stimulus novelty or deviance may be especially salient in anxiety-related states  due to sensitization to environmental change, a key symptom of anxiety disorders  such as posttraumatic stress disorder (PTSD). We aimed to identify human brain regions that show potentiated responses to stimulus deviance during anticipatory  anxiety. Twenty participants (14 men) were presented a passive oddball auditory task in which they were exposed to uniform auditory stimulation of tones with occasional deviations in tone frequency, a procedure that elicits the mismatch negativity (MMN) and its magnetic counterpart (MMNm). These stimuli were presented during threat periods when participants anticipated unpleasant electric shocks, and safe periods when no shocks were anticipated. Neuromagnetic data were collected with a 275-channel whole-head MEG system and event-related beamformer analyses were conducted to estimate source power across the brain in response to  stimulus deviance. Source analyses revealed greater right auditory and inferior parietal activity to stimulus deviance under threat relative to safe conditions,  consistent with locations of MMN and MMNm sources identified in other studies. Structures related to evaluation of threat, left amygdala and right insula, also  showed increased activity to stimulus deviance under threat. As anxiety level increased across participants, right and left auditory cortical as well as right  amygdala activity increased to stimulus deviance. These findings fit with evidence of a potentiated MMN in PTSD relative to healthy controls, and warrant closer evaluation of how these structures might form a functional network mediating sensitization to stimulus deviance during anticipatory anxiety.

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

PMID: 17566766 [PubMed - indexed for MEDLINE]

 

Pediatr Blood Cancer. 2007 Aug;49(2):177-82.

Posttraumatic stress disorder (PTSD) in young adult survivors of childhood cancer.

Rourke MT, Hobbie WL, Schwartz L, Kazak AE.

Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. rourke@email.chop.edu

BACKGROUND: Posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) were assessed in young adult survivors of childhood cancer, including the role of four sets of variables in understanding PTSD in this population: demographic characteristics, disease and treatment factors, psychosocial and functional outcomes, and cancer-related beliefs. PROCEDURE: One  hundred eighty-two survivors of pediatric malignancies, ages 18-37 years old completed a psychiatric interview and self-report measures. Survivors were >or=5  years from diagnosis and >or=2 years from the completion of cancer treatment for  a variety of cancers. RESULTS: Nearly 16% of the sample had PTSD. Most survivors  reported re-experiencing symptoms. There were no significant differences between  survivors with and without PTSD on demographic or disease and treatment variables. Survivors with PTSD reported more psychological problems and negative  beliefs about their illness and health status than those without PTSD. A logistic regression model predicted 50% of the variance in PTSD. CONCLUSIONS: PTSD affects a subset of young adult cancer survivors. These survivors experience more psychological problems in general. Beliefs about the cancer experience are more potent predictors of PTSD than demographic or disease and treatment factors. Screening for PTSS and PTSD in cancer survivors is recommended.

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

PMID: 16862538 [PubMed - indexed for MEDLINE]

 

Prenat Diagn. 2007 Aug;27(8):709-16.

A prospective study on parental coping 4 months after termination of pregnancy for fetal anomalies.

Korenromp MJ, Page-Christiaens GC, van den Bout J, Mulder EJ, Hunfeld JA, Potters CM, Erwich JJ, van Binsbergen CJ, Brons JT, Beekhuis JR, Omtzigt AW, Visser GH.

Department of Perinatology and Gynaecology, University Medical Centre Utrecht, The Netherlands. m.korenromp@umcutrecht.nl

OBJECTIVE: To identify short-term factors influencing psychological outcome of termination of pregnancy for fetal anomaly, in order to define those patients most vulnerable to psychopathology. STUDY DESIGN: A prospective cohort of 217 women and 169 men completed standardized questionnaires 4 months after termination. Psychological adjustment was measured by the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Edinburgh Postnatal Depression Scale (EPDS), and the Symptom Checklist-90 (SCL-90). RESULTS: Women and men showed high levels of posttraumatic stress (PTS) symptoms (44 and 22%, respectively) and symptoms of depression (28 and 16%, respectively). Determinants of adverse psychological outcome were the following: high level of doubt in the decision period, inadequate partner support, low self-efficacy, lower parental age, being religious, and advanced gestational age. Whether the condition was Down syndrome or another disability was irrelevant to the outcome. Termination did not have an important effect on future reproductive intentions. Only 2% of women and less than 1% of men regretted the decision to terminate. CONCLUSION: Termination of pregnancy (TOP) for fetal anomaly affects parents deeply. Four months after termination a considerable part still suffers from posttraumatic stress symptoms and depressive feelings. Patients who are at high risk could benefit from intensified support. Copyright (c) 2007 John Wiley & Sons, Ltd.

PMID: 17533631 [PubMed - indexed for MEDLINE]

 

Psicothema. 2007 Aug;19(3):459-66.

[Psychopathological profile of battered women according to age]

[Article in Spanish]

Sarasua B, Zubizarreta I, Echeburúa E, Del Corral P.

Centro de Violencia de Género, Programa de Asistencia Psicológica de la Diputación Foral de Alava y del Ayuntamiento de Vitoria-Gasteiz, Spain.

In this paper, differential psychopathological consequences in battered women according to age were analysed in a sample of 148 victims seeking psychological treatment in a Family Violence Centre. The younger victims exposed to intimate partner violence suffered more often from physical violence and were at higher risk for their lives than the older ones. The prevalence rate of posttraumatic stress disorder (PTSD) was higher (42%) in the younger victims than in the older  ones (27%). Likewise, younger victims were affected by more depressive symptoms and lower self-esteem than the older ones. The severity of PTSD in the younger victims was related to the presence of forced sexual relationship but in the older ones, it was related to the perceived threat to their lives. Implications of this study for clinical practice and future research in this field are commented upon.

Publication Types:      English Abstract

PMID: 17617986 [PubMed - indexed for MEDLINE]

 

Psicothema. 2007 Aug;19(3):446-51.

[Posttraumatic Stress Disorder and its relationship with negative cognitive schemas in battered women]

[Article in Spanish]

Calvete E, Estévez A, Corral S.

Facultad de Psicología, Universidad de Deusto, Bilbao, Spain. ecalvete@fice.deusto.es

This study assessed the association between Posttraumatic Stress Disorder symptoms (PTSD) and maladaptive cognitive schemas among intimate partner violence victims. The sample comprised 114 women from specialized services for victims, who completed measures of physical aggression, sexual abuse, psychological abuse, PTSD, and cognitive schemas. Results showed that 67.54% of women met the diagnostic criteria of PTSD. These women endorsed higher levels of schemas related to mistrust/abuse, vulnerability to harm, defectiveness, shame, enmeshment, abandonment and dependence. A structural equation model showed that the relationship between violence and cognitive schemas was fully mediated by the PTSD symptoms. Finally, the clinical implications of the results are discussed.

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

PMID: 17617984 [PubMed - indexed for MEDLINE]

 

Twin Res Hum Genet. 2007 Aug;10(4):564-72.

Trauma exposure and stress response: exploration of mechanisms of cause and effect.

Jang KL, Taylor S, Stein MB, Yamagata S.

Department of Psychiatry, University of British Columbia, Vancouver, Canada. kjang@interchange.ubc.ca

People differ markedly in their risk for developing posttraumatic stress symptoms (PTSS) after exposure to traumatic events. Twin studies suggest that the trauma-PTSS relationship is moderated by genetic and environmental influences. The present study tested for specific types of genetic and environmental interaction effects on PTSS. A sample of 222 monozygotic and 184 dizygotic twin pairs reported on lifetime frequency of assaultive and nonassaultive trauma and associated PTSS. Biometric analyses indicated that in the case of nonassaultive trauma, PTSS were directly affected by environmental factors that also influence  exposure to nonassaultive trauma. For assaultive trauma both genetic and non-shared environmental influences jointly affected PTSS, and the number of traumatic events moderated the severity of PTSS. Genetic factors were found to become less important beyond some threshold (e.g., 3 or 4 types of serious trauma) suggesting that genetic factors - which may confer either risk or resilience to PTSS - modify these symptoms within a range of human experience, beyond which environmental effects supervene.

Publication Types:      Twin Study

PMID: 17708697 [PubMed - indexed for MEDLINE]

 

Med J Aust. 2007 Jul 16;187(2):120-3.

Treating adults with acute stress disorder and post-traumatic stress disorder in  general practice: a clinical update.

Forbes D, Creamer MC, Phelps AJ, Couineau AL, Cooper JA, Bryant RA, McFarlane AC, Devilly GJ, Matthews LR, Raphael B.

Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, VIC, Australia. dforbes@unimelb.edu.au

General practitioners have an important role to play in helping patients after exposure to severe psychological trauma. In the immediate aftermath of trauma, GPs should offer "psychological first aid", which includes monitoring of the patient's mental state, providing general emotional support and information, and  encouraging the active use of social support networks, and self-care strategies.  Drug treatments should be avoided as a preventive intervention after traumatic exposure; they may be used cautiously in cases of extreme distress that persists. Adults with acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) should be provided with trauma-focused cognitive behaviour therapy (CBT). Eye movement desensitisation and reprocessing (EMDR) in addition to in-vivo exposure  (confronting avoided situations, people or places in a graded and systematic manner) may also be provided for PTSD. Drug treatments should not normally replace trauma-focused psychological therapy as a first-line treatment for adults with PTSD. If medication is considered for treating PTSD in adults, selective serotonin reuptake inhibitor antidepressants are the first choice. Other new generation antidepressants and older tricyclic antidepressants should be considered as second-line pharmacological options. Monoamine oxidase inhibitors may be considered by mental health specialists for use in people with treatment-resistant symptoms.

PMID: 17635099 [PubMed - indexed for MEDLINE]

 

Depress Anxiety. 2007 Jul 2 [Epub ahead of print]

Clinical and sociodemographic variables associated with the onset of posttraumatic stress disorder in road traffic accidents.

Coronas R, García-Parés G, Viladrich C, Santos JM, Menchón JM.

Corporació Hospitalŕria Parc Taulí, Sabadell 08205 (Barcelona), Spain.

Our objective was to identify variables related to the onset of acute posttraumatic stress disorder (PTSD) after a road traffic accident. We evaluated  60 victims of a motor vehicle accident (MVA) in 2004 at 2 months postaccident. Thirty of them had developed PTSD; the other 30 had not developed PTSD. Clinical  data, physical injuries, and sociodemographic characteristics were determined in  60 victims. The Davidson Trauma Scale (DTS) and a Structured Clinical Interview for DSM-IV (SCID) were used to evaluate PTSD occurrence. PTSD scores assessed by  DTS and SCID at 2 months were significantly and positively associated with female sex, severe physical injuries, perceived social deprivation, and loss of job activity due to the accident. Female sex, severe physical injury, perceived social deprivation, and sick leave were related to the diagnosis of PTSD 2 months after the accident. Depression and Anxiety 0:1-8, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17607753 [PubMed - as supplied by publisher]

 

AIDS Patient Care STDS. 2007 Jul;21(7):501-8.

Posttraumatic stress and trauma history in adolescents and young adults with HIV.

Radcliffe J, Fleisher CL, Hawkins LA, Tanney M, Kassam-Adams N, Ambrose C, Rudy BJ.

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19010, USA. radcliffe@email.chop.edu

This study examined trauma history and posttraumatic stress in a sample of 30 adolescents and young adults with HIV/AIDS, recruited from December 14, 2004 through May 3, 2005. Overall, participants reported a mean of 5.63 traumatic events, with 93% of the sample reporting that receiving a diagnosis of HIV was experienced as traumatic. Of these, 13.3% met criteria for posttraumatic stress disorder in response to HIV diagnosis, while an additional 20% showed significant post-traumatic stress symptoms. Even greater rates of posttraumatic stress were reported in response to other trauma, with 47% of youth surveyed reporting symptoms of posttraumatic stress in response to such traumatic events as being a  victim of a personal attack, sexual abuse, or being abandoned by a caregiver. These findings may inform professionals about the potential impact of the HIV diagnosis on adolescents and young adults, particularly as this may impact participation in medical care and need for mental health support.

PMID: 17651031 [PubMed - indexed for MEDLINE]

 

Am J Orthopsychiatry. 2007 Jul;77(3):434-42.

Do urban adolescents become desensitized to community violence? Data from a national survey.

McCart MR, Smith DW, Saunders BE, Kilpatrick DG, Resnick H, Ruggiero KJ.

Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC 29425, USA. mccartm@musc.edu

This study explored whether the response of urban adolescents to community violence exposure differs from their response to family violence and sexual assault. More specifically, the authors explored whether desensitization to community violence exposure was more common compared with desensitization to other violence-related stressors. Participants included 1,245 urban adolescents drawn from a national probability sample of 4,023 youth (aged 12-17 years) who were interviewed about their history of interpersonal violence exposure, symptoms of posttraumatic stress disorder (PTSD), and delinquency. A negative curvilinear  effect of community violence exposure on PTSD combined with a positive linear effect of exposure on delinquency was considered evidence for desensitization. Results provided minimal support for the desensitization hypothesis and revealed  increasing levels of PTSD symptoms and delinquent behaviors among boys and girls  exposed to higher levels of all three violence types. ((c) 2007 APA, all rights reserved).

PMID: 17696672 [PubMed - indexed for MEDLINE]

 

Am J Orthopsychiatry. 2007 Jul;77(3):419-26.

Posttraumatic distress and growth among wives of prisoners of war: the contribution of husbands' posttraumatic stress disorder and wives' own attachments.

Dekel R.

Bar-Ilan University, Ramat-Gan, Israel 52900. dekel1@mail.biu.ac.il

This study examined distress and growth among wives of former combat veterans and prisoners of war (POWs), and the contribution of their husband's posttraumatic stress disorder (PTSD) and the wives' own attachment style to these outcomes. Two groups of wives participated in the study: 87 wives of former POWs, and 74 wives  of control veterans. The wives of POWs reported significantly higher levels of distress and growth than did the wives of the controls. Husbands' PTSD symptomatology, as well as higher levels of avoidance and anxiety dimensions of attachment, contributed positively to distress and to growth. Further studies on  the unique predictors of growth are needed. ((c) 2007 APA, all rights reserved).

PMID: 17696670 [PubMed - indexed for MEDLINE]

 

Ann Epidemiol. 2007 Jul;17(7):525-32. Epub 2007 Apr 11.

Reliability of standard health assessment instruments in a large, population-based cohort study.

Smith TC, Smith B, Jacobson IG, Corbeil TE, Ryan MA; Millennium Cohort Study Team.

Department of Defense Center for Deployment Health Research at the Naval Health Research Center, San Diego, CA 92186-5122, USA. Smith@nhrc.navy.mil

PURPOSE: The Millennium Cohort Study began in 2001 using mail and Internet questionnaires to gather occupational and environmental exposure, behavioral risk factor, and health outcome data from a large, population-based US military cohort. Standardized instruments, including the Patient Health Questionnaire, the Medical Outcomes Study Short Form-36 for Veterans, and the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version, have been validated in various populations. The purpose of this study was to investigate internal consistency of standardized instruments and concordance of responses in a test-retest setting. METHODS: Cronbach alpha coefficients were used to investigate the internal consistency of standardized instruments among 76,742 participants. Kappa statistics were calculated to measure stability of aggregated responses in a subgroup of 470 participants who voluntarily submitted an additional survey within 6 months of their original submission. RESULTS: High internal consistency  was found for 14 of 16 health components, with lower internal consistency found among two alcohol components. Substantial test-retest stability was observed for  stationary variables, while moderate stability was found for more dynamic variables that measured conditions with low prevalence. CONCLUSIONS: These results substantiate internal consistency and stability of several standard health instruments applied to this large cohort. Such reliability analyses are vital to the integrity of long-term outcome studies.

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

PMID: 17433714 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 Jul;64(7):843-52.

Combat and peacekeeping operations in relation to prevalence of mental disorders  and perceived need for mental health care: findings from a large representative sample of military personnel.

Sareen J, Cox BJ, Afifi TO, Stein MB, Belik SL, Meadows G, Asmundson GJ.

Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB PZ430, Canada R3E 3N4. sareen@cc.umanitoba.ca

CONTEXT: Although military personnel are trained for combat and peacekeeping operations, accumulating evidence indicates that deployment-related exposure to traumatic events is associated with mental health problems and mental health service use. OBJECTIVE: To examine the relationships between combat and peacekeeping operations and the prevalence of mental disorders, self-perceived need for mental health care, mental health service use, and suicidality. DESIGN:  Cross-sectional, population-based survey. SETTING: Canadian military. PARTICIPANTS: A total of 8441 currently active military personnel (aged 16-54 years). MAIN OUTCOME MEASURES: The DSM-IV mental disorders (major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social phobia, and alcohol dependence) were assessed using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, a fully structured lay-administered psychiatric interview.  The survey included validated measures of self-perceived need for mental health treatment, mental health service use, and suicidal ideation. Lifetime exposure to peacekeeping and combat operations and witnessing atrocities or massacres (ie, mutilated bodies or mass killings) were assessed. RESULTS: The prevalences of any past-year mental disorder assessed in the survey and self-perceived need for care were 14.9% and 23.2%, respectively. Most individuals meeting the criteria for a mental disorder diagnosis did not use any mental health services. Deployment to combat operations and witnessing atrocities were associated with increased prevalence of mental disorders and perceived need for care. After adjusting for the effects of exposure to combat and witnessing atrocities, deployment to peacekeeping operations was not associated with increased prevalence of mental disorders. CONCLUSIONS: This is the first study to use a representative sample of active military personnel to examine the relationship between deployment-related  experiences and mental health problems. It provides evidence of a positive association between combat exposure and witnessing atrocities and mental disorders and self-perceived need for treatment.

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

PMID: 17606818 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2007 Jul 1;62(1):33-9. Epub 2007 Jan 3.

Persistent disruption of a traumatic memory by postretrieval inactivation of glucocorticoid receptors in the amygdala.

Tronel S, Alberini CM.

Department of Neuroscience, Mount Sinai School of Medicine, New York, New York 10029, USA. Cristina.Alberini@mssm.edu

BACKGROUND: Posttraumatic stress disorder (PTSD) is characterized by acute and chronic changes in the stress response, which include alterations in glucocorticoid secretion and critically involve the limbic system, in particular  the amygdala. Important symptoms of PTSD manifest as a classical conditioning to  fear, which recurs each time trauma-related cues remind the subject of the original insult. Traumatic memories based on fear conditioning can be disrupted if interfering events or pharmacological interventions are applied following their retrieval. METHODS AND RESULTS: Using an animal model, here we show that a  traumatic memory is persistently disrupted if immediately after its retrieval glucocorticoid receptors are inactivated in the amygdala. The disruption of the memory is long lasting and memory retention does not re-emerge following strong reminders of the conditioned fear. CONCLUSIONS: We propose that a combinatorial approach of psychological and pharmacological intervention targeting the glucocorticoid system following memory retrieval may represent a novel direction  for the treatment of PTSD.

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

PMID: 17207472 [PubMed - indexed for MEDLINE]

 

Eat Disord. 2007 Jul-Sep;15(4):285-304.

Eating disorders, trauma, and comorbidity: focus on PTSD.

Brewerton TD.

Medical University of South Carolina, Charleston, South Carolina, USA. tbrewerton1@comcast.net

This paper reviews the relationships among eating disorders (EDs), trauma, and comorbid psychiatric disorders, with a particular focus on posttraumatic stress disorder (PTSD). There have been a number of significant conclusions in the literature, applicable to clinical practice, which are essential to the understanding of the relationships between EDs and trauma. These are summarized as follows: a) childhood sexual abuse (CSA) is a nonspecific risk factor for EDs; b) the spectrum of trauma linked to EDs has been extended from CSA to include a variety of other forms of abuse and neglect; c) trauma is more common in bulimic  EDs compared to nonbulimic EDs; d) findings linking EDs with trauma have been extended to children and adolescents with EDs; e) findings linking EDs with trauma have been extended to boys and men with EDs; f) multiple episodes or forms of trauma are associated with EDs; g) trauma is not necessarily associated with greater ED severity; h) trauma is associated with greater comorbidity (including  and often mediated by PTSD) in ED subjects; i) partial or subthreshold PTSD may also be a risk factor for BN and bulimic symptoms; and j) the trauma and PTSD or  its symptoms must be expressly and satisfactorily addressed in order to facilitate full recovery from the ED and all associated comorbidity.

Publication Types:      Review

PMID: 17710567 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2007 Jul-Aug;29(4):357-63.

Depression, acute stress and behavioral risk factors in violently injured adolescents.

Pailler ME, Kassam-Adams N, Datner EM, Fein JA.

Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. pailler@email.chop.edu

OBJECTIVE: The objective of this study was to examine whether emergency department (ED) assessments of depressive and acute stress symptoms after an episode of interpersonal violence are associated with future risk behaviors, reinjury and posttraumatic stress disorder (PTSD) symptoms in adolescents. METHODS: Three hundred ninety-four injured adolescents (age range, 12-17 years) were assessed for depressive symptoms, acute stress symptoms and self-reported risk behaviors either during or immediately after an ED visit (T1). One hundred fifty-eight adolescents completed the follow-up assessment between 6 and 18 months later (T2), during which they were assessed again for self-reported risk behaviors, PTSD symptoms and reinjury. RESULTS: Depression ratings at T1 predicted risk behaviors at T2, controlling for risk behaviors at T1. Ratings of  depression and acute stress at T1 predicted PTSD symptoms at T2 but did not significantly predict the self-reported incidence of violent reinjury at T2. CONCLUSIONS: Assessment of depressive symptoms in adolescents who present to the  ED after a violent event can help identify those in need of further and more formal assessments as well as, possibly, interventions to prevent future risk behaviors. Identification of depressive and acute stress symptoms can also help identify those violently injured youth who report subsequent PTSD symptoms.

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

PMID: 17591513 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2007 Jul-Aug;29(4):294-301.

Performance characteristics of the posttraumatic stress disorder checklist and SPAN in Veterans Affairs primary care settings.

Yeager DE, Magruder KM, Knapp RG, Nicholas JS, Frueh BC.

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29452, USA.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a treatable disorder, and individuals with this condition may benefit from early detection. Many people with PTSD are not aware of its symptoms and do not seek treatment, making a brief and targeted screening program a worthwhile endeavor. For this reason, research aimed at improving screening instruments could yield substantial benefits. OBJECTIVES: The primary objective of this research was to assess the diagnostic performance of two popular PTSD screening assessments, the PTSD Checklist (PCL) and the SPAN, in a Veterans Affairs (VA) primary care setting. Additionally, we compared the screening performance of these two assessments by sex and race. METHODS: The PCL and SPAN were compared with a gold standard, the Clinician-Administered PTSD Scale. Receiver operating characteristic curves were  used in conjunction with sensitivity and specificity measures to assess the performance of each screening assessment. These analyses are based on a large database (n=1076) that was derived from a multisite cross-sectional study conducted at four southeastern VA medical centers. RESULTS: Results for the PCL support cutoff scores lower than those previously published, whereas results for  the SPAN support the previously recommended cutoff score of 5 (sensitivity of 73.68% and specificity of 81.99%). We found no significant difference in areas under the curve (AUCs) by sex and by race between the PCL and SPAN. We did find that there was a highly significant difference (P<.0006) in overall diagnostic ability (as measured by the AUC) between the PCL (AUC=0.882) and SPAN (AUC=0.837), making the PCL the preferred screening tool, unless brevity is essential. CONCLUSIONS: Clinicians and researchers should consider lower cutoff scores for the PCL, but the originally suggested cutoff score for the SPAN is appropriate.

PMID: 17591505 [PubMed - indexed for MEDLINE]

 

J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):811-9.

A pilot randomized controlled trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms.

Cohen JA, Mannarino AP, Perel JM, Staron V.

Drexel University College of Medicine, Allegheny General Hospital, Department of  Psychiatry, Pittsburgh, USA. jcohen1@wpahs.org

OBJECTIVE: To examine the potential benefits of adding a selective serotonin reuptake inhibitor, sertraline, versus placebo, to trauma-focused cognitive-behavioral therapy (TF-CBT) for improving posttraumatic stress disorder and related psychological symptoms in children who have experienced sexual abuse. METHOD: Twenty-four 10- to 17-year-old female children and adolescents and their  primary caretakers were randomly assigned to receive TF-CBT + sertraline or TF-CBT + placebo for 12 weeks. RESULTS: Both groups experienced significant improvement in posttraumatic stress disorder and other clinical outcomes from pre- to posttreatment with no significant group x time differences between groups except in Child Global Assessment Scale ratings, which favored the TF-CBT + sertraline group. CONCLUSIONS: Only minimal evidence suggests a benefit to adding sertraline to TF-CBT. A drawback of adding sertraline was determining whether TF-CBT or sertraline caused clinical improvement for children with comorbid depression. Current evidence therefore supports an initial trial of TF-CBT or other evidence-supported psychotherapy for most children with PTSD symptoms before adding medication.

Publication Types:      Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 17581445 [PubMed - in process]

 

J Clin Child Adolesc Psychol. 2007 Jul-Sep;36(3):392-404.

Suicide attempts among depressed adolescents in primary care.

Fordwood SR, Asarnow JR, Huizar DP, Reise SP.

Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90024-1759, USA.

Although depression is strongly associated with suicide attempts and suicide deaths, most depressed youth do not make an attempt, indicating the need to identify additional risk factors. We examined suicide attempts among 451 depressed primary care patients, 13 to 21 years of age. In bivariate analyses, youth classified as suicide attempters showed elevated levels of psychopathology, specifically depressive symptoms, externalizing behaviors, anxiety, substance use, mania, and posttraumatic stress disorder symptoms. Externalizing behaviors and depression severity uniquely contributed to the prediction of suicide attempts in multivariate analyses. High levels of environmental stress as well as a few key stressful events were associated with suicide attempts; a recent romantic breakup or being assaulted added to suicide attempt risk, beyond the effects of psychopathology. Implications of results for primary care preventive services and suicide attempt prevention are discussed.

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

PMID: 17658983 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2007 Jul;22(7):932-8.

Multiple traumatic experiences and the development of posttraumatic stress disorder.

Scott ST.

Department of Graduate Psychology, Azusa Pacific University, Azusa, CA 91702, USA. sscott@apu.edu

This study assesses the differential and combined impacts of multiple lifetime stressors in the development and severity of posttraumatic stress disorder (PTSD) symptoms. One hundred and four clinical and 64 nonclinical participants were assessed for their exposure to four types of interpersonal trauma: physical and sexual abuse in childhood, lifetime community violence, and domestic violence in  adulthood. PTSD symptomatology was assessed using the Los Angeles Symptom Checklist (LASC). Results indicated that exposure to lifetime multiple traumatic  experiences was positively correlated with severity of PTSD symptoms. Clinical participants had experienced significantly more multiple traumas and had a higher rate of PTSD than the nonclinical participants. Results also suggested that adults who had experienced childhood sexual abuse were at higher risk for the development of PTSD related to interpersonal violence than adults who were not sexually abused as children.

PMID: 17575070 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jul;195(7):580-7.

The role of negative affect intensity and the fear of emotions in posttraumatic stress symptom severity among victims of childhood interpersonal violence.

Tull MT, Jakupcak M, McFadden ME, Roemer L.

Department of Psychology, University of Maryland, College Park, Maryland 20742, USA. MTull@psyc.umd.edu

Heightened negative affect (NA) intensity and the tendency to negatively evaluate emotions may be associated with the development and maintenance of posttraumatic  stress symptoms. However, the specific role of these vulnerabilities has yet to be explored. Thus, this study was conducted to examine the influence of NA intensity and the fear of emotions in posttraumatic symptom severity among 102 childhood interpersonal violence victims. Fear of emotions significantly predicted posttraumatic symptom severity above and beyond NA intensity and NA. Findings suggest that posttraumatic outcomes may not be influenced by an underlying vulnerability of heightened NA intensity, but instead, are affected by the extent to which emotional responses are negatively evaluated. Results are discussed in terms of their implications for interventions and future research on posttraumatic responding.

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

PMID: 17632248 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jul;195(7):572-9.

Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees.

Mollica RF, Caridad KR, Massagli MP.

Harvard Program in Refugee Trauma, Massachusetts General Hospital, Cambridge, Massachusetts 02139, USA. rmollica@partners.org

This longitudinal study examined traumatic memory consistency over a 3-year period among a sample of highly traumatized Bosnian refugees, focusing on demographic factors, types of trauma, and posttraumatic stress disorder (PTSD) and depression. In 1996 and 1999, 376 Bosnian refugees were interviewed about 54  wartime trauma and torture events, and symptoms of PTSD and depression. Reports were compared for both time periods, and changed responses were analyzed for significance. Overall, there was consistency in reporting over time; when change  occurred it was in the direction of decreased reports at follow-up. This downward trend was not associated with any particular diagnosis. However, PTSD alone, without comorbid symptoms of depression, was uniquely associated with the group that exhibited an upward trend. This implies that increased reporting is related  specifically to the presence of PTSD symptoms, and that PTSD may be distinctly associated with the failed extinction of traumatic memories.

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

PMID: 17632247 [PubMed - indexed for MEDLINE]

 

J Subst Abuse Treat. 2007 Jul;33(1):25-32. Epub 2007 Jan 16.

Health problems of substance-dependent veterans with and those without trauma history.

Tate SR, Norman SB, McQuaid JR, Brown SA.

Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.

Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are associated with an increased risk for health problems. We examined whether trauma history and PTSD were related to physical health in patients with an SUD. We compared health stressors, health service utilization, and self-rated health status in three groups of male veterans receiving SUD treatment: (1) no trauma exposure (SUD-only group), n = 55; (2) with PTSD (SUD-PTSD group), n = 32; and (3) trauma exposure without PTSD (SUD-trauma group), n = 34. The veterans were assessed quarterly for 1 year. Groups differed in their likelihood of experiencing chronic health stressors at all time points. The SUD-only group consistently had the lowest rates of chronic health stressors, the SUD-PTSD group had the highest rates, and the SUD-trauma group fell in between. In contrast, groups did not differ in rates of acute health problems. Chronic health stressors appear to be associated with trauma exposure and psychologic response to the trauma. Substance use disorder interventions may benefit from incorporation of primary care services.

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

PMID: 17588486 [PubMed - indexed for MEDLINE]

 

J Trauma Nurs. 2007 Jul-Sep;14(3):165-9.

Gender comparison of exposed trauma and posttraumatic stress disorder in a community sample of adolescents.

Ghanizadeh A, Tavassoli M.

Department of Psychiatry, Hafez Hospital, Shiraz, Iran. ghanizad@sina.tums.ac.ir

This study surveys the prevalence of exposed traumatic events and posttraumatic stress disorder among the high school students. A total of 735 students were selected by stratified cluster sampling. The self-report trauma checklists and Mississippi Scale were used. The most common traumatic experiences were "witnessing or being in a bad car accident," "getting some really bad news unexpectedly," and witnessing violence. The last 2 experiences were more common among girls. The rate of the subjects who scored more than the cutoff point in the Mississippi Scale was 27.2%. There is an extremely high rate of exposed trauma rate, and approximately one third of them have posttraumatic stress disorder symptoms.

PMID: 18080581 [PubMed - indexed for MEDLINE]

 

J Urban Health. 2007 Jul;84(4):508-22.

Effects of integrated trauma treatment on outcomes in a racially/ethnically diverse sample of women in urban community-based substance abuse treatment.

Amaro H, Dai J, Arévalo S, Acevedo A, Matsumoto A, Nieves R, Prado G.

Institute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA. h.amaro@neu.edu

This study presents findings from a quasiexperimental, nonequivalent, group-design study with repeated measures that explored the effects of integrated trauma-informed services on the severity of substance abuse, mental health, posttraumatic stress disorder (PTSD) symptomatology among women with histories of trauma in urban, community-based substance abuse treatment. The study also explored if the model of integrated services was equally beneficial for women of  various racial/ethnic groups. Participants in the study were 342 women receiving  substance abuse treatment in intervention and comparison sites. Results indicated that at 6 and 12 month follow-ups, those in the trauma-informed intervention group, in contrast to the comparison group, had significantly better outcomes in  drug abstinence rates in the past 30 days as well as in mental health and PTSD symptomatology. Results also showed that, overall, integrated services were beneficial for women across the different racial/ethnic groups in substance abuse treatment, although some differences appear to exist across racial/ethnic groups  in improving addiction severity and mental health and PTSD symptomatology.

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

PMID: 17356904 [PubMed - indexed for MEDLINE]

 

Nervenarzt. 2007 Jul;78(7):809-17.

[The effects of stalking on psychiatrists, psychotherapists and psychologists. Prevalence of stalking and its emotional impact]

[Article in German]

Krammer A, Stepan A, Baranyi A, Kapfhammer HP, Rothenhäusler HB.

Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8010 Graz, Osterreich. Alexandra.Krammer@klinikum-graz.at

Stalking in the psychiatric context describes a pathological behaviour which is characterized by repeated persecution, harassment, or menacing of or assault on a person. Because of the association between stalking and mental disorders, psychiatrists, psychologists and psychotherapists belong to particularly exposed  professions. If they fall victim to stalking during their career, disruptive impacts up to posttraumatic stress disorder (PTSD) can be the consequence. A total of 117 psychiatrists, psychologists or psychotherapists in Graz participated in an anonymous interview. To register possible experiences with stalking defined behaviour, a modified version of the questionnaire of Kamleiter  was used. The prevalence and severity of posttraumatic stress symptoms were determined using the Impact of Event Scale of Horowitz. The study showed an incidence of stalking of 38.5%. The rate of female stalkers (60%) was extraordinary high. Most victims (68.9%) experienced non-violent threats. Most of the offenders (41.9%) were diagnosed as suffering from schizophrenia, schizotype  and delusional disorders (F2) followed by disorders of adult personality and behaviour (F6) (30.2%). Some 44.4% of the victims developed symptoms of PTSD, which were usually only slight. The analyses suggest that stalking, in the psychiatric field of activity, is a common and serious phenomenon, and that strategies for the prevention and protection of potentially affected professions  have to be developed.

Publication Types:      English Abstract

PMID: 17106727 [PubMed - indexed for MEDLINE]

 

Pediatrics. 2007 Jul;120(1):232-4; author reply 234-5.

Comment on:     Pediatrics. 2007 Mar;119(3):509-16.

Stressing about posttraumatic stress disorder.

Steen RG, Hamer RM.

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

PMID: 17606583 [PubMed - indexed for MEDLINE]

 

Perspect Psychiatr Care. 2007 Jul;43(3):146-9.

Psychobiological substrates of posttraumatic stress disorder: part II.

Dowben JS, Grant JS, Keltner NL.

Birmingham VA Hospital, AL, USA.

Publication Types:      Case Reports

PMID: 17576308 [PubMed - indexed for MEDLINE]

 

Psychiatry. 2007 Summer;70(2):167-74.

Pilot trial of memantine in the treatment of posttraumatic stress disorder.

Battista MA, Hierholzer R, Khouzam HR, Barlow A, O'Toole S.

VA Central California Health Care System Fresno, Fresno, CA 93703, USA. matthew.battista@med.va.gov

This multiple case series was initially designed as a prospective, open-label, 12-week trial investigation evaluating memantine (Namenda) for the treatment of psychiatric and cognitive symptoms associated with PTSD. In a selected, small sample of individuals (n = 4) with combat PTSD, treatment with memantine produced consistent improvement on a delayed recall measure of memory, variable reduction  of depressive symptoms, and variable reduction in hyperarousal symptoms. These data suggest potential positive treatment outcomes, both cognitively and psychiatrically, and provide rationale for future double-blind, placebo-controlled studies of memantine in PTSD.

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

PMID: 17661541 [PubMed - indexed for MEDLINE]

 

Psychophysiology. 2007 Jul;44(4):660-9. Epub 2007 May 22.

Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review.

Kobayashi I, Boarts JM, Delahanty DL.

Department of Psychology, Kent State University, Kent, Ohio 44242, USA. ikobayas@kent.edu

Although sleep complaints are common among patients with Posttraumatic stress disorder (PTSD), polysomnographic studies examining sleep abnormalities in PTSD have produced inconsistent results. To clarify discrepant findings, we conducted  a meta-analytic review of 20 polysomnographic studies comparing sleep in people with and without PTSD. Results showed that PTSD patients had more stage 1 sleep,  less slow wave sleep, and greater rapid-eye-movement density compared to people without PTSD. We also conducted exploratory analyses aimed at examining potential moderating variables (age, sex, and comorbid depression and substance use disorders). Overall, studies with a greater proportion of male participants or a  low rate of comorbid depression tended to find more PTSD-related sleep disturbances. These findings suggest that sleep abnormalities exist in PTSD, and  that some of the inconsistencies in prior findings may be explained by moderating variables.

Publication Types:      Meta-Analysis     Research Support, N.I.H., Extramural     Review

PMID: 17521374 [PubMed - indexed for MEDLINE]

 

Psychosomatics. 2007 Jul-Aug;48(4):304-8.

Posttraumatic stress disorder and pregnancy health: preliminary update and implications.

Morland L, Goebert D, Onoye J, Frattarelli L, Derauf C, Herbst M, Matsu C, Friedman M.

Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Manoa. leslie.morland@va

Posttraumatic stress disorder (PTSD) is pervasive among women of childbearing age. The cascade of behavioral health and neuroendocrine changes commonly associated with PTSD may adversely affect perinatal health. The authors examined  the relationship between PTSD and perinatal health in a sample of 101 women seeking prenatal care on the island of Oahu, Hawaii. Trauma, PTSD, and psychological and behavioral health were assessed during prenatal care. Pregnancy health, labor and delivery information, and birth outcomes were abstracted from medical records post-partum. Findings suggest that women with PTSD entering pregnancy are at increased risk for engaging in high-risk health behaviors, such  as smoking, alcohol consumption, substance use, poor prenatal care, and excessive weight gain. Authors discuss clinical and research implications.

PMID: 17600166 [PubMed - indexed for MEDLINE]

 

Trauma Violence Abuse. 2007 Jul;8(3):344-53.

Erratum in:     Trauma Violence Abuse. 2007 Jul;8(3):table of contents.

Violence against women and the perinatal period: the impact of lifetime violence  and abuse on pregnancy, postpartum, and breastfeeding.

Kendall-Tackett KA.

Family Research Laboratory, University of New Hampshire, USA.

Violence against women affects millions of women, including women who are pregnant or have recently given birth. During pregnancy, a woman's history of past abuse increases her risk of depression and posttraumatic stress disorder. And these increase the risk of pregnancy and neonatal complications. Women who have experienced past or current abuse are also at high risk for postpartum depression, which can affect their relationships with other adults and their babies. Violence against women can also affect women's ability to breastfeed, although abuse survivors often express an intention to breastfeed and are more likely to initiate breastfeeding than their nonabused counterparts. Current abuse, depression, posttraumatic stress disorder, social isolation, lack of social support, and cessation of breastfeeding all have negative health effects for mothers and babies.

Publication Types:      Review

PMID: 17596350 [PubMed - indexed for MEDLINE]

 

Voen Med Zh. 2007 Jul;328(7):55-61, 96.

[Characteristics of combat disorders in war veterans committed illegal aggressive actions]

[Article in Russian]

Reznik AM, Fastovtsov GA, Vasilevskiĭ VG, Savina OF.

peculiarities of battle posttraumatic stress disorder (PTSD) and personal grounds to criminal aggression of 174 veterans of local wars and armed conflicts. It's shown, that the highest probability of accomplishment of socially dangerous actions is at the term of first 3 years after the influence of stress battle factors. More over different PTSD symptoms. These traits concerned to the following spheres: emotional, cognitive and sphere of values. Among pathologic traits of character, especially clear were shown explosive treats of character, hostility, predominatation of negative emotions, hardly one-sided type of judgments, changes in structure of leading motives and values. Sometimes the scale of moral estimations had double character: "our-strange", "friend-enemy". The highest risk of progress of acute stress reactions with aggressive behavior takes place on condition of disphoria-anxious version of PTSD, which is maximally characterized by person's changes, having sthenic character.

Publication Types:      English Abstract

PMID: 17902346 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2007 Jun 30 [Epub ahead of print]

Self-mutilative behaviors in male veterans with posttraumatic stress disorder.

Sacks MB, Flood AM, Dennis MF, Hertzberg MA, Beckham JC.

San Francisco VA Medical Center, San Francisco, CA, United States.

Self-mutilative behaviors (SMB) were examined in a sample of male veterans with posttraumatic stress disorder (PTSD). The primary objective was to determine the  prevalence of SMB and any physical, cognitive, or affective antecedents and correlates for these behaviors. Participants included 509 male veterans with PTSD and levels of PTSD, depression, alcohol use, hostility, and impulsivity were evaluated to determine if these variables were related to SMB. Antecedents and sequelae of SMB were also examined to generate hypotheses regarding the functions of these behaviors. A second type of habit behavior, body-focused repetitive behaviors (BFRB), was also examined as part of the study. Findings indicated that veterans who engaged in either type of habit behavior were younger than those who did not engage in SMB or BFRB. Veterans reporting SMB also reported higher levels of PTSD, depression, hostility, and impulsivity compared to the BFRB and no-habit groups. Examination of habit antecedents and sequelae showed support for the automatic-positive reinforcement function of SMB. These findings are discussed in the context of research and treatment involving male veterans with PTSD who engage in SMB.

PMID: 17606271 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2007 Jun 30;151(3):249-54. Epub 2007 Mar 27.

Perceived stress in anxiety disorders and the general population: a study of the  Sheehan stress vulnerability scale.

Connor KM, Vaishnavi S, Davidson JR, Sheehan DV, Sheehan KH.

Anxiety and Traumatic Stress Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. kathryn.connor@duke.edu

The objectives of this study were to (1) validate and establish normative values  for a single-item, self-rated measure of perceived stress, the Stress Vulnerability Scale (SVS); and (2) compare levels of perceived stress in patients with anxiety disorders with the general population. The sample was drawn from the general population (n=630) and from participants in pharmacotherapy trials of anxiety disorders (social phobia, n=127; posttraumatic stress disorder, n=116). The SVS was administered at baseline in all groups and following treatment in the placebo-controlled clinical trial samples. The SVS demonstrated good reliability  and validity. Pretreatment scores in the anxiety disorders were significantly greater than in the general population. Perceptions of vulnerability to the effects of daily stress are considerably greater in anxiety disorders compared to the general population and also differ within the anxiety disorders.

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

PMID: 17391774 [PubMed - indexed for MEDLINE]

 

JAMA. 2007 Jun 27;297(24):2694-5; author reply 2695.

Comment on:     JAMA. 2007 Feb 28;297(8):820-30.

Posttraumatic stress disorder and cognitive behavioral therapy.

Spielmans GI, Gatlin ET.

Publication Types:      Comment     Letter

PMID: 17595268 [PubMed - indexed for MEDLINE]

 

Clin Psychol Rev. 2007 Jun 23 [Epub ahead of print]

Understanding posttraumatic nightmares: An empirical and conceptual review.

Phelps AJ, Forbes D, Creamer M.

Posttraumatic nightmares (PTNMs) are a highly prevalent and distressing symptom of posttraumatic stress disorder (PTSD), yet have been subject to limited phenomenological investigation. As a result, the parameters of the symptom required to meet diagnostic criterion for PTSD are unclear and their relationship with normal dreams following trauma is not known. A categorical distinction between PTNMs and normal dreams has been assumed, explicitly within dreaming theories and perhaps implicitly within the PTSD field, but lacks empirical support. This paper reviews the current understanding of PTNMs and normal dreams  following trauma within the PTSD and dreaming fields respectively. It is argued that models of PTSD can readily account for repetitive PTNMs that accurately replay the traumatic event, but not those that are symbolic of the traumatic event. On the other hand, theories of dreaming that propose a psychologically adaptive function of dreams can account for both replay and symbolic nightmares that evolve over time, but not those that are stuck in repetition. It is concluded that there is no adequate explanation for the range of dreams following trauma including the PTNM of PTSD that is both symbolic and repetitive. Three alternate explanatory models are proposed that draw on existing knowledge within  both the PTSD and dreaming fields to explain the full range of nightmares following trauma.

PMID: 17629384 [PubMed - as supplied by publisher]

 

Spine. 2007 Jun 15;32(14):1561-5.

Factors associated with back pain after physical injury: a survey of consecutive  major trauma patients.

Harris IA, Young JM, Rae H, Jalaludin BB, Solomon MJ.

Liverpool Hospital Orthopaedic Department, Liverpool, NSW, Australia. iaharris@optushome.com.au

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: To measure the association between physical and psychosocial factors, and symptoms of back pain after major  physical injury. The study was conducted at a major metropolitan trauma center. SUMMARY OF BACKGROUND DATA: Persistence of back pain has been associated more with psychosocial factors, such as job satisfaction and stress, than with physical factors, such as injury characteristics. Predictors of back pain after major accidental, non-self-inflicted injury have not previously been reported. METHODS: Consecutive adult patients presenting to a single institution with accidental major trauma over a 5-year period were surveyed between 1 and 6 years  postinjury (mean, 41 months; range, 12-74 months). Data pertaining to general factors, injury severity, and psychosocial factors were gathered from the hospital trauma registry and the follow-up questionnaire. The main outcome was symptomatic back pain at follow-up derived from the SF-36 bodily pain subscale. Multivariate analysis was performed to determine which factors were independently associated with back pain at follow-up. RESULTS: Back pain after major trauma was not associated with measures of injury severity, such as the Injury Severity Score or the presence of a spinal fracture. Back pain was also not associated with patient-specific factors, such as age, gender, or occupation. Back pain was  significantly associated with the presence of posttraumatic stress disorder, the  use of a lawyer, the presence of chronic illnesses, and lower education levels. CONCLUSIONS: This study highlights the importance of psychosocial factors as predictors of symptomatic back pain after major physical trauma. The findings do  not support physical factors as important contributors to future low back pain.

PMID: 17572628 [PubMed - indexed for MEDLINE]

 

BMC Psychiatry. 2007 Jun 12;7:24.

Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation.

Suliman S, Ericksen T, Labuschgne P, de Wit R, Stein DJ, Seedat S.

MRC Research Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town, South Africa. sharain@sun.ac.za

BACKGROUND: The weight of evidence suggests that women who freely choose to terminate a pregnancy are unlikely to experience significant mental health risks, however some studies have documented psychological distress in the form of posttraumatic stress disorder and depression in the aftermath of termination. Choice of anaesthetic has been suggested as a determinant of outcome. This study  compared the effects of local anaesthesia and intravenous sedation, administered  for elective surgical termination, on outcomes of pain, cortisol, and psychological distress. METHODS: 155 women were recruited from a private abortion clinic and state hospital (mean age: 25.4 +/- 6.1 years) and assessed on various  symptom domains, using both clinician-administered interviews and self-report measures just prior to termination, immediately post-procedure, and at 1 month and 3 months post-procedure. Morning salivary cortisol assays were collected prior to anaesthesia and termination. RESULTS: The group who received local anaesthetic demonstrated higher baseline cortisol levels (mean = 4.7 vs 0.2), more dissociative symptoms immediately post-termination (mean = 14.7 vs 7.3), and higher levels of pain before (mean = 4.9 vs 3.0) and during the procedure (mean = 8.0 vs 4.4). However, in the longer-term (1 and 3 months), there were no significant differences in pain, psychological outcomes (PTSD, depression, self-esteem, state anxiety), or disability between the groups. More than 65% of the variance in PTSD symptoms at 3 months could be explained by baseline PTSD symptom severity and disability, and post-termination dissociative symptoms. Of interest was the finding that pre-procedural cortisol levels were positively correlated with PTSD symptoms at both 1 and 3 months. CONCLUSION: High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD), with women who receive local anaesthetic experiencing more severe acute reactions. The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status.

Publication Types:      Clinical Trial     Comparative Study     Research Support, Non-U.S. Gov't

PMID: 17565666 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2007 Jun;32(6):1272-83. Epub 2006 Nov 13.

Domestic violence and alcohol use: trauma-related symptoms and motives for drinking.

Kaysen D, Dillworth TM, Simpson T, Waldrop A, Larimer ME, Resick PA.

Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, MO, USA. dkaysen@u.washington.edu

Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting  more severe symptoms. Mediational analyses suggest that the relationship between  drinking and trauma symptoms is mediated by drinking to cope, which has not been  previously demonstrated in a battered population. Results suggest the importance  of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.

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

PMID: 17098370 [PubMed - indexed for MEDLINE]

 

Ann Pharmacother. 2007 Jun;41(6):1013-7. Epub 2007 May 15.

Comment in:     Ann Pharmacother. 2007 Nov;41(11):1917-8.

Prazosin treatment of nightmares related to posttraumatic stress disorder.

Dierks MR, Jordan JK, Sheehan AH.

School of Pharmacy and Pharmaceutical Sciences, Purdue University, West Lafayette, IN, USA. matthew.dierks@alumni.purdue.edu

OBJECTIVE: To describe current data evaluating the use of prazosin in adults with posttraumatic stress disorder (PTSD) who are experiencing nightmares. DATA SOURCES: A literature search using MEDLINE (1966-March 2007) and the Published International Literature on Traumatic Stress database (1982-March 2007) was conducted using the search terms alpha-antagonist, alpha-blocker, prazosin, and posttraumatic stress disorder. References of identified articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION: All English-language articles regarding the use of prazosin in adults with nightmares related to PTSD were reviewed. DATA SYNTHESIS: PTSD is a psychiatric disorder that develops in some people after exposure to trauma. Sleep disturbances occur in up to 70% of patients with PTSD. Several neurotransmitters have been implicated in the pathophysiology of sleep disturbances in PTSD. Adrenergic agents that inhibit norepinephrine, such as prazosin, may decrease the arousal produced by norepinephrine in response to a stressor. Four open-label studies, 1  retrospective chart review, and 2 placebo-controlled trials reporting the use of  prazosin for nightmares related to PTSD were reviewed. All studies included a small number of patients (4-59) and evaluated prazosin dosages ranging from 1 to  20 mg/day. Despite various limitations, all of the studies showed significant improvements in the sleep-related symptoms of PTSD following the addition of prazosin therapy, based on the Clinician Administered PTSD Scale recurrent distressing dreams item and the Clinical Global Impression of Change scale. CONCLUSIONS: Prazosin appears to be a promising and fairly well tolerated agent for the management of PTSD-related nightmares and sleep disturbances. Further well designed trials are warranted to establish its place in therapy.

Publication Types:      Review

PMID: 17504838 [PubMed - indexed for MEDLINE]

 

Behav Ther. 2007 Jun;38(2):155-68. Epub 2007 Jan 18.

Does altering the writing instructions influence outcome associated with written  disclosure?

Sloan DM, Marx BP, Epstein EM, Lexington JM.

Temple University, USA.

This study examined the effect of changing the instructional set for written disclosure on psychological and physical health reports among traumatized college students with current posttraumatic stress symptoms. Eighty-two participants were randomly assigned to one of three writing conditions that focused on emotional expression (EE), insight and cognitive assimilation, or to a control condition. Participants assigned to the EE condition reported significant improvements in psychological and physical health 1 month following the writing sessions relative to the other two conditions. The EE participants also reported and displayed significantly greater initial psychophysiological reactivity and subsequent habituation compared with the other two conditions. These findings suggest the importance of emphasizing emotional expression during written disclosure and underscore the importance of examining how modifying the written disclosure protocol can affect outcome.

Publication Types:      Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 17499082 [PubMed - indexed for MEDLINE]

 

Epilepsy Behav. 2007 Jun;10(4):539-46. Epub 2007 Apr 6.

The role of comorbid psychiatric conditions in health status in epilepsy.

Zeber JE, Copeland LA, Amuan M, Cramer JA, Pugh MJ.

South Texas Veterans Health Care System (HSR&D Verdict), San Antonio, TX 78229-4404, USA. zeber@uthscsa.edu

Comorbid psychiatric conditions are highly prevalent in patients with epilepsy, yet the long-term implications across multiple mental health conditions are poorly understood. We examined the association between psychiatric diagnoses and  self-reported health status in veterans with epilepsy. ANCOVA models were used to derive adjusted SF-36V scores for individuals with epilepsy alone (N=7379) or with additional psychiatric conditions (N=6320): depression, schizophrenia, bipolar disorder, anxiety disorder, substance abuse, and posttraumatic stress disorder (PTSD). Compared with patients with epilepsy alone, scores of veterans with comorbid psychiatric diagnoses averaged 21% lower across all domains. Role Limitation scales exhibited the greatest decrement across domains. A PTSD diagnosis consistently corresponded to lower scores, followed by depression. Schizophrenia contributed the least detriment to perceived health status. Comorbid psychiatric conditions impart significant emotional and physical burdens, requiring timely recognition and treatment of these disorders. Patients  with epilepsy are uniquely at risk for high physical-psychiatric comorbidity profiles, with concomitant losses in perceived health status.

PMID: 17416208 [PubMed - indexed for MEDLINE]

 

Eur Arch Psychiatry Clin Neurosci. 2007 Jun;257(4):191-6.

Psychopathology and alexithymia in severe mental illness: the impact of trauma and posttraumatic stress symptoms.

Spitzer C, Vogel M, Barnow S, Freyberger HJ, Grabe HJ.

Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt University, Rostocker Chaussee 70, 18437 Stralsund, Germany. spitzer@uni-greifswald.de

OBJECTIVE: To empirically investigate whether or not symptoms of posttraumatic stress disorder (PTSD) are essential for transferring the negative effects of trauma on the severity of severe mental illness (SMI) as recently suggested by an interactive model. METHODS: About 122 inpatients with either schizophrenia or major affective disorder were administered the Posttraumatic Diagnostic Scale, the Symptom Checklist and the Toronto Alexithymia Scale. RESULTS: At least one trauma was reported by 83 participants (68%) and 28 patients (23%) reported symptoms of current PTSD. Those SMI subjects with current PTSD symptoms had significantly more psychopathological distress and alexithymic features than those with a trauma exposure but without PTSD symptoms and those patients without any traumatic experiences. DISCUSSION: In line with prior research, our data indicate that patients with SMI have frequently been exposed to traumatic events  and that a third suffers from current posttraumatic stress symptoms. Despite some methodological limitations our findings support the interactive model, which posits that a comorbid PTSD increases the symptom severity of SMI. More attention should be directed at assessing trauma and PTSD in SMI patients and at developing therapeutic interventions.

PMID: 17464547 [PubMed - indexed for MEDLINE]

 

Exp Clin Psychopharmacol. 2007 Jun;15(3):256-63.

Emotional reactivity to trauma stimuli and duration of past smoking cessation attempts in smokers with posttraumatic stress disorder.

Calhoun PS, Dennis MF, Beckham JC.

Veterans Affairs Medical Center, Durham, NC 27705, USA. Patrick.calhoun2@va.gov

The present study examined whether reactivity to emotional stressors is related to early relapse from smoking cessation in persons with posttraumatic stress disorder (PTSD). Smokers with PTSD who had failed to sustain any previous quit attempt for 7 days (n=26) and PTSD smokers who were able to sustain a quit attempt for more than a week (n=50) were exposed to emotional stimuli in the form of personalized scripts that included neutral/relaxing experiences, stressful/nontraumatic experiences, and traumatic experiences. Results indicated  an interaction between script type and group. Although groups did not differ after presentation of neutral scripts, persons with PTSD unable to sustain a quit attempt for as long as 7 days responded with greater levels of emotional reactivity to both stressful and trauma stimuli relative to those able to sustain a quit attempt longer than 7 days. Further, results suggested that emotional reactivity to stressors (both traumatic and nontraumatic) is related to duration  of past longest quit attempt in smokers with PTSD. Results are consistent with findings in nonpsychiatric samples that suggest that individual differences in affective regulatory processes are related to duration of smoking cessation attempts. Systematic replications including a prospective design are recommended. (c) 2007 APA, all rights reserved

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

PMID: 17563212 [PubMed - indexed for MEDLINE]

 

Fam Process. 2007 Jun;46(2):207-27.

Traumatic loss and major disasters: strengthening family and community resilience.

Walsh F.

School of Social Service Administration and Department of Psychiatry, University  of Chicago, USA. fwalsh@uchicago.edu

This article presents the core principles and value of a family and community resilience-oriented approach to recovery from traumatic loss when catastrophic events occur. In contrast to individually based, symptom-focused approaches to trauma recovery, this multisystemic practice approach contextualizes the distress in the traumatic experience and taps strengths and resources in relational networks to foster healing and posttraumatic growth. The intertwining of trauma and traumatic losses is discussed. Key family and social processes in risk and resilience in traumatic loss situations are outlined. Case illustrations, model programs, and intervention guidelines are described in situations of community violence and major disasters to suggest ways to foster family and community resilience.

Publication Types:      Case Reports     Review

PMID: 17593886 [PubMed - indexed for MEDLINE]

 

J ECT. 2007 Jun;23(2):93-5.

Electroconvulsive therapy for comorbid major depressive disorder and posttraumatic stress disorder.

Watts BV.

VA Outcomes Group Research Enhancement Awards Program, VA National Center for Patient Safety, White River Junction VA Medical Center, White River Junction, VT  05001, USA. bradley.v.watts@dartmouth.edu

OBJECTIVE: Posttraumatic stress disorder (PTSD) and major depressive disorder frequently co-occur. Electroconvulsive therapy (ECT) is the most effective treatment for refractory major depressive disorder. We examined the effect of ECT in patients with co-occurring major depression and PTSD. METHOD: Using a retrospective chart review, we examined the outcome of the cases of 26 patients with major depression and co-occurring PTSD who received a course of ECT. The patients received either suprathreshold right unilateral, bilateral, or a combination of both. Using paired t test analysis, we compared the pretreatment and the posttreatment symptoms using the Montgomery-Asberg Depression Rating Scale and the PTSD Checklist. RESULTS: The patients receiving ECT had a significant reduction in the symptoms of major depression and some amelioration in PTSD symptoms. CONCLUSIONS: Electroconvulsive therapy may be an effective treatment for patients with refractory depression and co-occurring PTSD.

PMID: 17548978 [PubMed - indexed for MEDLINE]

 

J Fam Psychol. 2007 Jun;21(2):270-7.

Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans.

Taft CT, Street AE, Marshall AD, Dowdall DJ, Riggs DS.

Behavioral Science Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. casey.taft@va.gov

The authors examined interrelationships among posttraumatic stress disorder (PTSD) symptomatology, anger, and partner abuse perpetration among a sample of 60 combat veterans. Compared with PTSD-negative participants, PTSD-positive participants reported higher state anger across time and neutral and trauma prime conditions and higher anger reactivity during the trauma prime condition. PTSD-positive participants also exhibited more anger reactivity during the trauma prime than during the neutral condition. The same pattern of results was not found for anxiety reactivity during trauma memory activation. PTSD symptoms were  associated with physical assault and psychological aggression perpetration, and trait anger mediated these relationships. Findings indicate a heightened anger response among PTSD-positive veterans and suggest the salience of dispositional components of anger in abuse perpetration in this population.

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

PMID: 17605549 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2007 Jun;22(6):818-21.

Feeling bad in more ways than one: comorbidity patterns of medically unexplained  and psychiatric conditions.

Schur EA, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan PF, Buchwald D.

Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. ellschur@u.washington.edu

BACKGROUND: Considerable overlap in symptoms and disease comorbidity has been noted among medically unexplained and psychiatric conditions seen in the primary  care setting, such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder. OBJECTIVE: To examine interrelationships among these 9 conditions. DESIGN: Using  data from a cross-sectional survey, we described associations and used latent class analysis to investigate complex interrelationships. PARTICIPANTS: 3,982 twins from the University of Washington Twin Registry. MEASUREMENTS: Twins self-reported a doctor's diagnosis of the conditions. RESULTS: Comorbidity among  these 9 conditions far exceeded chance expectations; 31 of 36 associations were significant. Latent class analysis yielded a 4-class solution. Class I (2% prevalence) had high frequencies of each of the 9 conditions. Class II (8% prevalence) had high proportions of multiple psychiatric diagnoses. Class III (17% prevalence) participants reported high proportions of depression, low back pain, and headache. Participants in class IV (73% prevalence) were generally healthy. Class I participants had the poorest markers of health status. CONCLUSIONS: These results support theories suggesting that medically unexplained conditions share a common etiology. Understanding patterns of comorbidity can help clinicians care for challenging patients.

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

PMID: 17503107 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2007 Jun;22(6):719-26. Epub 2007 Mar 10.

Comment in:     J Gen Intern Med. 2007 Jun;22(6):888-9.

PTSD in urban primary care: high prevalence and low physician recognition.

Liebschutz J, Saitz R, Brower V, Keane TM, Lloyd-Travaglini C, Averbuch T, Samet  JH.

Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 91 East Concord St., Suite 200, Boston, MA 02118, USA. jliebs@bu.edu

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with medical and psychological morbidity. The prevalence of PTSD in urban primary care has not been well described. OBJECTIVE: To measure the prevalence of PTSD in primary care patients overall and among those with selected conditions (chronic pain, depression, anxiety, heavy drinking, substance dependence (SD), irritable bowel syndrome (IBS), and immigrant status). DESIGN: Cross-sectional study. PARTICIPANTS: English-speaking patients aged 18-65 years old, awaiting primary care appointments in an urban academic medical center, were eligible for enrollment to determine PTSD prevalence (N = 509). Additional eligible participants (n = 98) with IBS or SD were subsequently enrolled. MEASUREMENTS: PTSD (past year) and trauma exposure were measured with Composite International Diagnostic Interview. We calculated the prevalence of PTSD associated with depression, anxiety, heavy drinking, SD, IBS, and chronic pain. Only the analyses on heavy drinking, SD, and IBS used all 607 participants. RESULTS: Among the 509  adults in primary care, 23% (95% CI, 19-26%) had PTSD, of whom 11% had it noted in the medical record. The prevalence of PTSD, adjusted for age, gender, race, and marital and socioeconomic statuses, was higher in participants with, compared to those without, the following conditions: chronic pain (23 vs 12%, p = .003), major depression (35 vs 11%, p < .0001), anxiety disorders (42 vs 14%, p < .0001), and IBS (34 vs 18%, p = .01) and lower in immigrants (13 vs 21%, p = .05). CONCLUSIONS: The prevalence of PTSD in the urban primary care setting, and  particularly among certain high-risk conditions, compels a critical examination of optimal approaches for screening, intervention, and referral to PTSD treatment.

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

PMID: 17503105 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2007 Jun;22(6):711-8.

Comment in:     J Gen Intern Med. 2007 Jun;22(6):888-9.

Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions.

Campbell DG, Felker BL, Liu CF, Yano EM, Kirchner JE, Chan D, Rubenstein LV, Chaney EF.

Department of Veterans Affairs, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington, USA. Duncan.Campbell@umontana.edu

BACKGROUND: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. OBJECTIVE: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). DESIGN: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. PARTICIPANTS: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. MEASUREMENTS: The Patient Health Questionnaire-9 assessed  MDD. Probable PTSD was defined as a Primary Care PTSD Screen > or = 3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. RESULTS: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P < .001), lower social support (P < .001), more frequent outpatient  health care visits (P < .001), and were more likely to report suicidal ideation (P < .001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. CONCLUSIONS: PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.

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

PMID: 17503104 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2007 Jun;22(6):888-9.

Comment on:     J Gen Intern Med. 2007 Jun;22(6):711-8.    J Gen Intern Med. 2007 Jun;22(6):719-26.

In the shadow of Iraq: posttraumatic stress disorder in 2007.

Greenburg DL, Roy MJ.

Publication Types:      Comment     Editorial

PMID: 17375357 [PubMed - indexed for MEDLINE]

305: J Natl Med Assoc. 2007 Jun;99(6):642-9.

Cardiovascular manifestations of posttraumatic stress disorder.

Bedi US, Arora R.

Department of Internal Medicine, Rosalind Franklin University of Medicine & Science/Chicago Medical School, IL, USA.

Posttraumatic stress disorder (PTSD) involves the onset of psychiatric symptoms after exposure to a traumatic event. PTSD has an estimated lifetime prevalence of 7.8% among adult Americans, and about 15.2% of the men and 8.5% of the women who  served in Vietnam suffered from posttraumatic stress disorder (PTSD) > or =15 years after their military service. Physiological responses (increase in heart rate, blood pressure, tremor and other symptoms of autonomic arousal) to reminders of the trauma are a part of the DSM-IV definition of PTSD. Multiple studies have shown that patients suffering from PTSD have increased resting heart rate, increased startle reaction, and increased heart rate and blood pressure as  responses to traumatic slides, sounds and scripts. Some researchers have studied  the sympathetic nervous system even further by looking at plasma norepinephrine and 24-hour urinary norepinephrine and found them to be elevated in veterans with PTSD as compared to those without PTSD. PTSD is associated with hyperfunctioning  of the central noradrenergic system. Hyperactivity of the sympathoadrenal axis might contribute to cardiovascular disease through the effects of the catecholamines on the heart, the vasculature and platelet function. A psychobiological model based on allostatic load has also been proposed and states that chronic stressors over long durations of time lead to increased neuroendocrine responses, which have adverse effects on the body. PTSD has also been shown to be associated with an increased prevalence of substance abuse. With this review, we have discussed the effects of PTSD on the cardiovascular system.

Publication Types:      Review

PMID: 17595933 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jun;195(6):537-9.

The impact of posttraumatic stress disorder on dysfunctional implicit and explicit emotions among women with borderline personality disorder.

Rüsch N, Corrigan PW, Bohus M, Kühler T, Jacob GA, Lieb K.

Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany. nicolas.ruesch@uniklinik-freiburg.de

A comorbid posttraumatic stress disorder (PTSD) aggravates symptoms, course of illness and social functioning of persons with borderline personality disorder (BPD). However, it is largely unclear how this effect is mediated. In 60 women with BPD of whom 23 had a comorbid current PTSD we investigated whether dysfunctional explicit and implicit emotions were associated with a comorbid PTSD. Shame and guilt proneness, anxiety, anger-hostility, and general psychopathology were assessed by self-report measures. Implicit anxiety-related self-concept was measured using the Implicit Association Test. Self-reported guilt proneness and general psychopathology, but not shame proneness or trait anxiety, were significantly higher in women with BPD and PTSD than in women with  BPD alone. A comorbid PTSD was associated with a more anxiety-prone (relative to  shame-prone) implicit self-concept as assessed by the Implicit Association Test.  Self-reported guilt proneness and implicit anxiety may mediate the negative impact of comorbid PTSD on women with BPD.

Publication Types:      Comparative Study

PMID: 17568303 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jun;195(6):521-31.

A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders.

Norton PJ, Price EC.

Department of Psychology, University of Houston, Houston, TX 77204-5022, USA.

The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses,  outcomes for generalized anxiety disorder and posttraumatic stress disorder were  superior to those for social anxiety disorder, but no other differences emerged.  CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.

Publication Types:      Comparative Study     Meta-Analysis     Research Support, N.I.H., Extramural

PMID: 17568301 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jun;195(6):504-13.

Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial.

Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag R.

Department of Psychiatry and Behavioral Sciences and Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA.

The purpose of the study was to evaluate the potential efficacy and acceptability of accupuncture for posttraumatic stress disorder (PTSD). People diagnosed with PTSD were randomized to either an empirically developed accupuncture treatment (ACU), a group cognitive-behavioral therapy (CBT), or a wait-list control (WLC).  The primary outcome measure was self-reported PTSD symptoms at baseline, end treatment, and 3-month follow-up. Repeated measures MANOVA was used to detect predicted Group X Time effects in both intent-to-treat (ITT) and treatment completion models. Compared with the WLC condition in the ITT model, accupuncture provided large treatment effects for PTSD (F [1, 46] = 12.60; p < 0.01; Cohen's d = 1.29), similar in magnitude to group CBT (F [1, 47] = 12.45; p < 0.01; d = 1.42) (ACU vs. CBT, d = 0.29). Symptom reductions at end treatment were maintained at 3-month follow-up for both interventions. Accupuncture may be an efficacious and acceptable nonexposure treatment option for PTSD. Larger trials with additional controls and methods are warranted to replicate and extend these  findings.

Publication Types:      Comparative Study     Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 17568299 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jun;195(6):492-6.

Seclusion and restraint in patients with schizophrenia: clinical and biographical correlates.

Steinert T, Bergbauer G, Schmid P, Gebhardt RP.

Department of Psychotherapy, Center for Psychiatry Weissenau, Department of Psychiatry I, University of Ulm, Ulm, Germany. tilman.steinert@zfp-weissenau.de

Seclusion and restraint represent adverse experiences that cause negative attitudes against psychiatric treatment and psychopathologic sequels such as posttraumatic stress disorder. We examined 117 consecutive admissions with schizophrenia, with an average of 8.7 previous admissions. Positive and Negative  Syndrome Scale and Global Assessment of Functioning were obtained at admission and discharge, and traumatic events in the biography were recorded using the Posttraumatic Diagnostic Scale. Twenty-four men (42.9%) and 18 women (29.0%) had  experienced seclusion or restraint in their psychiatric history. Seclusion or restraint during the present admission was best predicted in a logistic regression model by physical aggressive behavior [odds ratio (OR), 11.5] and the  Positive and Negative Syndrome Scale hostility item at admission (OR, 23.6). Seclusion or restraint ever in the psychiatric history, however, was mostly associated with lifetime exposure to life-threatening traumatic events (OR, 7.2). We conclude that exposure to traumatic events in the biography severely enhances  the risk of revictimization and retraumatization during inpatient treatment.

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

PMID: 17568297 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Jun;195(6):463-9.

Disability associated with psychiatric symptoms among torture survivors in rural  Nepal.

Tol WA, Komproe IH, Thapa SB, Jordans MJ, Sharma B, De Jong JT.

HealthNet TPO, Department of Public Health and Research, Tolstraat 127, Amsterdam, the Netherlands. wtol@healthnettpo.org

Our objective was to explore the relationships between psychiatric symptom categories (posttraumatic stress disorder (PTSD), anxiety, and depression) and disability among torture survivors. We conducted a cross-sectional study of help-seeking torture survivors in highly affected conflict areas in rural mid-Western Nepal, using rating scales to assess symptomatology and disability.Validated screening instruments for the Nepali setting revealed that a high amount of psychopathology was present. Exploration of the relationships between psychiatric symptomatology and disability showed a central role for PTSD  and anxiety complaints, but not for depressive complaints. A recursive model in which PTSD has (a) a direct relationship with disability and (b) an indirect relationship with disability mediated by anxiety and depression best fits the data. Findings are consistent with research on tortured refugees, suggesting the  importance of a PTSD-anxiety mechanism. Implications for refugees in Western settings are discussed. Complexity of the mental status of torture survivors indicates multidisciplinary treatment.

Publication Types:      Comparative Study

PMID: 17568293 [PubMed - indexed for MEDLINE]

 

J Pers Assess. 2007 Jun;88(3):328-37.

Varying cautionary instructions, monetary incentives, and comorbid diagnostic training in malingered psychopathology research.

Elhai JD, Butcher JJ, Reeves AN, Baugher SN, Gray MJ, Jacobs GA, Fricker-Elhai AE, North TC, Arbisi P.

Disaster Mental Health Institute, University of South Dakota,. Vermillion, SD 57069-2390, USA. jonelhai@fastmail.fm

In this article, we combine two analogue experiments in which we empirically examined three malingering methodological issues in individuals trained and instructed to simulate posttraumatic stress disorder (PTSD) on the Trauma Symptom Inventory (TSI; Briere, 1995). In Experiment 1, we examined TSI scale effects of  the following manipulations using a 2 x 2 design with 330 college students: (a) inclusion or exclusion of cautionary instructions regarding believability of participants' simulation and (b) different financial incentive levels. In Experiment 2, we examined comorbid psychiatric diagnostic training with 180 college students who were either trained to simulate PTSD and comorbid major depressive disorder or trained to simulate only PTSD. Caution main effects were significant for all but two TSI Clinical Scales, incentive main effects and interactions were only significant for one Clinical scale each, and the comorbidity manipulation did not yield any scale differences. We discuss malingering research design implications regarding the use of cautionary instructions, financial incentive levels, and comorbid training.

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

PMID: 17518554 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):353-7.

Are trauma narratives unique and do they predict psychological adjustment?

Beaudreau SA.

Department of Psychology, Washington University in St. Louis, St. Louis, MO, USA. Sherry.Beaudreau@va.gov

Community-dwelling adults (N = 104) aged 20- to 99-years-old told narratives about neutral, positive, and worst traumatic events; they also completed mental health questionnaires. Consistent with previous research, trauma narratives were  longer, and contained more somatosensory and negative bodily experience detail. Recent trauma was associated with more somatosensory detail. Longer trauma narratives were associated with better psychological adjustment, whereas negative bodily experiences related to poorer psychological adjustment and more posttraumatic stress symptoms. Results provide some support for unique trauma narrative characteristics indicative of psychological adjustment among community-dwelling adults.

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

PMID: 17598170 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):221-37.

A randomized trial of self-management and psychoeducational group therapies for comorbid chronic posttraumatic stress disorder and depressive disorder.

Dunn NJ, Rehm LP, Schillaci J, Souchek J, Mehta P, Ashton CM, Yanasak E, Hamilton JD.

Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. ndunn@bcm.tmc.edu

The authors randomized 101 male veterans with chronic combat-related posttraumatic stress disorder (PTSD) and depressive disorder to an evidence-based depression treatment (self-management therapy; n = 51) or active-control therapy  (n = 50). Main outcome measures for efficacy, using intention-to-treat analyses,  were subjective and objective PTSD and depression scales at pretest, posttest, and 3-, 6-, and 12-month follow-up. Other measures included treatment compliance, satisfaction, treatment-targeted constructs, functioning, service utilization, and costs. Self-management therapy's modestly greater improvement on depression symptoms at treatment completion disappeared on follow-up. No other differences on symptoms or functioning appeared, although psychiatric outpatient utilization  and overall outpatient costs were lower with self-management therapy. Despite success in other depressed populations, self-management therapy produced no clinically significant effect in depression with chronic PTSD.

Publication Types:      Comparative Study     Randomized Controlled Trial     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17598141 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):365-9.

Left hand preference is related to posttraumatic stress disorder.

Choudhary CJ, O'carroll RE.

Department of Psychology, University of Stirling, Stirling, Scotland, UK. cjc2@stir.ac.uk

Previous studies have found an increased prevalence of mixed/left handedness in male combat veterans and children with posttraumatic stress disorder (PTSD). This study examined lateral preference and screened for possible PTSD using a self-completion instrument in a general population sample (N = 596). Fifty-one individuals met all criteria for possible diagnosis of PTSD and, significantly, this group contained relatively more left handers; this effect was associated with strong left-handedness, rather than weak or mixed handedness. Left handers were found to have significantly higher scores in arousal symptoms of PTSD. This  study extends previous findings to a civilian population and to women and suggests the association with left handedness may be a robust finding in people with PTSD.

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

PMID: 17598139 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):347-51.

PTSD symptoms in children and adolescents 28 months after a flood: age and gender differences.

Bokszczanin A.

Department of Psychology, Opole University, Opole, Poland. Anna.Bokszczanin@uni.opole.pl

The present study examined the prevalence and predictors of posttraumatic stress  disorder symptoms (PTSD) in a sample of 533 students (aged 11 to 21), 28 months after the 1997 Flood in southwestern Poland. The results show that 18% of the participants met all diagnostic criteria for PTSD. Based on hierarchical multiple regression analyses, PTSD criteria symptoms were positively correlated with the degree of exposure to trauma experienced during the disaster. A three-way interaction of trauma, age, and gender showed that more PTSD symptoms were observed among the younger participants and girls than among the older boys. The  results confirm the need of research testing culturally sensitive implementation  of mental health programs for young victims of disasters, taking into account their age and gender.

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

PMID: 17598138 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):313-23.

Reliability of self-reported trauma exposure among people with heroin dependence: a longitudinal investigation.

Mills K, Teesson M, Darke S, Ross J.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. k.mills@unsw.edu.au

Estimates of trauma exposure rely almost exclusively on retrospective self-reports; however, the reliability of these reports has received little attention. The present study examined the reliability of self-reported lifetime trauma exposure among 309 dependent heroin users over 2 years, and the factors associated with inconsistent recall. The correlation between the number of events reported at baseline and follow-up was .72; however, 87% of the sample reported at least one event inconsistently. Variability in reporting was associated with trauma type, a lifetime posttraumatic stress disorder, and antisocial personality disorder. These findings suggest that dependent heroin users are moderately reliable in their reports of trauma exposure, and their reports of trauma exposure are as reliable as those of nonsubstance use disordered samples.

PMID: 17598137 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):239-49.

PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals.

Simpson TL, Kaysen D, Bowen S, MacPherson LM, Chawla N, Blume A, Marlatt GA, Larimer M.

VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. tracey.simpson@va.gov

The present study evaluated whether Posttraumatic Stress Disorder (PTSD) symptom  severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample. This study utilizes secondary data. The original study demonstrated that Vipassana meditation is associated with reductions in substance use. The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course. Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual, regardless of PTSD symptom severity levels. These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.

Publication Types:      Comparative Study     Controlled Clinical Trial     Research Support, N.I.H., Extramural

PMID: 17597132 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):303-12.

Posttraumatic stress disorder and posttraumatic growth among Israeli ex-pows.

Solomon Z, Dekel R.

Adler Research Center, Tel Aviv University, Ramat Aviv, Israel. solomon@post.tau.ac.il

In this article, the authors present a prospective study that dealt with pathological (posttraumatic stress disorder; PTSD) and salutary (posttraumatic growth; PTG) outcomes of captivity and the correlates of those outcomes among a sample of ex-prisoners of war (POWs) and a control group of combat veterans. Posttraumatic stress disorder and its correlates were assessed in 1991 and 2003,  and PTG was assessed in 2003. The results indicate that ex-POWs exhibited higher  levels of PTSD and PTG than did the controls. In addition, both linear and quadratic associations between PTSD and PTG were found. The authors discuss some  unresolved issues related to assessment of PTG and salutary outcomes, and outline directions for future research.

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

PMID: 17597131 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):335-45.

Psychological symptoms of Turkish children and adolescents after the 1999 earthquake: exposure, gender, location, and time duration.

Sahin NH, Batigün AD, Yilmaz B.

Ankara University, DTCF, Psychology Department, Ankara, Turkey. nesrinhislisahin@gmail.com

The authors describe their study of posttraumatic stress symptoms of children and adolescents after the 1999 earthquakes in Turkey. The rate of possible PTSD cases is also presented. The findings are reported as the results of two different studies. Location had a main effect on almost all of the dependent variables for  both samples. The posttraumatic stress symptom scores for both groups significantly decreased 3 months after the initial assessment. The best predictors of the perceived posttraumatic stress symptoms for both children and adolescents were found to be perceived negative school performance and exposure.

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

PMID: 17597126 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):281-9.

Confirmatory factor analysis of the PTSD checklist in the elderly.

Schinka JA, Brown LM, Borenstein AR, Mortimer JA.

James A. Haley VA Medical Center, Tampa, FL 33612, USA. jschinka@hsc.usf.edu

The authors examined the psychometric characteristics and factor structure of the Civilian Version of the PTSD Checklist (PCL-C; F. W. Weathers, B. T. Litz, J. A.  Huska, & T. Keane, 1994) in elderly survivors, aged 66-90, of the 2004 Florida hurricane disasters. Confirmatory factor analyses of nine models of PCL-C structure revealed the strongest support for a 4-factor model consisting of reexperiencing, avoidance, numbing, and arousal dimensions. Future studies will be facilitated by the knowledge that the PCL-C 4-factor model appears to apply across the adult age range and a variety of posttraumatic stress disorder-producing conditions.

PMID: 17597125 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):251-62.

Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks.

Neria Y, Gross R, Litz B, Maguen S, Insel B, Seirmarco G, Rosenfeld H, Suh EJ, Kishon R, Cook J, Marshall RD.

Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.  ny126@columbia.edu

A Web-based survey of adults who experienced loss during the September 11, 2001,  terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a  study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed.

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

PMID: 17597124 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Jun;20(3):271-80.

Factor structure of PTSD symptoms among West and Central African refugees.

Rasmussen A, Smith H, Keller AS.

Bellevue Hospital, New York, NY 10016, USA. rasmua01@med.nyu.edu

Although trauma is widespread in Africa, Africans are unrepresented in the literature on posttraumatic stress disorder (PTSD). The authors used confirmatory factor analysis of responses to the Harvard Trauma Questionnaire to model PTSD symptom structure in a sample of African refugees presenting at a U.S. torture treatment clinic. They tested four models that are proposed in the literature and one based on their clinical experience in which some symptoms of hyperarousal were integrated into intrusion. Their findings support a preference for a 4-factor aroused intrusion model. Discussion focuses on interpretation of models, the role of numbing and avoidance, and the limitations of Euro American symptoms  in non-Euro American populations.

PMID: 17597123 [PubMed - indexed for MEDLINE]

 

Metab Brain Dis. 2007 Jun;22(2):183-95. Epub 2007 Apr 29.

Early maternal separation alters the response to traumatization: resulting in increased levels of hippocampal neurotrophic factors.

Faure J, Uys JD, Marais L, Stein DJ, Daniels WM.

Department of Medical Physiology, University of Stellenbosch, Tygerberg, Western  Cape, South Africa. jfaure@sun.ac.za

Early life adversity predisposes individuals to the development of psychopathology in later life, especially depression and anxiety disorders. Prior history of stressors may also be a vulnerability factor for developing posttraumatic stress disorder (PTSD) in response to trauma. We examined the mechanisms underlying this phenomenon by employing two animal stress models, early maternal separation followed by later time-dependent sensitization (TDS). In animals exposed to adult TDS, those with prior early adversity did not differ  from controls on tests of anxiety (elevated plus maze, open field), or HPA function (ACTH and corticosterone levels). However, those with prior early adversity had increased levels of neurotrophic factors (BDNF, NGF and NT-3) in both the dorsal and ventral hippocampus. Although early adversity is known to be  associated with negative effects on neuronal function, it may also be associated  with an increased ability to respond to subsequent stressors with compensatory mechanisms such as increased neurotrophic factor release.

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

PMID: 17468977 [PubMed - indexed for MEDLINE]

 

Ophthalmology. 2007 Jun;114(6):1238.

Posttraumatic stress.

Singh RP, Hatton M, Sprich S, Loewenstein J.

Publication Types:      Letter

PMID: 17544795 [PubMed - indexed for MEDLINE]

 

Prim Care. 2007 Jun;34(2):387-405; abstract ix.

Psychological impact of trauma on developing children and youth.

Spates CR, Samaraweera N, Plaisier B, Souza T, Otsui K.

Department of Psychology, Western Michigan University, Kalamazoo, MI 49008, USA.  rspates@wmich.edu

All too often, children and adolescents are exposed to traumatic events that lead to physical injury in many cases, psychological perturbation in most cases, and enduring psychological reactions, notably posttraumatic stress disorder, in a minority of individuals. This sequence of events can affect later development, learning, emotions, and behavior. In the process of caring for the physical injury, it is important for the primary care practitioner (PCP) to correctly interpret these presentations and anticipate the need for specific assessments, immediate intervention, referral, and follow-up. This report provides the foundation for such actions on the part of the PCP.

Publication Types:      Review

PMID: 17666234 [PubMed - indexed for MEDLINE]

 

Psychiatr Danub. 2007 Jun;19(1-2):49-55.

Cerebral cortical atrophy and silent brain infarcts in psychiatric patients.

Avdibegović E, Bećirović E, Selimbasić Z, Hasanović M, Sinanović O.

Psychiatry Clinic, University Clinical Center Tuzla, School of Medicine, University of Tuzla, XVIII Hrvatske brigade 49, 75000 Tuzla, Bosnia and Herzegovina. esmina@bih.net.ba

AIM: To assess the frequency of silent brain infarcts and cerebral cortical atrophy in psychiatric patients with cognitive dysfunction. METHODS: One hundred  and ninety four patients with cognitive dysfunction determined by the use of the  Benton Visual Retention Test and Wechsler Memory Scale were analyzed according to age, gender, education, duration of psychiatric treatment, presence of mental disorders, neurological findings, and CT scan of neurocranium. The results were analyzed using descriptive statistics. RESULTS: Average age of the group of patients studied was 48+/-9.7 years, and average duration of psychiatric treatment was 6+/-7.3 years. Regarding mental disorders, patients suffered from posttraumatic stress disorder (PTSD) in comorbidity with depression (21.1%), depressive disorder (14.4%), Complex PTSD (13.9%), PTSD (11.3%), and post-concussion syndrome (7.7%). Cerebral cortical atrophy was determined in 47.4%, silent brain infarct in 3.6%, whereas the combination of cerebral cortical atrophy and silent brain infarct was found in 26.3% of patients. In 22.6% of patients with cognitive dysfunction on the Benton Visual Retention Test and Wechsler Memory Scale CT scan findings were completely normal. Cerebral cortical  atrophy was more frequent in patients with PTSD in comorbidity with depression (43%), PTSD (39.0%), Complex PTSD (26%), depression (25%), whereas the silent brain infarct was more frequent in patients with post-concussion syndrome (53.3%) and depression (42.8%). CONCLUSION: Cerebral cortical atrophy and silent brain infarct are frequent findings in computerized tomography of the brain in psychiatric patients with cognitive dysfunction. Cerebral atrophy is frequent in  patients with PTSD, whereas in patients with depression, besides cerebral atrophy, silent brain infarct is also frequently present.

PMID: 17603416 [PubMed - indexed for MEDLINE]

 

Psychiatr Q. 2007 Jun;78(2):145-55.

Posttraumatic growth in treatment-seeking female assault victims.

Grubaugh AL, Resick PA.

Center for Trauma Recovery, University of Missouri--St. Louis, St. Louis, MO, USA. grubaugh@musc.edu

The importance of measuring growth outcomes following a traumatic event has been  highlighted in recent literature (e.g., Linley, Joseph: Journal of Traumatic Stress 17:11-21, 2004). Although reports of growth are abundant, the relationship between growth outcomes and post-trauma distress remains unclear, with studies yielding conflicting results regarding this relationship. The purpose of the present study was to explore the interrelationships among growth outcomes and measures of depression and posttraumatic stress disorder (PTSD) among 100 female  treatment-seeking physical and sexual assault victims. Although the majority of women reported some degree of growth in this study, and growth scores were comparable to those from other samples, measures of depression and PTSD were not  significantly related to growth scores. The implication of these findings and future direction for research are discussed.

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

PMID: 17380387 [PubMed - indexed for MEDLINE]

 

Psychol Assess. 2007 Jun;19(2):165-75.

Longitudinal factor structure of posttraumatic stress symptoms related to intimate partner violence.

Krause ED, Kaltman S, Goodman LA, Dutton MA.

Department of Psychiatry, Georgetown University Medical Center, Washington, DC 20007, USA. edk4@georgetown.edu

Confirmatory factor analysis (CFA) studies have suggested that a model of posttraumatic stress disorder (PTSD) that is characterized by 4 factors is preferable to competing models. However, the composition of these 4 factors has varied across studies, with 1 model splitting avoidance and numbing symptoms (e.g., D. W. King, G. A. Leskin, L. A. King, & F. W. Weathers, 1998) and the other including a dysphoria factor that combines numbing and nonspecific hyperarousal symptoms (L. J. Simms, D. Watson, & B. N. Doebbeling, 2002). Using the PTSD Checklist (F. W. Weathers, B. T. Litz, D. S. Herman, J. A. Huska, & T. M. Keane, 1993) and CFA, the authors compared these models with competing models. A model of PTSD with 4 intercorrelated factors of Intrusions, Avoidance, Dysphoria, and Hyperarousal was found superior among 396 medical patients who screened positive for intimate partner violence (IPV) and 405 women seeking services for IPV. Structural invariance testing indicated that this 4-factor model remains stable across service setting and time. (c) 2007 APA, all rights reserved

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

PMID: 17563198 [PubMed - indexed for MEDLINE]

 

Psychol Rep. 2007 Jun;100(3 Pt 2):1115-20.

Trauma and posttraumatic stress disorder in a rural primary care population in South Africa.

Peltzer K, Seakamela MJ, Manganye L, Mamiane KG, Motsei MS, Mathebula TT.

Human Sciences Research Council, University of Limpopo, South Africa. KPeltzer@hsrc.ac.za

The aim of this study was to assess trauma events experienced and PTSD among 250  consecutive rural primary clinic patients (all Black Africans, 24% male and 76% female; M age 31.1 yr., SD = 11.8; range 18-65 years) in South Africa using the Trauma History Questionnaire and the PTSD Checklist-Civilian Version, interview administered. Results indicated that the mean number of traumatic events reported was 3.5 (SD = 2.9, range = 0-19) and was significantly higher among men (M= 4.9,  SD = 3.5) than women (M = 3.0, SD = 2.6). Among the most frequently endorsed traumas among men were seeing someone seriously injured or killed (60%), serious  accident (43.3%), and seeing dead bodies (43.3%), and among women natural disaster (mostly floods) (51.6%), news of a serious injury, life-threatening illness or unexpected death of someone close (31.1%), and seeing someone seriously injured or killed (30%). A current diagnosis of PTSD was found in 12.4% of the sample. Trauma incidence figures were high (M = 3.5) and were comparable with an urban Xhosa primary care population in South Africa (M = 3.8). A current  indicative diagnosis of PTSD of 12.4% also compares with other studies; 19.9% among urban Xhosa primary care patients and 11.8% among American primary care patients.

PMID: 17886497 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2007 Jun;69(5):435-40. Epub 2007 Jun 7.

Disaster-related posttraumatic stress disorder and physical health.

Dirkzwager AJ, van der Velden PG, Grievink L, Yzermans CJ.

Netherlands Institute for Health Services Research, Utrecht, Netherlands. a.dirkzwager@nivel.nl

OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and self-reported as well as physician-recorded physical health in a sample of survivors (n = 896) of a man-made disaster, using a longitudinal design that included predisaster health data. Most studies on the relationship between PTSD and physical health are cross-sectional and use self-reported physical health outcomes. METHODS: A surveillance using the electronic medical records of  survivors' family practitioners (FPs), 1 year predisaster until 4 years postdisaster, was combined with a survey, 3 weeks and 18 months postdisaster. Self-reported PTSD and self-reported physical health were assessed at 18 months postdisaster. FP-recorded physical health problems in the subsequent 2 years were classified according to the International Classification of Primary Care. Multiple regression analyses were used to describe the relationships between PTSD and physical health. RESULTS: After adjusting for demographics, smoking behavior, and predisaster physical health, PTSD was significantly associated with FP-recorded vascular, musculoskeletal, and dermatological problems, and with all  self-reported physical health aspects. Prospectively, PTSD signaled an increased  risk of new vascular problems (odds ratio = 1.92; 1.04-3.55). CONCLUSIONS: This study suggests an effect of PTSD in the development of vascular problems. The results imply that clinicians should be alert that disaster survivors with PTSD can suffer from comorbid medical problems as well.

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

PMID: 17556645 [PubMed - indexed for MEDLINE]

 

Depress Anxiety. 2007 May 31 [Epub ahead of print]

The SCID PTSD module's trauma screen: validity with two samples in detecting trauma history.

Elhai JD, Franklin CL, Gray MJ.

Disaster Mental Health Institute, The University of South Dakota, Vermillion, South Dakota.

We investigated the posttraumatic stress disorder (PTSD) module's trauma screen of the Structured Clinical Interview for DSM-IV (SCID), a single-item traumatic event history query. Compared to the Stressful Life Events Screening Questionnaire (SLESQ), the SCID trauma screen was 76% sensitive in identifying trauma histories in 199 medical patients (correctly ruling out 67%) but only 66%  sensitive in 253 college students (ruling out 87%). A modified, more behaviorally specific SCID trauma screen (M-SCID) yielded poorer results in identifying trauma among 245 additional college students. Based on probable PTSD diagnoses (PTSD Symptom Scale), using the SCID screen instead of the SLESQ, 3% (M-SCID screen) to 11-14% (standard SCID) of PTSD cases were missed due to not having a trauma history. Our results lend support to previous research establishing the SCID trauma screen as a useful screening device in settings where a more comprehensive trauma screen is not possible. Depression and Anxiety 0:1-5, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17541975 [PubMed - as supplied by publisher]

 

Hum Brain Mapp. 2007 May 24 [Epub ahead of print]

Enhanced amygdala and medial prefrontal activation during nonconscious processing of fear in posttraumatic stress disorder: An fMRI study.

Bryant RA, Kemp AH, Felmingham KL, Liddell B, Olivieri G, Peduto A, Gordon E, Williams LM.

Brain Dynamics Centre, Westmead Hospital, Sydeny, New South Wales, Australia.

Biological models of posttraumatic stress disorder (PTSD) suggest that patients will display heightened amygdala but decreased medial prefrontal activity during  processing of fear stimuli. However, a rapid and automatic alerting mechanism for responding to nonconscious signals of fear suggests that PTSD may display heightened rather than decreased MPFC under nonconscious processing of fear stimuli. This study used functional magnetic resonance imaging to examine blood oxygenation level-dependent signal changes during nonconscious presentation (16.7 ms, masked) of fearful and neutral faces in 15 participants with PTSD and 15 age  and sex-matched healthy control participants. Results indicate that PTSD participants display increased amygdala and MPFC activity during nonconscious processing of fearful faces. These data extend existing models by suggesting that the impaired MPFC activation in PTSD may be limited to conscious fear processing. Hum Brain Mapp, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17525984 [PubMed - as supplied by publisher]

 

Health Qual Life Outcomes. 2007 May 21;5:26.

The predictive value of post-traumatic stress disorder symptoms for quality of life: a longitudinal study of physically injured victims of non-domestic violence.

Johansen VA, Wahl AK, Eilertsen DE, Weisaeth L, Hanestad BR.

Faculty of Health Buskerud University College, Drammen, Norway. venke.a.johansen@helse-bergen.no

BACKGROUND: Little is known about longitudinal associations between post-traumatic stress disorder (PTSD) and quality of life (QoL) after exposure to violence. The aims of the current study were to examine quality of life (QoL) and the predictive value of post-traumatic stress disorder (PTSD) for QoL in victims  of non-domestic violence over a period of 12 months. METHODS: A single-group (n = 70) longitudinal design with three repeated measures over a period of 12 months were used. Posttraumatic psychological symptoms were assessed by using the Impact of Event Scale, a 15-item self-rating questionnaire comprising two subscales (intrusion and avoidance) as a screening instrument for PTSD. The questionnaire WHOQOL-Bref was used to assess QoL. The WHOQOL-BREF instrument comprises 26 items, which measure the following broad domains: physical health, psychological  health, social relationships, and environment. Results of the analysis were summarized by fitting Structural Equation Modelling (SEM). RESULTS: For each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOL-Bref subscales (the four domains and the two single items) were stable across time of assessment. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. In addition, the two items examining perception of overall quality of life and perception of overall health in WHOQOL showed the  same results according to PTSD symptoms such as QoL domains. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3. CONCLUSION: The presence of PTSD symptoms predicted lower QoL, both from an acute and prolonged perspective, in victims of non-domestic violence. Focusing on the individual's perception of his/her QoL in addition to the illness may increase the treatment priorities and efforts.

PMID: 17517126 [PubMed - indexed for MEDLINE]

 

Behav Brain Res. 2007 May 16;179(2):192-207. Epub 2007 Feb 6.

Involvement of noradrenergic and corticoid receptors in the consolidation of the  lasting anxiogenic effects of predator stress.

Adamec R, Muir C, Grimes M, Pearcey K.

Department of Psychology, Memorial University, St. John's, Newfoundland, Canada A1B 3X9. radamec@mun.ca

The roles of beta-NER (beta-noradrenergic receptor), GR (glucocorticoid) and mineral corticoid receptors (MR) in the consolidation of anxiogenic effects of predator stress were studied. One minute after predator stress, different groups  of rats were injected (ip) with vehicle, propranolol (beta-NER blocker, 5 and 10  mg/kg), mifepristone (RU486, GR blocker, 20 mg/kg), spironolactone (MR blocker, 50 mg/kg), propranolol (5 mg/kg) plus RU486 (20 mg/kg) or the anxiolytic, chloradiazepoxide (CPZ, 10 mg/kg). One week later, rodent anxiety was assessed in elevated plus maze, hole board, light/dark box, social interaction and acoustic startle. Considering all tests except startle, propranolol dose dependently blocked consolidation of lasting anxiogenic effects of predator stress in all tests. GR receptor block alone was ineffective. However, GR block in combination  with an ineffective dose of propranolol did blocked consolidation of predator stress effects in all tests, suggesting a synergism between beta-NER and GR. Surprisingly, MR block prevented consolidation of anxiogenic effects in all tests except the light/dark box. CPZ post stress was ineffective against the anxiogenic impact of predator stress. Study of startle was complicated by the fact that anxiogenic effects of stress on startle amplitude manifested as both an increase  and a decrease in startle amplitude. Suppression of startle occurred in stressed  plus vehicle injected groups handled three times prior to predator stress. In contrast, stressed plus vehicle rats handled five times prior to predator stress  showed increases in startle, as did all predator stressed only groups. Mechanisms of consolidation of the different startle responses appear to differ. CPZ post stress blocked startle suppression but not enhancement of startle. Propranolol post stress had no effect on either suppression or enhancement of startle. GR block alone post stress prevented suppression of startle, but not enhancement. In contrast blocking GR and beta-NER together prevented startle enhancement. MR block also prevented startle enhancement. Effects of MR block on startle suppression were not tested. Delay of habituation to startle was found in all stressed rats. Consolidation of delay of habituation was blocked or attenuated by post stress MR block, GR plus beta-NER block and CPZ but not by post stress GR or beta-NER block alone. Taken together, present findings suggest consolidation of lasting anxiogenic effects of predator stress may share some of the same neurochemical mechanisms implicated in some forms of fear memory consolidation. Implications of these findings for the study of stress-induced changes in affect  including posttraumatic stress disorder (PTSD) are discussed.

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

PMID: 17335916 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2007 May 15;155(1):45-56. Epub 2007 Apr 6.

Neural correlates of trauma script-imagery in posttraumatic stress disorder with  and without comorbid major depression: a functional MRI investigation.

Lanius RA, Frewen PA, Girotti M, Neufeld RW, Stevens TK, Densmore M.

Department of Psychiatry, University of Western Ontario, London, Ontario, Canada. ruth.lanius@lhsc.on.ca

The goal of this study was to compare neural activation patterns in patients with PTSD with and without current comorbid major depression. Traumatized subjects with PTSD (n=11), PTSD+major depression (MDD, n=15), and subjects (n=16) who met  criterion A for PTSD but never developed the disorder were studied using the script-driven symptom-provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4-Tesla field strength. Both the PTSD+MDD and PTSD-MDD groups revealed decreased brain activation in the anterior cingulate gyrus (BA 24) and the right ventrolateral prefrontal cortex (BA 47). After covariation for differences in PTSD severity between these groups, the left insula (BA 13) remained more significantly activated in the PTSD-MDD group than in the PTSD+MDD group. In contrast, the PTSD+MDD group showed greater activation  than the PTSD-MDD group in the bilateral anterior cingulate gyrus (BA 24) and posterior cingulate cortices (BA 23, 31). These results suggest different patterns of brain activation related to comorbid major depression occurring in the context of PTSD.

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

PMID: 17412567 [PubMed - indexed for MEDLINE]

 

Brain Res. 2007 May 4;1144:165-74. Epub 2007 Jan 31.

Brain responses to symptom provocation and trauma-related short-term memory recall in coal mining accident survivors with acute severe PTSD.

Hou C, Liu J, Wang K, Li L, Liang M, He Z, Liu Y, Zhang Y, Li W, Jiang T.

The Mental Health Institute, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Changsha, Hunan 410011, PR China.

Functional neuroimaging studies have largely been performed in patients with longstanding chronic posttraumatic stress disorder (PTSD). Additionally, memory function of PTSD patients has been proved to be impaired. We sought to characterize the brain responses of patients with acute PTSD and implemented a trauma-related short-term memory recall paradigm. Individuals with acute severe PTSD (n=10) resulting from a mining accident and 7 men exposed to the mining accident without PTSD underwent functional magnetic resonance imaging (fMRI) while performing the symptom provocation and trauma-related short-term memory recall paradigms. During symptom provocation paradigm, PTSD subjects showed diminished responses in right anterior cingulate gyrus, left inferior frontal gyrus and bilateral middle frontal gyrus and enhanced left parahippocampal gyrus  response compared with controls. During the short-term memory recall paradigm, PTSD group showed diminished responses in right inferior frontal gyrus, right middle frontal and left middle occipital gyrus in comparison with controls. PTSD  group exhibited diminished right parahippocampal gyrus response during the memory recall task as compared to the symptom provocation task. Our findings suggest that neurophysiological alterations and memory performance deficit have developed in acute severe PTSD.

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

PMID: 17331476 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2007 May;32(5):902-11. Epub 2006 Jul 20.

Prevalence of posttraumatic stress disorder in alcohol dependent patients in Poland.

Dragan M, Lis-Turlejska M.

Faculty of Psychology, Warsaw University, ul. Stawki 5/7, 00-183 Warsaw, Poland.  mpolak@psych.uw.edu.pl

The present study investigates the prevalence of comorbid posttraumatic stress disorder (PTSD) in a sample of Polish alcohol dependent patients and examines the relationship between comorbid PTSD and alcohol use-related problems. Patients (n=458) were recruited from randomly chosen clinical settings and were administered self-report measures of trauma exposure, PTSD symptomatology, and alcohol use-related problems. From this sample, 67% of the patients reported having experienced at least one criterion A traumatic event, and 60% of them reported multiple traumas. Approximately 25% of them met the criteria for current PTSD. The only significant difference between the PTSD and non-PTSD groups was abuse/dependence of other psychoactive substances. However, patients reporting physical assaults committed by a non-stranger reported more frequent PTSD diagnosis, more extensive symptomatology, more conflicts with the law and more physical injuries due to drinking. The findings of the study confirm the importance of assessing trauma and PTSD in alcohol dependent patients.

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

PMID: 16857322 [PubMed - indexed for MEDLINE]

 

Am Psychol. 2007 May-Jun;62(4):304-16.

The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears.

Marshall RD, Bryant RA, Amsel L, Suh EJ, Cook JM, Neria Y.

Trauma Studies and Services Center, New York State Psychiatric Institute, New York, NY 10032, USA.

There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of  persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic "bull's eye" disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective  response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology. ((c) 2007 APA, all rights reserved).

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

PMID: 17516775 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 May;64(5):577-84.

Comment in:     Arch Gen Psychiatry. 2007 Dec;64(12):1451.

Traumatic events and posttraumatic stress in childhood.

Copeland WE, Keeler G, Angold A, Costello EJ.

Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. william.copeland@duke.edu

CONTEXT: Traumatic events are common and are related to psychiatric impairment in childhood. Little is known about the risk for posttraumatic stress disorder (PTSD) across different types of trauma exposure in children. OBJECTIVE: To examine the developmental epidemiology of potential trauma and posttraumatic stress (PTS) in a longitudinal community sample of children. METHODS: A representative population sample of 1420 children aged 9, 11, and 13 years at intake were followed up annually through 16 years of age. Main Outcome Measure Traumatic events and PTS were assessed from child and parent reports annually to  16 years of age. Risk factors and DSM-IV disorders were also assessed. RESULTS: More than two thirds of children reported at least 1 traumatic event by 16 years  of age, with 13.4% of those children developing some PTS symptoms. Few PTS symptoms or psychiatric disorders were observed for individuals experiencing their first event, and any effects were short-lived. Less than 0.5% of children met the criteria for full-blown DSM-IV PTSD. Violent or sexual trauma were associated with the highest rates of symptoms. The PTS symptoms were predicted by previous exposure to multiple traumas, anxiety disorders, and family adversity. Lifetime co-occurrence of other psychiatric disorders with traumatic events and PTS symptoms was high, with the highest rates for anxiety and depressive disorders. CONCLUSIONS: In the general population of children, potentially traumatic events are fairly common and do not often result in PTS symptoms, except after multiple traumas or a history of anxiety. The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders.

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

PMID: 17485609 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2007 May 1;61(9):1049-61. Epub 2006 Nov 1.

The striatal-enriched protein tyrosine phosphatase gates long-term potentiation and fear memory in the lateral amygdala.

Paul S, Olausson P, Venkitaramani DV, Ruchkina I, Moran TD, Tronson N, Mills E, Hakim S, Salter MW, Taylor JR, Lombroso PJ.

Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06520, USA.

BACKGROUND: Formation of long-term memories is critically dependent on extracellular-regulated kinase (ERK) signaling. Activation of the ERK pathway by  the sequential recruitment of mitogen-activated protein kinases is well understood. In contrast, the proteins that inactivate this pathway are not as well characterized. METHODS: Here we tested the hypothesis that the brain-specific striatal-enriched protein tyrosine phosphatase (STEP) plays a key  role in neuroplasticity and fear memory formation by its ability to regulate ERK1/2 activation. RESULTS: STEP co-localizes with the ERKs within neurons of the lateral amygdala. A substrate-trapping STEP protein binds to the ERKs and prevents their nuclear translocation after glutamate stimulation in primary cell  cultures. Administration of TAT-STEP into the lateral amygdala (LA) disrupts long-term potentiation (LTP) and selectively disrupts fear memory consolidation.  Fear conditioning induces a biphasic activation of ERK1/2 in the LA with an initial activation within 5 minutes of training, a return to baseline levels by 15 minutes, and an increase again at 1 hour. In addition, fear conditioning results in the de novo translation of STEP. Inhibitors of ERK1/2 activation or of protein translation block the synthesis of STEP within the LA after fear conditioning. CONCLUSIONS: Together, these data imply a role for STEP in experience-dependent plasticity and suggest that STEP modulates the activation of ERK1/2 during amygdala-dependent memory formation. The regulation of emotional memory by modulating STEP activity may represent a target for the treatment of psychiatric disorders such as posttraumatic stress disorder (PTSD), panic, and anxiety disorders.

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

PMID: 17081505 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2007 May 1;61(9):1030-8. Epub 2006 Aug 30.

Altered central micro-opioid receptor binding after psychological trauma.

Liberzon I, Taylor SF, Phan KL, Britton JC, Fig LM, Bueller JA, Koeppe RA, Zubieta JK.

Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan 48109-0118, USA. liberzon@umich.edu

BACKGROUND: Functional neuroimaging studies have detected abnormal limbic and paralimbic activation to emotional probes in posttraumatic stress disorder (PTSD), but few studies have examined neurochemical mechanisms that underlie functional alterations in regional cerebral blood flow. The mu-opioid neurotransmitter system, implicated in responses to stress and suppression of pain, is distributed in and is thought to regulate the function of brain regions  that are implicated in affective processing. METHODS: Here we examined the micro-opioid system with positron emission tomography and the micro-opioid receptor-selective radiotracer [11C] carfentanil in 16 male patients with PTSD and two non-PTSD male control groups, with (n = 14) and without combat exposure (n = 15). Differences in micro-opioid receptor binding potential (BP2) were detected within discrete limbic and paralimbic regions. RESULTS: Relative to healthy controls, both trauma-exposed groups had lower micro-opioid receptor BP2  in extended amygdala, nucleus accumbens, and dorsal frontal and insular cortex but had higher BP2 in the orbitofrontal cortex. PTSD patients exhibited reduced BP2 in anterior cingulate cortex compared with both control groups. Micro-opioid  receptor BP2 in combat-exposed subjects without PTSD was lower in the amygdala but higher in the orbitofrontal cortex compared with both PTSD patients and healthy controls. CONCLUSIONS: These findings differentiate the general response  of the micro-opioid system to trauma from more specific changes associated with PTSD.

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

PMID: 16945349 [PubMed - indexed for MEDLINE]

 

Bosn J Basic Med Sci. 2007 May;7(2):162-5.

Detection of the hippocampal formation asymmetry in patients with posttraumatic stress disorder.

Sarac-Hadzihalilović A, Dilberović F.

Department of Anatomy, Faculty of Medicine, University of Sarajevo, Cekalusa 90,  71000 Sarajevo, Bosnia and Herzegovina.

The goal of this work was to analyze asymmetry of hippocampal formation in PTSD patients. The objects of the analysis were 10 MRI scans of patients with PTSD with established cognitive function damage. MRI scans were obtained using MAGNET  IMPACT SIEMENS 1,0 TESLA in T1 and T2 relaxation. The measurement of hippocampal  formation dimensions, and comparisons between the right and the left side were done using evaluate - distance program on the MRI instrument of the Institute of  Radiology at Sarajevo Clinics Center. We tested 20 patients with PTSD 49,9 years  of average age with standard deviation of 4,62 years. Based on the analysis of our results regarding the size of hippocampal formation in all the three projections (axial, coronal and sagital), in the group of patients with PTSD, we  can the make the following observations: 1. In axial slice the length of hippocampal formation measured on the left and right side is significantly asymmetric in all patients. In the sagital slice, the hippocampal formation measured on the left side is in many cases longer than in the right - 50 %. In coronal slice no significant differences were found in the proportion of patients according to symmetry/asymmetry of hippocampal formation width on the left and right. 2. The difference in average size of hippocampal formation between the left and right side measured in axial and coronal slices is not statistically significant, but it is significant in sagitall slice. So, the results of this new research, showed smaller hippocampal dimensions in PTSD as measured using MRI. We have to be careful about what projection we are refusing to as being watched hippocampal formation because the results will depend on that. We suggest that future studies be done in more projections because of the importance of statistically significant conclusions. MRI - volumetric measurements have their value.

PMID: 17489754 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2007 May-Jun;48(3):269-75. Epub 2007 Mar 21.

Long-term psychological outcome of 1999 Taiwan earthquake survivors: a survey of  a high-risk sample with property damage.

Chen CH, Tan HK, Liao LR, Chen HH, Chan CC, Cheng JJ, Chen CY, Wang TN, Lu ML.

Department of Psychiatry, Tsao-Tun Psychiatric Center, Nantou, Taiwan.

OBJECTIVE: Severe natural disasters can cause long-term psychological impact on the survivors. This study aimed to examine the prevalence and risk factors of posttraumatic stress symptoms and psychiatric morbidity among survivors of the severe earthquake that occurred in Chi-Chi, Taiwan, in September 21, 1999. METHODS: A total of 6412 earthquake survivors whose houses were destroyed by earthquake were recruited about 2 years after the disaster. They completed a self-report questionnaire assessing posttraumatic stress symptoms, psychiatric morbidity, and information of demographics, trauma exposure, and current living status. RESULTS: The estimated rates of posttraumatic stress disorder caseness and psychiatric morbidity were 20.9% and 39.8%, respectively. Psychiatric morbidity occurred mainly in survivors who were female, older, with low education level, and currently living in a prefabricated house. The risk factors for posttraumatic stress disorder caseness were female sex, currently living in a prefabricated house, low education level, and experienced complete destruction of property. CONCLUSION: These results showed that severe earthquake can cause long-term psychological impact in the survivors. The findings of risk factors suggest avenues for targeting postdisaster interventions.

PMID: 17445522 [PubMed - indexed for MEDLINE]

 

Emotion. 2007 May;7(2):227-38.

The aftermath of 9/11: effect of intensity and recency of trauma on outcome.

Ganzel B, Casey BJ, Glover G, Voss HU, Temple E.

Sackler Institute for Developmental Psychobiology, Weill Medical College of Cornell University, Ithaca, NY 14853, USA. blg4@cornell.edu

Does trauma exposure have a long-term impact on the brain and behavior of healthy individuals? The authors used functional magnetic resonance imaging to assess the impact of proximity to the disaster of September 11, 2001, on amygdala function in 22 healthy adults. More than three years after the terrorist attacks, bilateral amygdala activity in response to viewing fearful faces compared to calm ones was higher in people who were within 1.5 miles of the World Trade Center on  9/11, relative to those who were living more than 200 miles away (all were living in the New York metropolitan area at time of scan). This activity mediated the relationship between group status and current symptoms of posttraumatic stress disorder. In turn, the effect of group status on both amygdala activation (fearful vs. calm faces) and current symptoms was statistically explained by time since worst trauma in lifetime and intensity of worst trauma, as indicated by reported symptoms at time of the trauma. These data are consistent with a model of heightened amygdala reactivity following high-intensity trauma exposure, with  relatively slow recovery.

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

PMID: 17516802 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2007 May-Jun;29(3):264-6.

Impact of war stress on posttraumatic stress symptoms in hospital personnel.

Ben-Ezra M, Palgi Y, Essar N.

Department of Psychology, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. menbe@post.tau.ac.il

OBJECTIVE: This study examines the relationship between exposure to war stress and posttraumatic symptoms among nurses and physicians in a general hospital targeted by missiles. METHOD: Hospital staff who were exposed to missile attacks  and casualties of war, both military and civilians (n=80), were assessed for posttraumatic stress disorder (PTSD) symptoms a month after the war between Lebanon and Israel erupted (during the last days of the war). RESULTS: High levels of PTSD symptoms were found in 10.5% of physicians and 35.7% of nurses. Logistic regression analysis showed that nurses had an increased risk for PTSD in comparison to physicians (odds ratio=5.28). CONCLUSION: These findings show that  nurses suffered from more severe posttraumatic symptoms compared to physicians after exposure to prolonged war stress. The gap between physicians and nurses warrants further study.

Publication Types:      Comparative Study

PMID: 17484945 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2007 May-Jun;29(3):236-43.

Characteristics and psychosocial needs of victims of violent crime identified at  a public-sector hospital: data from a large clinical trial.

Boccellari A, Alvidrez J, Shumway M, Kelly V, Merrill G, Gelb M, Smart S, Okin RL.

Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94110, USA. alicia.boccellari@sfdph.org

OBJECTIVE: This study explores the feasibility of recruiting acutely injured public-sector crime victims into a research protocol and identifies baseline characteristics associated with posttraumatic distress in the enrolled sample (N=541). METHOD: Assertive research tracking methods were used to enroll participants, who completed baseline interviews. Descriptive statistics were used to define characteristics of the sample and prevalence of psychosocial problems and posttraumatic distress. Multiple regression analysis was performed to identify predictors of posttraumatic distress. RESULTS: A high percentage (78%) of eligible victims completed baseline interviews within 1 month of victimization. The sample was largely male, ethnic minority, unemployed and living below the poverty level. Trauma symptoms were highly prevalent, with three quarters having significant posttraumatic distress. Female gender, preexisting psychiatric disorder, trauma history, case management needs and employment status were predictive of greater symptomatology. Stabbing victims had lower distress. CONCLUSIONS: Comprehensive mental health and case management services that proactively engage disadvantaged victims are needed to meet the complex problems  of this population.

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

PMID: 17484941 [PubMed - indexed for MEDLINE]

 

Health Soc Work. 2007 May;32(2):129-37.

The aftermath of road trauma: survivors' perceptions of trauma and growth.

Harms L, Talbot M.

School of Social Work, University of Melbourne, Australia. louisekh@unimelb.edu.au

For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented in relation to posttraumatic growth and posttraumatic stress experiences, as measured by the Posttraumatic Growth Inventory and the Impact of Event Scale. Data were collected from 79 anonymous self-administered postal surveys from participants who had received treatment in  an Australian rehabilitation center following serious orthopedic injury. One-third of these survivors continued to experience serious psychological distress in the aftermath of road trauma and a range of other psychosocial consequences four years after their accident. Although 87 percent of the sample continued to experience posttraumatic stress difficulties, 99 percent reported experiences of posttraumatic growth. Implications of these findings for social work practice are discussed.

PMID: 17571646 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 May;116(2):342-51.

Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity.

Bonanno GA, Neria Y, Mancini A, Coifman KG, Litz B, Insel B.

Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY 10027, USA. gab38@columbia.edu

There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N = 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N = 447) used cross-sectional data collected  2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both cross-sectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology.

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

PMID: 17516766 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2007 May;116(2):329-41.

Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero.

Palmieri PA, Weathers FW, Difede J, King DW.

Center for the Treatment and Study of Traumatic Stress and Department of Psychiatry, St. Thomas Hospital, Summa Health System, Akron, OH 44310, USA. palmierp@summa-health.org

Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional  support for the dysphoria model. Implications regarding the underlying structure  of PTSD are discussed.

PMID: 17516765 [PubMed - indexed for MEDLINE]

 

J Am Osteopath Assoc. 2007 May;107(5):181-9.

Diagnosis and management of posttraumatic stress disorder in returning veterans.

Reeves RR.

Chief of Mental Health, G.V. (Sonny) Montgomery VA Medical Center (11M), 1500 E Woodrow Wilson Dr, Jackson, MS 39216-5116, USA. roy.reeves@med.va.gov

As the conflict in Iraq continues, public health authorities in the United States anticipate that many returning soldiers will suffer from posttraumatic stress disorder (PTSD). Initially, most of these veterans are likely to consult their primary care physicians about health problems. However, the diagnosis of PTSD is  often missed in primary care settings. The author encourages physicians to become better prepared to recognize this disorder in their patients and initiate proper  treatment or appropriate referral. Current diagnostic approaches and treatment modalities for combat-related PTSD are reviewed-with an emphasis on clinical procedures for the primary care physician.

Publication Types:      Review

PMID: 17596586 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2007 May;68(5):711-20.

Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting.

Friedman MJ, Marmar CR, Baker DG, Sikes CR, Farfel GM.

Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, White River Junction, Vt 05009, USA. MatthewJ.Friedman@Dartmouth.edu

OBJECTIVE: To evaluate the efficacy of sertraline in the treatment of posttraumatic stress disorder (PTSD) in a Veterans Affairs (VA) clinic setting involving patients with predominantly combat-related PTSD. METHOD: 169 outpatient subjects with a DSM-III-R diagnosis of PTSD and who scored 50 or higher on Part 2 of the Clinician-Administered PTSD Scale (CAPS-2) at the end of a 1-week placebo  run-in period participated. Patients recruited from 10 VA medical centers were randomly assigned to 12 weeks of flexibly dosed sertraline (25-200 mg/day) (N = 86; 70% with combat-related PTSD; 79% male) or placebo (N = 83; 72% combat-related PTSD; 81% male) between May 1994 and September 1996. The primary efficacy measures were the mean change in CAPS-2 total severity score from baseline to endpoint, in the total score from the Impact of Event Scale, and in the Clinical Global Impressions-Severity of Illness and Improvement scales. RESULTS: There were no significant differences between sertraline and placebo on  any of the primary or secondary efficacy measures at endpoint. In order to understand the results, gender, duration of illness, severity of illness, type of trauma, and history of alcohol/substance abuse were explored as potential moderators of outcome, but no consistent effects were uncovered. Sertraline was well tolerated, with 13% of patients discontinuing due to adverse events. CONCLUSION: Sertraline was not demonstrated to be efficacious in the treatment of PTSD in the VA clinic settings studied.

Publication Types:      Multicenter Study     Randomized Controlled Trial     Research Support, Non-U.S. Gov't

PMID: 17503980 [PubMed - indexed for MEDLINE]

 

J Forensic Sci. 2007 May;52(3):717-25.

Detection of malingered PTSD: an overview of clinical, psychometric, and physiological assessment: where do we stand?

Hall RC, Hall RC.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 North Wolfe Street/Meyer 113, Baltimore, MD 21287-7113, USA.

Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes  an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic  stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.

Publication Types:      Review

PMID: 17456103 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 May;195(5):415-20.

Neurocognitive deterioration in elderly chronic schizophrenia patients with and without PTSD.

Goodman C, Finkel B, Naser M, Andreyev P, Segev Y, Kurs R, Melamed Y, Bleich A.

Lev-Hasharon Mental Health Center, Netanya, Israel. craiggoodman7@yahoo.com

Neurocognitive deficits are associated with chronic schizophrenia and aging. We investigated whether elderly chronic schizophrenia inpatients who also suffer from posttraumatic stress disorder (PTSD) have more severe cognitive impairment than elderly schizophrenia inpatients that do not. Fourteen schizophrenia inpatients that are Holocaust survivors and suffer from PTSD (survivor group) were compared with schizophrenia inpatients not exposed to the holocaust and without PTSD (comparison group) using neurocognitive assessments and psychiatric  evaluation instruments. The survivors performed significantly worse on measures of processing speed and visual scanning, recognition memory, and general mental status, than the comparison group. Though nonsignificantly, the comparison group  revealed better performance on tests that measured visuospatial perception, visuospatial planning and strategies, organizational and constructional skills. The survivor group displayed a greater severity of antipsychotic-induced side effects that were not associated with differences in cognitive performance. Comorbid PTSD may contribute to the severity of neurocognitive impairment in elderly chronic schizophrenia patients.

Publication Types:      Comparative Study

PMID: 17502807 [PubMed - indexed for MEDLINE]

 

J Stud Alcohol Drugs. 2007 May;68(3):353-61.

Six-month treatment outcomes of cocaine-dependent patients with and without PTSD  in a multisite national trial.

Najavits LM, Harned MS, Gallop RJ, Butler SF, Barber JP, Thase ME, Crits-Christoph P.

National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. lisa_najavits@hms.harvard.edu

OBJECTIVE: This study examined 6-month treatment outcomes among 428 cocaine-dependent outpatients with (n = 34) and without (n = 394) posttraumatic stress disorder (PTSD) in a randomized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder (SUD). METHOD: Assessments were completed at baseline and monthly during the 6-month treatment.  With longitudinal mixed-effects models, we compared outcomes between SUD-PTSD and SUD-only patients and also examined rates of within-group change. RESULTS: Results indicated a highly consistent pattern: the SUD-PTSD patients were more impaired to begin with and remained so across time compared with SUD-only patients (with the exception of substance use and addiction-related legal and employment problems, which did not differ between groups). Also, the SUD-PTSD patients improved less than SUD-only patients in alcohol use and the majority of  addiction-related psychosocial problems. However, the two groups did not differ significantly in improvement over time on drug use or global psychological severity. CONCLUSIONS: The greater impairment and relative lack of improvement of SUD-PTSD patients, compared with those with SUD-only, suggest a need for dual-diagnosis treatments that more directly target their areas of difficulty.

Publication Types:      Multicenter Study     Randomized Controlled Trial     Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 17446974 [PubMed - indexed for MEDLINE]

 

Neuropsychology. 2007 May;21(3):275-84.

Attentional networks reveal executive function deficits in posttraumatic stress disorder.

Leskin LP, White PM.

Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA.

Executive function was assessed with the Trail Making Test (Army Individual Test  Battery; M. D. Lezak, 1983), the Comprehensive Trail Making Test (C. Reynolds, 2002), and a neurocognitive measure of executive control (Attentional Network Task [ANT]; J. I. Fan, B. D. McCandliss, T. Somer, A. Raz, & M. I. Posner, 2002)  in 19 undergraduates with posttraumatic stress disorder (PTSD; Posttraumatic Stress Disorder Symptom Scale-Self-Report version; E. B. Foa, D. S. Riggs, C. V.  Dancu, & B. O. Rothbaum, 1993), 15 high trauma participants without PTSD, and 18  low trauma control participants. Although groups did not differ on any trail making task or on the ANT measures of alerting or orienting, PTSD participants were significantly more impaired on the ANT executive network index than were high or low trauma control participants, even when level of depressive symptoms was covaried. Previous animal research identified a relationship between dopamine and the ANT measure of executive function. Elevated PTSD symptom severity and levels of hyperarousal, reexperiencing, and avoidance-numbing were associated significantly with executive function deficits indexed by the ANT. These results  indicate a potentially subtle but specific deficit in executive function and a possible relationship between PTSD symptoms and irregularities in dopamine function. (c) 2007 APA, all rights reserved

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

PMID: 17484590 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2007 May;58(5):703-7.

Clinical characteristics and health service use of veterans with comorbid bipolar disorder and PTSD.

Thatcher JW, Marchand WR, Thatcher GW, Jacobs A, Jensen C.

Department of Mental Health, George E. Wahlen Department of Veterans Affairs Medical Center, 500 Foothill Blvd., Salt Lake City, UT 84148, USA. john.thatcher@hsc.utah.edu

OBJECTIVE: This study aimed to increase the understanding of the clinical characteristics and utilization of health services among veterans with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). METHODS: A retrospective chart review was conducted that examined the clinical and health service use data of 139 male veterans with bipolar disorder (N=49), PTSD (N=49),  or comorbid bipolar disorder and PTSD (N=41) who obtained services over two years from the Department of Veterans Affairs Salt Lake City Health Care System. RESULTS: Compared with patients with bipolar disorder or those with PTSD alone, those with both conditions had significantly higher mean Clinical Global Impression-Severity scores and required more frequent inpatient psychiatric treatment. Patients with both conditions and those with bipolar disorder were significantly less likely to have received psychotherapy and antidepressant pharmacotherapy than patients with PTSD. CONCLUSIONS: Patients with both conditions have a more severe illness course than those with bipolar disorder alone. Psychotherapy and antidepressant pharmacotherapy may be underutilized among patients with comorbid bipolar disorder and PTSD.

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

PMID: 17463354 [PubMed - indexed for MEDLINE]

 

Psychol Bull. 2007 May;133(3):529-32; author reply 533-4.

Comment on:     Psychol Bull. 2007 May;133(3):482-528.

Conundrums in a theory of disturbed dreaming: comment on Levin and Nielsen (2007).

Weiss DS.

Department of Psychiatry, University of California, San Francisco, CA 94143, USA. daniel.weiss@ucsf.edu

Levin and Nielsen (2007) presented a review of research emphasizing dreams whose  content is distressing. With some broad conclusions about factors important in the understanding of distressing dreams as a springboard, the authors offered potential explanatory mechanisms for distressing dreams that range from brain structures to personality variables, drawing heavily on findings about posttraumatic stress disorder. Though a reasonable case is made for elements of the argument, implications from one perspective are not always considered in making the argument for others, issues that follow logically from certain assertions are not discussed, and certain assumptions appear unjustified. Definitional or phenomenological presentations are not always consistent, making  it difficult to determine the real nature of the variables being offered and to get a clear sense of the boundaries of the model. (c) 2007 APA, all rights reserved

Publication Types:      Comment

PMID: 17469989 [PubMed - indexed for MEDLINE]

 

Psychol Bull. 2007 May;133(3):482-528.

Comment in:     Psychol Bull. 2007 May;133(3):529-32; author reply 533-4.

Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review  and neurocognitive model.

Levin R, Nielsen TA.

Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA. rlevin@yu.edu

Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or  without posttraumatic stress disorder) and relations with waking functioning. No  models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion. (c) 2007 APA, all rights reserved

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

PMID: 17469988 [PubMed - indexed for MEDLINE]

 

Psychol Bull. 2007 May;133(3):419-37.

Overgeneral autobiographical memory and traumatic events: an evaluative review.

Moore SA, Zoellner LA.

Department of Psychology, University of Washington, Seattle, WA 98195, USA. samoore@u.washington.edu

Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of  life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining  samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology. (c) 2007 APA, all rights reserved

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

PMID: 17469985 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2007 May;69(4):365-9. Epub 2007 May 17.

Consistent association between mixed lateral preference and PTSD: confirmation among a national study of 2490 US Army Vietnam veterans.

Boscarino JA, Hoffman SN.

Geisinger Center for Health Research, Geisinger Clinic, Danville, PA 17822-3003,  USA. jaboscarino@geisinger.edu

OBJECTIVE: To evaluate the research-based association between mixed lateral preference for handedness and risk for posttraumatic stress disorder (PTSD) in a  large-scale sample of US Army Vietnam veterans exposed to war zone stressors. METHOD: We used a national sample of 2490 male US Army veterans, who completed the Edinburgh Handedness Inventory (EHI), a measure ranging from -100 (pure left-handedness) to +100 (pure right-handedness). We developed several classifications representing levels of mixed laterality: a) an EHI -70 to +70 (EHI 70, moderate mixed); b) an EHI -50 to +50 (EHI 50, consistent mixed); and c) an EHI 0, plus reports of using either hand on > or =50% of the tasks assessed (EHI 0+, extreme mixed). We controlled for intelligence, race, Army entry age, and Army volunteer status, and we assessed the impact of combat exposure. RESULTS: Although all three handedness measures were associated with current PTSD in bivariate analyses, only Edinburgh 0+ was associated with PTSD in the multivariate model (odds ratio (OR) = 2.1; p = .021). However, when we classified handedness by high combat exposure, all three measures were associated with PTSD, with ORs = 2.5, 2.8, and 4.7 for EHI 70, EHI 50, and EHI 0+, respectively (all p  < .001). Veterans with mixed laterality and high combat exposure also had significantly increased PTSD symptoms (all p < .001). CONCLUSION: Our study confirmed findings reported among mostly smaller clinical samples and suggested that mixed lateral preference was associated with PTSD, especially among those individuals exposed to more severe psychological trauma.

PMID: 17510288 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2007 Apr 29 [Epub ahead of print]

Memory impairments in posttraumatic stress disorder are related to depression.

Johnsen GE, Kanagaratnam P, Asbjřrnsen AE.

University of Bergen, Bergen, Norway.

The present study focuses on verbal learning and memory alterations in refugees with posttraumatic stress disorder, and whether the alterations are related to attention, acquisition, storage, or retrieval. Twenty-one refugees exposed to war and political violence with chronic PTSD, were compared to an exposed control sample of 21 refugees without PTSD. No differences were found in attention span,  but tests of verbal memory showed less efficient learning in the PTSD sample. Group differences in delayed recall could be explained by learning efficiency. No differences were seen in recognition memory. These results indicate that memory alterations in PTSD are related to impaired acquisition and less effective encoding of the memory material and not to impaired attention span and/or impaired retrieval. Controlling for specific PTSD symptom clusters and self-reported depression showed that the intrusion subscale and depressive reactions are the most important symptoms in understanding the memory alterations in PTSD.

PMID: 17532601 [PubMed - as supplied by publisher]

 

BMC Psychiatry. 2007 Apr 19;7:13.

Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial.

Knaevelsrud C, Maercker A.

Treatment Center for Torture Victims, Berlin, Germany. c.knaevelsrud@bzfo.de

BACKGROUND: The present study was designed to evaluate the efficacy of an internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated. METHOD: Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioural therapy (CBT) conducted over a 5-week period or a waiting list control group. Severity of PTSD was the primary outcome. Secondary outcome variables were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 months after treatment. RESULTS: From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group x time interaction effect size d = 1.40). Additionally, patients of the treatment condition showed significantly greater reduction of co-morbid depression and anxiety as compared to the waiting  list condition. These effects were sustained during the 3-months follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online.  Significant improvement of the online working alliance in the course of treatment and a substantial correlation between the quality of the online relationship at the end of treatment and treatment outcome emerged. CONCLUSION: Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012606000401550.

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

PMID: 17442125 [PubMed - indexed for MEDLINE]

 

Clin Neuropsychol. 2007 Apr 18;:1-13 [Epub ahead of print]

Comparison of the Morel emotional numbing test for posttraumatic stress disorder to the word memory test in neuropsychological evaluations.

Morel KR.

VA Tennessee Valley Healthcare System, Nashville, TN, USA.

The most commonly feigned cognitive and psychiatric disorders for survivors of traumatic injury are memory dysfunction and posttraumatic stress disorder (PTSD). The position of the National Academy of Neuropsychology is that symptom validity  tests (SVTs) should be part of any comprehensive neuropsychological evaluation. In this article the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT), a SVT for PTSD, was compared to a SVT for memory, the Word Memory Test (WMT). Available archival data on 216 consecutive referrals for neuropsychological evaluations at the Veterans Affairs Tennessee Valley Healthcare System were reviewed. Of the total records reviewed, 37 patients had been administered both the MENT and the WMT. The clinically recommended cutoff on the WMT was used as the main criterion to classify patients into two groups: simulating impairment or credible. The results indicated that the simulating impairment group had significantly more errors on the MENT than the credible group did (p < .0001). The criterion-related characteristics of the MENT in assessing response bias in relation to the WMT were confirmed. Clinical and research implications of the utilization of the MENT are discussed in this study.

PMID: 17853136 [PubMed - as supplied by publisher]

 

Ann Intern Med. 2007 Apr 17;146(8):617-20.

Posttraumatic stress disorder needs to be recognized in primary care.

Wilson JF.

jenwilson@acponline.org

PMID: 17438329 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2007 Apr 15;61(8):957-65. Epub 2006 Nov 29.

Salivary cortisol and psychopathology in children bereaved by the september 11, 2001 terror attacks.

Pfeffer CR, Altemus M, Heo M, Jiang H.

Department of Psychiatry, Weill Medical College of Cornell University, New York,  10605 USA. cpfeffer@med.cornell.edu

BACKGROUND: Studies suggest that stressful events increase risk for childhood anxiety and depression and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This prospective longitudinal study evaluated relationships among  severe psychosocial stress, psychiatric morbidity, and HPA axis function in children. METHODS: Forty-five children (mean age: 8.9 +/- 2.9 years) suffering parent death from September 11, 2001 terror attacks and 34 nonbereaved children (mean age: 9.3 +/- 2.5 years) were evaluated prospectively at 6-month intervals in this 2-year study. Assessments involved diagnostic interviews (Child Schedule  for Affective Disorders and Schizophrenia [K-SADS]) for psychopathology and 3 days of baseline salivary cortisol and a salivary dexamethasone suppression test  for HPA axis function. RESULTS: Bereaved children, but not nonbereaved children,  had significantly increased rates of psychiatric disorders involving anxiety disorders, especially posttraumatic stress disorder (PTSD), after September 11, 2001 compared with retrospective assessments before September 11, 2001. Morning (AM) and 4:00 pm baseline cortisol were significantly and persistently higher for bereaved than nonbereaved children. Compared with bereaved children without psychopathology, bereaved children with PTSD had significantly lower 4:00 pm baseline cortisol and significantly greater 4:00 pm cortisol suppression. Children with generalized anxiety disorder had significantly less AM cortisol suppression than children without psychopathology. CONCLUSIONS: Children bereaved by sudden, unexpected parent death had persistent psychological dysfunction and HPA axis dysregulation in this study.

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

PMID: 17137565 [PubMed - indexed for MEDLINE]

 

Am J Orthopsychiatry. 2007 Apr;77(2):199-205.

Immigration and attendant psychological sequelae: a comparison of three waves of  Iraqi immigrants.

Jamil H, Nassar-McMillan SC, Lambert RG.

Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA.

Acculturation, the process by which individuals or groups transition from one or  more cultures into another, can be complex and often stressful. In many cases, reason for immigration can contribute, both positively and negatively, to levels  of acculturative stress. Immigrants to the United States from Iraq over the past  several decades have shifted in terms of prevalence, reason for and ease of immigration, and pre and postmigration trauma among individuals and groups. The authors examined the psychological by-products of acculturative stress by measuring posttraumatic stress disorder, anxiety, and depression among three distinct waves of immigrants from Iraq. The authors found support for the hypotheses that these variables were positively correlated with recency of immigration. Implications for psychological practitioners are discussed. 2007 APA, all rights reserved

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

PMID: 17535117 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Apr;164(4):683-4.

Imagery rehearsal therapy for acute posttraumatic nightmares among combat soldiers in Iraq.

Moore BA, Krakow B.

Publication Types:      Letter

PMID: 17403990 [PubMed - indexed for MEDLINE]

368: Am J Public Health. 2007 Apr;97 Suppl 1:S116-23. Epub 2007 Apr 5.

Trauma and stress response among Hurricane Katrina evacuees.

Mills MA, Edmondson D, Park CL.

Department of Psychology, Clinical Division, University of Connecticut, Storrs, CT 06269, USA. maryalicemills@gmail.com

OBJECTIVES: Hurricane Katrina's impact on public health has been significant and  multifaceted, with trauma-related psychological sequelae likely to result in a sizable burden of disease. Data were collected that assessed acute stress disorder (ASD) prevalence and factors related to ASD symptomatology among sheltered evacuees. METHODS: On days 12 to 19 after Katrina, evacuees at a major  emergency shelter completed surveys that assessed demographics, Katrina-specific  experiences, and ASD symptomatology. RESULTS: Sixty-two percent of the sample met ASD threshold criterion. Projections based on the predictive power of ASD to posttraumatic stress disorder (PTSD) suggest that 38% to 49% of the sample will meet PTSD criteria 2 years post-disaster. Female gender (odds ratio [OR] = 4.08), positive psychiatric history (OR=5.84), injury (OR=2.75), increased life-threat perception (OR=1.37), and decreased sense of personal control (OR=1.56) were significantly related to ASD. Black race was associated with greater symptom severity (B=7.85, SE[B]=3.50). CONCLUSIONS: Katrina-related trauma and its psychological sequelae will remain a significant public health issue for years to come. The identification of several vulnerability factors related to ASD and PTSD provides a brief sketch of those at greatest risk.

PMID: 17413068 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2007 Apr;97 Suppl 1:S103-8. Epub 2007 Apr 5.

Psychological sequelae resulting from the 2004 Florida hurricanes: implications for postdisaster intervention.

Acierno R, Ruggiero KJ, Galea S, Resnick HS, Koenen K, Roitzsch J, de Arellano M, Boyle J, Kilpatrick DG.

National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA. acierno@musc.edu

OBJECTIVES: Data are limited regarding mental health effects of disasters such as hurricanes. We sought to determine the prevalence of and major risk factors associated with posttraumatic stress disorder (PTSD), generalized anxiety disorder, and major depressive episode 6 to 9 months after the 2004 Florida hurricanes. METHODS: Random-digit dialing was used to recruit a representative population sample of 1452 hurricane-affected adults. RESULTS: Posthurricane prevalence for PTSD was 3.6%, for generalized anxiety disorder was 5.5%, and for  major depressive episode was 6.1%. Risk factors varied somewhat across disorders, with the exception of previous exposure to traumatic events, which increased risk of all negative outcomes. CONCLUSIONS: Storm exposure variables and displacement  were associated primarily with PTSD. Notably, high social support in the 6 months preceding the hurricanes protected against all types of disorders.

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

PMID: 17413067 [PubMed - indexed for MEDLINE]

 

Arch Med Sadowej Kryminol. 2007 Apr-Jun;57(2):245-7.

[Differentiation possibilities in posttraumatic neuropsychiatric disorders in medico-legal certification]

[Article in Polish]

Jabłoński C, Chowaniec C, Kobek M, Kowalczyk-Jabłońska D.

Z Katedry i Zakładu Medycyny Sadowej Slaskiej Akademii Medycznej w Katowicach. christianjablonski@poczta.onet.pl

This paper is a continuation of the previous work entitled "Difficulties in estimation of posttraumatic neuropsychiatric disorders for the purpose of criminal and civil law proceedings" presented during the 5th National Symposium "Days of Medical Certification", Poznan 2005. Referring to the then mentioned problem, the authors present in a greater detail the possibilities of objectivization of claims using simple psychiatric and psychological diagnostic tools

Publication Types:      English Abstract

PMID: 17691184 [PubMed - indexed for MEDLINE]

 

Can J Psychiatry. 2007 Apr;52(4):241-7.

Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers.

McAlonan GM, Lee AM, Cheung V, Cheung C, Tsang KW, Sham PC, Chua SE, Wong JG.

Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.

OBJECTIVE: To assess the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak. METHODS: At the peak of the 2003 SARS outbreak, we assessed health care workers in 2 acute care Hong Kong general hospitals with the Perceived Stress Scale (PSS-10). One year later, we reassessed these health care workers with the PSS-10, the 21-Item Depression and Anxiety Scale (DASS-21), and the Impact of Events Scale-Revised (IES-R). We recruited high-risk health care workers who practised respiratory medicine and compared them with nonrespiratory medicine workers, who formed the low-risk health care worker control group. RESULTS: In 2003, high-risk health care workers had elevated stress levels (PSS-10 score = 17.0) that were not significantly different from levels in low-risk health care worker control subjects (PSS-10 score = 15.9). More high-risk health care workers reported fatigue, poor sleep, worry about health, and fear of social contact, despite their confidence in infection-control measures. By 2004, however, stress levels in the high-risk group were not only higher (PSS-10 score = 18.6) but also significantly higher than scores among low-risk health care worker control subjects (PSS-10 score = 14.8, P < 0.05). In 2004, the perceived stress levels in the high-risk group were associated with higher depression, anxiety, and posttraumatic stress scores (P <  0.001). Posttraumatic stress scores were a partial mediator of the relation between the high risk of exposure to SARS and higher perceived stress. CONCLUSIONS: Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety. Front-line staff could benefit from stress management as part of preparation for  future outbreaks.

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

PMID: 17500305 [PubMed - indexed for MEDLINE]

 

Can J Psychiatry. 2007 Apr;52(4):233-40.

Stress and psychological distress among SARS survivors 1 year after the outbreak.

Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, Chu CM, Wong PC, Tsang KW, Chua SE.

Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.

OBJECTIVE: Our study examined the stress level and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak. METHOD: During the SARS outbreak in 2003, we used the 10-item Perceived Stress Scale (PSS-10) to assess SARS survivors treated in 2 major hospitals (non-health  care workers, n = 49; health care workers, n = 30). We invited SARS survivors from the same hospitals (non-health care workers, n = 63; health care workers, n  = 33) to complete the PSS-10 again in 2004. At that time, they were also asked to complete the General Health Questionnaire (GHQ-12) and measures of depression, anxiety, and posttraumatic symptoms. PSS-10 scores were also obtained from matched community control subjects during the outbreak (n = 145) and again in 2004 (n = 112). RESULTS: SARS survivors had higher stress levels during the outbreak, compared with control subjects (PSS-10 scores = 19.8 and 17.9, respectively; P < 0.01), and this persisted 1 year later (PSS-10 scores = 19.9 and 17.3, respectively; P < 0.01) without signs of decrease. In 2004, SARS survivors also showed worrying levels of depression, anxiety, and posttraumatic symptoms. An alarming proportion (64%) scored above the GHQ-12 cut-off that suggests psychiatric morbidity. During the outbreak, health care worker SARS survivors had stress levels similar to those of non-health care workers, but health care workers showed significantly higher stress levels in 2004 (PSS-10 score = 22.8, compared with PSS-10 score = 18.4; P < 0.05) and had higher depression, anxiety, posttraumatic symptoms, and GHQ-12 scores. CONCLUSIONS: One  year after the outbreak, SARS survivors still had elevated stress levels and worrying levels of psychological distress. The situation of health care worker SARS survivors is particularly worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an important role in rehabilitation.

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

PMID: 17500304 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):198-206.

Circulating lymphocyte subsets, natural killer cell cytotoxicity, and components  of hypothalamic-pituitary-adrenal axis in Croatian war veterans with posttraumatic stress disorder: cross-sectional study.

Vidović A, Vilibić M, Sabioncello A, Gotovac K, Rabatić S, Folnegović-Smalc V, Dekaris D.

Department for Cellular Immunology, Institute of Immunology, Zagreb, Croatia. avidovic@imz.hr

AIM: To determine peripheral blood lymphocyte subsets--T cells, helper T cells, cytotoxic T cells, B cells, and natural killer cells, natural killer cell cytotoxicity, serum cortisol concentration, and lymphocyte glucocorticoid receptor expression in Croatian combat veterans diagnosed with chronic posttraumatic stress disorder (PTSD); and to examine the relationship between the assessed parameters and the time passed since the traumatic experience. METHODS:  Well-characterized group of 38 PTSD patients was compared to a group of 24 healthy civilians. Simultaneous determination of lymphocyte subsets and the expression of intracellular glucocorticoid receptor was performed using three-color flow cytometry. Natural killer cell cytotoxicity was measured by (51)Cr-release assay and the serum cortisol concentration was determined by radioimmunoassay. RESULTS: We found higher lymphocyte counts in PTSD patients than in healthy controls (2294.7+/-678.0/microL vs 1817.2+/-637.0/microL, P=0.007) and a positive correlation between lymphocyte glucocorticoid receptor expression and the number of years that passed from the traumatic experience (r(s)=0.43, P=0.008). Lymphocyte glucocorticoid receptor expression positively correlated with serum cortisol concentration both in PTSD patients (r=0.46, P=0.006) and healthy controls (r=0.46, P=0.035). CONCLUSION: This study confirmed that the immune system was affected in the course of chronic PTSD. Our findings also indicated that the hypothalamic-pituitary-adrenal axis profile in PTSD was associated with the duration of the disorder. Due to the lack of power, greater sample sizes are needed to confirm the results of this study.

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

PMID: 17436384 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):185-97.

Posttraumatic stress disorder: diagnostic data analysis by data mining methodology.

Marinić I, Supek F, Kovacić Z, Rukavina L, Jendricko T, Kozarić-Kovacić D.

Dubrava University Hospital, Department of Psychiatry, Referral Center of the Ministry of Health and Social Welfare for Stress-related Disorders, Zagreb, Croatia.

AIM: To use data mining methods in assessing diagnostic symptoms in posttraumatic stress disorder (PTSD). METHODS. The study included 102 inpatients: 51 with a diagnosis of PTSD and 51 with psychiatric diagnoses other than PTSD. Several models for predicting diagnosis were built using the random forest classifier, one of the intelligent data analysis methods. The first prediction model was based on a structured psychiatric interview, the second on psychiatric scales (Clinician-administered PTSD Scale--CAPS, Positive and Negative Syndrome Scale--PANSS, Hamilton Anxiety Scale--HAMA, and Hamilton Depression Scale--HAMD), and the third on combined data from both sources. Additional models placing more  weight on one of the classes (PTSD or non-PTSD) were trained, and prototypes representing subgroups in the classes constructed. RESULTS: The first model was the most relevant for distinguishing PTSD diagnosis from comorbid diagnoses such  as neurotic, stress-related, and somatoform disorders. The second model pointed out the scores obtained on the CAPS scale and additional PANSS scales, together with comorbid diagnoses of neurotic, stress-related, and somatoform disorders as  most relevant. In the third model, psychiatric scales and the same group of comorbid diagnoses were found to be most relevant. Specialized models placing more weight on either the PTSD or non-PTSD class were able to better predict their targeted diagnoses at some expense of overall accuracy. Class subgroup prototypes mainly differed in values achieved on psychiatric scales and frequency of comorbid diagnoses. CONCLUSION: Our work demonstrated the applicability of data mining methods for the analysis of structured psychiatric data for PTSD. In  all models, the group of comorbid diagnoses, including neurotic, stress-related,  and somatoform disorders, surfaced as important. The important attributes of the  data, based on the structured psychiatric interview, were the current symptoms and conditions such as presence and degree of disability, hospitalizations, and duration of military service during the war, while CAPS total scores, symptoms of increased arousal, and PANSS additional criteria scores were indicated as relevant from the psychiatric symptom scales.

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

PMID: 17436383 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):177-84.

Secondary traumatization of wives of war veterans with posttraumatic stress disorder.

Francisković T, Stevanović A, Jelusić I, Roganović B, Klarić M, Grković J.

Department of Psychiatry, Psychological Medicine Section, Rijeka University School of Medicine, Rijeka, Croatia.

AIM: To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD). METHOD: The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short  structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version  of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders. RESULTS: Out of 56 veterans' wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms.  Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (mean+/-standard deviation, 19.1+/-9.1 vs 13.2+/-7.8 years, respectively; P=0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (P=0.05). CONCLUSION: As more  than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family.

PMID: 17436382 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):167-76.

Psychological consequences of war trauma and postwar social stressors in women in Bosnia and Herzegovina.

Klaric M, Klarić B, Stevanović A, Grković J, Jonovska S.

Department of Psychiatry, Mostar University Hospital, Mostar, Bosnia and Herzegovina. klaricmiro@net.hr

AIM: To assess the consequences of psychotrauma in civilian women in Herzegovina  who were exposed to prolonged and repetitive traumatic war events and postwar social stressors. METHODS: The study included a cluster sample of 367 adult women, divided into two groups. One group (n=187) comprised women from West Mostar who were exposed to serious war and posttraumatic war events. The other group (n=180) comprised women from urban areas in Western Herzegovina who were not directly exposed to war destruction and material losses, but experienced war  indirectly, through military drafting of their family members and friends. Demographic data on the women were collected by a questionnaire created for the purpose of this study. Data on trauma exposure and posttraumatic stress disorder  (PTSD) symptoms were collected by Harvard Trauma Questionnaire (HTQ)--Bosnia-Herzegovina version. General psychological symptoms were determined with Symptom Check List-90-revised (SCL-90-R). Data on postwar stressors were collected by a separate questionnaire. RESULTS: In comparison with the control group, women from Western Mostar experienced significantly more traumatic events  (mean+/-standard deviation [SD], 3.3+/-3.2 vs 10.1+/-4.9, respectively, t=15.91;  P<0.001) and had more posttraumatic symptoms (12.3+/-10.3 vs 21.2+/-10.9, respectively, t=8.42; P<0.001). They also had significantly higher prevalence of  PTSD (4.4% vs 28.3%, respectively; chi(2)=52.56; P<0.001). The number of traumatic events experienced during the war was positively associated with postwar stressful events both in the West Mostar group (r=0.223; P=0.002) and control group (r=0.276; P<0.001). Postwar stressful events contributed both to the number and intensity of PTSD symptoms and all general psychological symptoms  measured with SCL-90 questionnaire, independently from the number of experienced  traumatic war events. CONCLUSION: Long-term exposure to war and postwar stressors caused serious psychological consequences in civilian women, with PTSD being only one of the disorders in the wide spectrum of posttraumatic reactions. Postwar stressors did not influence the prevalence of PTSD but they did contribute to the intensity and number of posttraumatic symptoms.

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

PMID: 17436381 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):157-66.

Treatment outcomes and perception of social acknowledgment in war veterans: follow-up study.

Ljubotina D, Pantić Z, Francisković T, Mladić M, Priebe S.

Department of Psychology, Zagreb University Faculty of Philosophy, Zagreb, Croatia. dljuboti@ffzg.hr

AIM: To assess treatment outcomes of psychotherapy for war veterans suffering from posttraumatic stress disorder (PTSD) and to investigate self-perceived social acknowledgment. METHODS: In this prospective cohort study, a set of psychological instruments was used to assess the level of posttraumatic stress symptoms (Clinician-Administered PTSD Scale, Impact of Event Scale--Revised), symptoms of general psychopathology (Brief Symptom Inventory), quality of life (The Manchester Short Assessment of Quality of Life), and perceived social acknowledgment on a sample of 152 Croatian war veterans participating in group psychotherapy. All participants were interviewed at baseline and followed up after 3 and 12 months. We analyzed the changes in symptom levels over the course  of one year, as well as the correlations between symptoms (both at baseline and after therapy) and perceived social acknowledgment. RESULTS: The analysis of symptom levels at the beginning of group therapy and after 12 months showed minimal or no changes in their intensity. Only the symptoms of intrusion (ANOVA,  F-value=7.09, P<0.001) were significantly reduced after a period of 12 months. Levels of hostility (ANOVA, F-value=7.85, P<0.001) and psychoticism were significantly increased (ANOVA, F-value=7.80, P<0.001) at the end of the treatment. Other categories of posttraumatic symptoms and the level of general psychopathology did not change significantly during the course of treatment. The  results showed that war veterans perceive extremely low levels of social acknowledgment, especially from their wider social environment: 92.9% perceived a lack of acknowledgment from governmental institutions and 95.4% from the state in general. CONCLUSION: Despite some methodological constraints, our results showed  that even 10 years after the traumatization, PTSD symptoms among war veterans remained intense and that undergoing therapy over a year did not produce significant improvements, except on the dimension of intrusion. Veterans were highly sensitive to the way their primary social environment and the society as a whole react to their problems.

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

PMID: 17436380 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):146-56.

Psychiatric heredity and posttraumatic stress disorder: survey study of war veterans.

Dijanić Plasć I, Peraica T, Grubisić-Ilić M, Rak D, Jambrosić Sakoman A, Kozarić-Kovacić D.

Department of Psychiatry, The Referral Center of the Ministry of Health and Social Welfare for Stress-related Disorders, Regional Center for Psychotrauma, University Hospital Dubrava, Zagreb, Croatia.

AIM: To explore the prevalence of psychiatric heredity (family history of psychiatric illness, alcohol dependence disorder, and suicidality) and its association with the diagnosis of stress-related disorders in Croatian war veterans established during psychiatric examination. METHODS: The study included  415 war veterans who were psychiatrically assessed and diagnosed by the same psychiatrist during an expert examination conducted for the purposes of compensation seeking. Data were collected by a structured diagnostic procedure. RESULTS: There was no significant correlation between psychiatric heredity of psychiatric illness, alcohol dependence, or suicidality and diagnosis of posttraumatic stress disorder (PTSD) or PTSD with psychiatric comorbidity. Diagnoses of psychosis or psychosis with comorbidity significantly correlated with psychiatric heredity (Phi=0.111; P=0.023). There was a statistically significant correlation between maternal psychiatric illness and the patients' diagnoses of partial PTSD or partial PTSD with comorbidity (Phi=0.104; P=0.035) and psychosis or psychosis with comorbidity (Phi=0.113; P=0.022); paternal psychiatric illness and the patients' diagnoses of psychosis or psychosis with comorbidity (Phi=0.130; P=0.008), alcohol dependence or alcohol dependence with comorbidity (Phi=0.166; P=0.001); psychiatric illness in the primary family with  the patients' psychosis or psychosis with comorbidity (Phi=0.115; P=0.019); alcohol dependence in the primary family with the patients' personality disorder  or personality disorder with comorbidity (Phi=0.099; P=0.044); and suicidality in the primary family and a diagnosis of personality disorder or personality disorder with comorbidity (Phi=0.128; P=0.009). CONCLUSION: The study confirmed that parental and familial positive history of psychiatric disorders puts the individual at higher risk for developing psychiatric illness or alcohol or drug dependence disorder. Psychiatric heredity might not be necessary for the individual who was exposed to severe combat-related events to develop symptoms of PTSD.

PMID: 17436379 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):140-5.

Short-term memory in Croatian war veterans with posttraumatic stress disorder.

Sodić L, Anticević V, Britvić D, Ivkosić N.

Department of Neurology, Split University Hospital and School of Medicine, Split, Croatia.

AIM: To assess short-term memory impairment in war veterans with combat-related posttraumatic stress disorder (PTSD). METHOD: The study included 20 war veterans  diagnosed with PTSD and 21 control subjects matched for age, sex, and education level. Both groups were tested with the Rey-Osterrieth Complex Figure Test (ROCFT), consisting of Copy, Immediate Recall, and Delayed Recall steps, and Benton Visual Retention Test (BVRT). Subjects with visuoperceptive and visuoconstructional deficits, as indicated by their ROCFT Copy scores were excluded from the analysis, because this type of cognitive deficit could interfere with the results of the next two ROCFT steps measuring short-term memory. RESULTS: Subjects with PTSD scored significantly lower than control subjects on both Immediate Recall (mean+/-standard deviation [SD], 16.3+/-6.4 vs  26.7+/-4.5, respectively; P<0.001, t-test for independent samples) and Delayed Recall tests (15.7+/-6.1 vs 26.3+/-4.6, respectively; P<0.001, t-test for independent samples) on ROCFT test. Intragroup comparison showed that both groups scored significantly lower on Immediate Recall test in comparison with Copy test  (19.3+/-6.4 for veterans and 8.9+/-4.5 for controls; P<0.001 for both, t-test for dependent samples), whereas no significant score difference was found between Immediate and Delayed Recall scores in either group (0.7+/-2.4 for veterans, P=0.239, t-test for dependent samples; and 0.5+/-1.8 for controls, P=0.248, t-test for dependent samples), which indicated greater difficulties with acquiring new information than with recalling already memorized information. Subjects with PTSD made significantly more errors on the BVRT for visuoperceptive and visuoconstructional abilities than control subjects (7.8+/-2.9 for veterans;  4.0+/-1.88 for controls; P<0.001, t-test for independent samples). CONCLUSION: War veterans with PTSD had impaired short-term memory and visual retention, but these cognitive deficits could not be related to traumatic experiences with certainty.

PMID: 17436378 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2007 Apr;48(2):133-9.

Heterogeneity of posttraumatic stress disorder symptoms in Croatian war veterans: retrospective study.

Begić D, Jokić-Begić N.

Department of Psychiatry, Zagreb University Hospital Center and School of Medicine, Zagreb, Croatia.

AIM: To determine the relationship between the intensity of combat-related posttraumatic stress disorder (PTSD) and the intensity of predominating symptoms. METHOD: The study included 151 veterans from 1992-1995 war in Croatia (aged 38.3+/-7.3 years) with PTSD. The veterans were psychologically tested with the Mississippi Scale for Combat-related PTSD (M-PTSD), Questionnaire on Traumatic Combat and War Experiences (USTBI-M), and Minnesota Multiphasic Personality Inventory-version 201 (MMPI-201). RESULTS: The discriminative analysis of the data revealed that the group with lower PTSD intensity had the highest scores on  MMPI scales D (depression, T-score 98.3+/-5.6), Hs (hypochondriasis, 90.1+/-5.1), and Hy (hysteria, 89.5+/-4.9), whereas the group with higher PTSD intensity, besides these three scales (D=95.7+/-5.3; Hs=87.6+/-4.3; Hy=85.6+/-4.7), also had clinically significantly elevated Pt (psychastenia, 80.6+/-5.6), Sc (schizophrenia, 79.6+/-4.8), and Pa (paranoia, 85.6+/-5.4) scales, with the highest Pa scale. CONCLUSION: It was possible to differentiate study participants with different PTSD intensity on the basis of their MMPI profile. More intense PTSD was associated with externalized symptoms, such as aggression, acting-out, hostility, and mistrust, whereas less intensive PTSD was associated with mostly depressive symptoms. Our study showed that different intensity of PTSD has different symptom patterns.

PMID: 17436377 [PubMed - indexed for MEDLINE]

 

Cultur Divers Ethnic Minor Psychol. 2007 Apr;13(2):161-8.

Psychometric analyses of the Clinician-Administered PTSD Scale (CAPS)--Bosnian translation.

Charney ME, Keane TM.

Department of Veterans Affairs Boston Healthcare System, Boston University, Boston, MA 02130, USA. mecharney@partners.org

Methods for assessing psychological distress in culturally diverse populations are not firmly established. This study was designed to examine the psychometric properties of the Bosnian translation of the Clinician-Administered PTSD Scale (CAPS; D. D. Blake, F. W. Weathers, L. M. Nagy, D. Kaloupek, G. Klauminzer, D. Charney, et al., 1995) in a Bosnian refugee sample. The authors interviewed 115 help-seeking Bosnian refugees with the CAPS-Bosnian translation to examine its internal consistency and convergent validity, and to provide an assessment of its factor structure. This study demonstrated optimal fit with a 2-factor model of posttraumatic stress disorder (PTSD); the authors also found high reliability with a coefficient alpha of 0.92 and strong convergent validity with instruments  measuring depression, anxiety, and levels of psychosocial functioning. Future directions for the assessment of PTSD in cross-cultural populations are discussed. (c) 2007 APA, all rights reserved.

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

PMID: 17500605 [PubMed - indexed for MEDLINE]

 

Curr Opin Anaesthesiol. 2007 Apr;20(2):124-9.

Delirium, cognitive dysfunction and posttraumatic stress disorder.

Griffiths RD, Jones C.

Division of Metabolic and Cellular Medicine, School of Clinical Science, University of Liverpool, Liverpool, UK. rdg@liverpool.ac.uk

PURPOSE OF REVIEW: In the critically ill patient, disease and the therapies we use impact on brain function. Simple tools are now available to recognise such problems. This review highlights neuropsychiatric and cognitive observations that have direct relevance to patient care and outcome. RECENT FINDINGS: Delirium is a common event, especially the hypoactive forms in the elderly. The recognition of  significant cognitive dysfunction is worrying since it has profound implications  for how we treat and manage patients within intensive care and beyond. The most important message is that the 'awake' intensive care unit patient is not necessarily free of significant brain dysfunction. There is also the added complication of psychological disturbances related to real or imagined delusional experiences underlying the importance of memory and recall. Longer-term implications, particularly debilitating conditions such as posttraumatic stress disorder, mean that there is a need for improved post-intensive care unit rehabilitation care. SUMMARY: Health professionals working with the critically ill must routinely include the assessment of brain cognitive function. While some of the consequences may be unavoidable, we need to reassess our sedation and care practices to ensure we are not confounding the problem. Practical options to improve outcome are being developed and emphasise that the recovery from critical illness is psychological as well as physical.

Publication Types:      Review

PMID: 17413395 [PubMed - indexed for MEDLINE]

 

Curr Opin Obstet Gynecol. 2007 Apr;19(2):126-32.

Psychosomatic disorders in pregnancy.

Tam WH, Chung T.

Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong. tamwh@cuhk.edu.hk

PURPOSE OF REVIEW: Common and important psychosomatic disorders in pregnancy reviewed here include perinatal depression, posttraumatic stress disorders, anxiety disorders, eating disorders, and postpartum psychosis. RECENT FINDINGS: Research has focused on antenatal depression as postpartum depression often has onset prior to delivery. Certain psychosocial and psychological interventions can effectively prevent postnatal depression. Although the use of selective serotonin reuptake inhibitors was associated with miscarriage, preterm delivery, and fetal  death, discontinuation of antidepressants also increased the relapse rate during  pregnancy. Studies also show that about 8% of mothers had eating problems during  their pregnancy, which increased to 19% in the postpartum period. Postpartum psychosis is an important diagnosis related to maternal death from suicide. Personal and family history of bipolar disorders are important risk factors. SUMMARY: Recent findings highlight the importance of correct diagnosis and awareness of serious mental illness. In view of the higher rate of relapse, women should be counselled carefully regarding discontinuation of antidepressants during pregnancy. Differentiation of posttraumatic stress disorders with comorbid anxiety and depression, awareness of risk factors, and clinical features of psychosis are important in the management of psychosomatic disorders in pregnancy.

Publication Types:      Review

PMID: 17353680 [PubMed - indexed for MEDLINE]

 

Int J Clin Exp Hypn. 2007 Apr;55(2):167-88.

Hypnosis and the treatment of posttraumatic conditions: an evidence-based approach.

Lynn SJ, Cardeńa E.

Psychology Department, Binghamton University, Binghamton, New York 13902, USA. slynn@binghamton.edu

This article reviews the evidence for the use of hypnosis in the treatment of posttraumatic conditions including posttraumatic stress disorder and acute stress disorder. The review focuses on empirically supported principles and practices and suggests that hypnosis can be a useful adjunctive procedure in the treatment  of posttraumatic conditions. Cognitive-behavioral and exposure-based interventions, which have the greatest empirical support, are highlighted, and an illustrative case study is presented.

Publication Types:      Case Reports

PMID: 17427292 [PubMed - indexed for MEDLINE]

 

J Abnorm Child Psychol. 2007 Apr;35(2):191-201.

Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma.

Meiser-Stedman R, Smith P, Glucksman E, Yule W, Dalgleish T.

Department of Psychology (P77), Institute of Psychiatry, De Crespigny Park, London, UK. r.meiser-stedman@iop.kcl.ac.uk

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more  likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters,  based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's kappa = -.04), but fair for PTSD (Cohen's kappa = .21). Agreement ranged widely for other emotional disorders (Cohen's kappa = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma.

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

PMID: 17219079 [PubMed - indexed for MEDLINE]

 

J Affect Disord. 2007 Apr;99(1-3):165-72. Epub 2006 Oct 12.

Affective disorders, anxiety disorders and psychological distress in non-drinkers.

Rodgers B, Parslow R, Degenhardt L.

National Centre for Epidemiology and Population Health, The Australian National University, Canberra ACT 0200, Australia. Bryan.Rodgers@anu.edu.au

BACKGROUND: Non-drinkers have elevated levels of psychological distress but a recent study reported no elevation in prevalence of diagnosed disorders. We aimed to determine the prevalence of affective and anxiety disorders (from the CIDI-A)  in current abstainers and contrast results with findings for psychological distress (K10) in the same sample. METHODS: Cross-sectional, representative household survey of adult Australians. RESULTS: Non-/occasional drinkers had higher levels of psychological distress than light drinkers, and distress in heavy drinkers was even higher. Heavy drinkers also had the highest rates of most disorders. Non-/occasional drinkers showed significantly elevated prevalence only of dysthymia, agoraphobia and posttraumatic stress disorder compared with light drinkers. LIMITATIONS: Statistical power was limited for investigating low prevalence disorders. History of alcohol consumption was not collected. The CIDI-A and K10 have finite validity. CONCLUSIONS: This study confirmed J-shaped relationships between psychological distress and alcohol consumption. Although affective and anxiety disorders also showed non-linear relationships with alcohol consumption, non-/occasional drinkers are not at increased risk for all disorders compared to light drinkers. The pattern of symptomatology in non-/occasional drinkers may be of a different character to that in heavy drinkers, as well as being less severe.

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

PMID: 17046068 [PubMed - indexed for MEDLINE]

 

J Am Acad Psychoanal Dyn Psychiatry. 2007 Spring;35(1):51-69.

Contemporary group treatment of combat-related posttraumatic stress disorder.

Kingsley G.

The Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530-0701, USA.

The contemporary group treatment of veterans from the Vietnam War to the present  who suffer from combat-related PTSD is reviewed in light of the dynamic understanding of combat trauma developed during and since World War II. Both dynamic and cognitive behavioral group therapies are explored. The common features of all group treatments of combat PTSD involve the development of trust  and the communalization of trauma within a cohesive group. Further research is needed to increase our understanding of effectiveness, mediating factors, and relationships between childhood experience and combat trauma.

PMID: 17480188 [PubMed - indexed for MEDLINE]

 

J Am Acad Psychoanal Dyn Psychiatry. 2007 Spring;35(1):39-50.

The need for psychodynamic principles in outreach to new combat veterans and their families.

Kudler H.

Mental Health Service Line, Veterans Integrated Service Network, VA Medical Center, Durham, NC 27705, USA.

Although Posttraumatic Stress Disorder (PTSD) has come to be understood in primarily biological terms, the problems of returning combat veterans from Iraq and Afghanistan (and indeed, of their families) are best understood in psychodynamic terms. Their needs would be better met through a public health model that incorporates progressive outreach and engagement of all new veterans rather than a traditional medical model which focuses only on those with a biological disorder. Work with new veterans and their families requires facilitation of their own adaptive processes (psychological, social, and biological). This approach carries with it the potential to reorient and revitalize the theory and practice of psychiatry.

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

PMID: 17480187 [PubMed - indexed for MEDLINE]

 

J Am Acad Psychoanal Dyn Psychiatry. 2007 Spring;35(1):1-12.

Franklin Delano Jones, M.D., and war psychiatry.

Ivany CG, Gray SH.

Walter Reed Army Medical Center, and Adjunct Professor of Psychiatry, Uniformed Services University of the Health Sciences, USA.

Through a long career that spanned three wars and important changes in patterns of health care, Franklin Delano Jones (1935-2005) provided medical and psychiatric care to the most vulnerable members of our society, civilian as well  as military. Recognizing that individuals tend to forget lessons learned in stressful situations, he compiled and codified the essential practices of wartime psychiatry into comprehensive and accessible texts. His neutrality, persistence,  and sharp intellect stabilized and strengthened American military psychiatry in the post-Vietnam era. His culminating achievement, War Psychiatry, which is the codified clinical intelligence of several generations of military psychiatrists,  is an essential foundation for clinical practice and for research. This article explores Jones'ss contributions, particularly the variations in the presentation  of combat stress, the efficacy of the principles of forward treatment, and a comprehensive understanding of posttraumatic stress disorder.

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

Personal Name as Subject:      Jones FD

PMID: 17480184 [PubMed - indexed for MEDLINE]

 

J Child Adolesc Psychopharmacol. 2007 Apr;17(2):223-32.

Risperidone treatment of preschool children with thermal burns and acute stress disorder.

Meighen KG, Hines LA, Lagges AM.

Department of Psychiatry, Section of Child and Adolescent Psychiatry, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202-5200, USA. kmeighen@iupui.edu

Pharmacologic treatment of acute stress disorder (ASD) is a novel area of investigation across all age groups. Very few clinical drug trials have been reported in children and adolescents diagnosed with ASD. Most of the available, potentially relevant, data are from studies of adults with posttraumatic stress disorder (PTSD). The atypical antipsychotic agents have been reported to be effective as an adjunctive treatment for adults with PTSD. There have been a limited number of studies published regarding atypical antipsychotic treatment of PTSD in children and adolescents, and there is no current literature available on the use of these agents for children with ASD. This report describes the successful treatment of three preschool-aged children with serious thermal burns  as a result of physical abuse or neglect. Each of these children was hospitalized in a tertiary-care children's hospital and was diagnosed with ASD. In all cases,  risperidone provided rapid and sustained improvement across all symptom clusters  of ASD at moderate dosages. Minimal to no adverse effects were reported. These cases present preliminary evidence for the potential use of risperidone in the treatment of ASD in childhood.

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

PMID: 17489717 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2007 Apr-Jun;36(2):260-6.

Sexual assault disclosure in relation to adolescent mental health: results from the National Survey of Adolescents.

Broman-Fulks JJ, Ruggiero KJ, Hanson RF, Smith DW, Resnick HS, Kilpatrick DG, Saunders BE.

Department of Psychology, Appalachian State University, Boone, NC 28608, USA. bromanfulks@appstate.edu

Child sexual assault is a risk factor for a wide range of emotional and behavioral problems. Little is known about mental health functioning in relation  to victims' decisions to tell someone (or not) about their assault. This study used data from a nationally representative sample of 4,023 adolescents to examine the relation between sexual assault disclosure characteristics and mental health  outcomes. Results indicated that youth who disclosed the assault to someone within 1 month were at reduced risk for current major depressive episode (MDE) and delinquency. No relation was found between disclosure latency and risk for posttraumatic stress disorder (PTSD) or substance use problems. Notably, disclosure to mothers was associated with significantly reduced risk for current  PTSD and delinquency.

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

PMID: 17484698 [PubMed - indexed for MEDLINE]

 

J Clin Psychopharmacol. 2007 Apr;27(2):193-7.

A placebo-controlled trial of bupropion SR in the treatment of chronic posttraumatic stress disorder.

Becker ME, Hertzberg MA, Moore SD, Dennis MF, Bukenya DS, Beckham JC.

Durham VA Medical Center, NC 27705, USA.

OBJECTIVE: Although selective serotonin reuptake inhibitors have been the most empirically studied pharmacotherapy for posttraumatic stress disorder (PTSD), a need remains for the investigation of additional pharmacological agents in the treatment of PTSD. The present study examined the use of bupropion sustained release (SR) as compared with placebo for symptom reduction in patients with PTSD: approximately half who were already prescribed an selective serotonin reuptake inhibitor and half who were not. METHOD: Thirty patients (mean age, 50 years) with civilian- or military-related PTSD enrolled in an 8-week evaluation of bupropion SR versus placebo assigned in a 2:1 ratio in addition to their usual pharmacological care. Statistical tests included analyzing both study completers  and using an intent-to-treat analysis, as well as post hoc examination of responders versus nonresponders. RESULTS: Although no between-group differences were detected, both groups reported a reduction in PTSD symptoms. In a hypothesis-generating post hoc analysis of responders versus nonresponders in the bupropion SR condition (defined as a Clinician Global Improvement score of at least minimally improved), it seemed that younger patients not currently on another antidepressant were more likely to benefit from bupropion. CONCLUSIONS: Bupropion SR in the treatment of PTSD had no significant effect in the current sample. Factors contributing to the absence of an effect need further study. Our  analysis points to the inclusion of age and concomitant antidepressant treatment  as important variables in any future larger-scale study.

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

PMID: 17414245 [PubMed - indexed for MEDLINE]

 

J Clin Psychopharmacol. 2007 Apr;27(2):166-70.

Failed efficacy of fluoxetine in the treatment of posttraumatic stress disorder:  results of a fixed-dose, placebo-controlled study.

Martenyi F, Brown EB, Caldwell CD.

Lilly Research Laboratories, Vienna, Austria.

A multicenter, double-blind, 12-week, placebo-controlled trial of 411 randomized  patients, predominantly women diagnosed with posttraumatic stress disorder, failed to show a difference between either dose of fluoxetine treatment and placebo. The mean changes from baseline (SD) measured by the Clinician-Administered PTSD Scale scores were -42.9 (23.1), -42.8 (27.9), and -36.6 (25.7) in the 20-mg fluoxetine, 40-mg fluoxetine, and placebo arms, respectively. Placebo response rate was substantially higher in this study than in a previously published fluoxetine trial of posttraumatic stress disorder.

Publication Types:      Multicenter Study     Randomized Controlled Trial     Research Support, Non-U.S. Gov't

PMID: 17414240 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2007 Apr;75(2):316-24.

Posttraumatic intrusion, avoidance, and social functioning: a 20-year longitudinal study.

Solomon Z, Mikulincer M.

Adler Research Center, Tel-Aviv University, Tel Aviv, Israel. solomon@post.tau.ac.il

The study assesses posttraumatic intrusion, avoidance, and social functioning among 214 Israeli combat veterans from the first Lebanon War with and without combat stress reaction (CSR) 1, 2, 3, and 20 years after the war. CSR veterans reported higher intrusion and avoidance than did non-CSR veterans. With time, there was a decline in these symptoms. In addition, intrusion and avoidance were  associated with problems in social functioning on a given year, and they longitudinally predicted social dysfunction 2, 3, and 20 years after the war. CSR veterans presented stronger temporal covariations between intrusion-avoidance and social functioning. The findings suggest that CSR is a marker for future psychopathology and point to the role of avoidance in social dysfunction. Copyright 2007 APA, all rights reserved.

PMID: 17469889 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Apr;195(4):298-306.

Change in prevalence of psychiatric disorders from ages 21 to 30 in a community sample.

Tanner JL, Reinherz HZ, Beardslee WR, Fitzmaurice GM, Leis JA, Berger SR.

Rutgers University, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, New Jersey, USA. jetanner@rci.rutgers.edu

The authors examined change and demonstrated variation in the prevalence of psychiatric disorders from ages 21 to 30 in a prospective community study (n = 352) using generalized estimating equations and investigated effects of past and  recent psychiatric disorder on emerging adult functioning (at age 30). Results revealed significant declines in 12-month prevalence of phobia and substance use  disorders from ages 21 to 30 but not in depression or posttraumatic stress disorder. Males were at significantly higher risk for lifetime substance use disorders; females were at higher risk for lifetime depression, phobia, and PTSD. Twelve-month and lifetime disorder were associated with impaired global functioning at age 30. Internalizing disorders were associated with impaired interpersonal functioning, whereas externalizing disorders were associated with impaired socioeconomic functioning. Results of this study have implications for mental health service planning in emerging adulthood.

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

PMID: 17435479 [PubMed - indexed for MEDLINE]

 

J Neuropsychiatry Clin Neurosci. 2007 Spring;19(2):106-27.

Neuropsychiatric complications of traumatic brain injury: a critical review of the literature (a report by the ANPA Committee on Research).

Kim E, Lauterbach EC, Reeve A, Arciniegas DB, Coburn KL, Mendez MF, Rummans TA, Coffey EC; ANPA Committee on Research.

Bristol-Myers Squibb Company, Neuroscience Medical Strategy, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA. edward.kim@bms.com

Psychiatric disorders frequently complicate recovery and rehabilitation from traumatic brain injury (TBI). This study reviews the literature from 1978 to 2006 on psychosis, depression, posttraumatic stress disorder, mania, and aggression following nonpenetrating TBI. The studies were reviewed using the American Academy of Neurology's criteria for classification of articles on diagnostic methods. No studies were found to be Class I or II. Of the 66 studies reviewed, the majority were Class IV. There are significant gaps in the literature on post-TBI psychiatric conditions with respect to nosology, epidemiology, and risk  factors. Larger multicenter prospective studies using standardized diagnostic instruments are needed to further clarify the nosology, risk factors, and clinical course of these disorders. Specific directions for research are provided.

Publication Types:      Review

PMID: 17431056 [PubMed - indexed for MEDLINE]

 

J Orofac Pain. 2007 Spring;21(2):107-19.

Comment in:     J Orofac Pain. 2007 Spring;21(2):85-6.

Prevalence and impact of post-traumatic stress disorder symptoms in patients with masticatory muscle or temporomandibular joint pain: differences and similarities.

Bertoli E, de Leeuw R, Schmidt JE, Okeson JP, Carlson CR.

Orofacial Pain Center, College of Dentistry, University of Kentucky, Lexington, KY 40532-0297, USA.

AIMS: To evaluate temporomandibular disorder (TMD) patients for differences between masticatory muscle (MM) and temporomandibular joint (TMJ) pain patients in the prevalence of posttraumatic stress disorder (PTSD) symptoms and evaluate the level of psychological dysfunction and its relationship to PTSD symptoms in these patients. METHODS: This study included 445 patients. Psychological questionnaires included the Symptom Check List-90-Revised (SCL-90-R), the Multidimensional Pain Inventory, the Pittsburgh Sleep Quality Index, and the PTSD Check List Civilian. The total sample of patients was divided into 2 major groups: the MM group (n = 242) and the TMJ group (n = 203). Each group was divided into 3 subgroups based on the presence of a stressor and severity of PTSD symptoms. RESULTS: Thirty-six patients (14.9%) in the MM group and 20 patients (9.9%) in the TMJ group presented with PTSD symptomatology (P = .112). Significant differences were found between the MM and the TMJ group in several psychometric domains, but when the presence of PTSD symptomatology was considered, significant differences were mostly maintained in the subgroups without PTSD. MM and TMJ pain patients in the "positive PTSD" subgroups scored higher on all SCL-90-R scales (P < .001) than patients in the other 2 subgroups and reached levels of distress indicative of psychological dysfunction. TMJ pain  patients (58.3%; P = .008) in the positive-PTSD subgroups were more often classified as dysfunctional. Both positive-PTSD subgrounps of the MM and TMJ groups presented with more sleep disturbance (P < .005) than patients in the other 2 subgroups. CONCLUSION: A somewhat elevated prevalence rate for PTSD symptomatology was found in the MM group compared to the TMJ group. Significant levels of psychological dysfunction appeared to be linked to TMD patients with PTSD symptoms.

PMID: 17547122 [PubMed - indexed for MEDLINE]

 

J Pediatr Psychol. 2007 Apr;32(3):309-18. Epub 2006 Jun 8.

Parental posttraumatic stress symptoms as a moderator of child's acute biological response and subsequent posttraumatic stress symptoms in pediatric injury patients.

Nugent NR, Ostrowski S, Christopher NC, Delahanty DL.

Department of Psychology, Kent State University, Kent, Ohio 44242, USA.

OBJECTIVE: To examine how parental responses following pediatric injury may influence their child's posttraumatic stress symptoms (PTSS). METHODS: Heart rate (HR) from 82 pediatric injury patients was measured during emergency medical services (EMSs) transport and following hospital admission. Twelve-hour urinary cortisol levels were assessed upon admission. Child PTSS and parental PTSS and general distress were assessed 6 weeks and 6 months after trauma. RESULTS: Six-week parental PTSS predicted 6-month child PTSS even after controlling for demographics and general parent distress (DeltaR(2) = .08, p = .03). Parental PTSS moderated the relationship between (a) child cortisol levels and 6-month child PTSS (DeltaR2 = .08, p = .03) and between (b) hospital HR and 6-month child PTSS (DeltaR2 = .09, p = .03). CONCLUSION: The present findings suggest that parental response to trauma may interact with child acute physiological responses to predict persistent child PTSS.

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

PMID: 16762993 [PubMed - indexed for MEDLINE]

 

J Pediatr Psychol. 2007 Apr;32(3):338-42. Epub 2006 May 22.

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims.

Ostrowski SA, Christopher NC, Delahanty DL.

Department of Psychology, 118 Kent Hall, Kent State University, Kent, Ohio 44242, USA.

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress  disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic  injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in  girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child  PTSD, especially in girls.

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

PMID: 16717137 [PubMed - indexed for MEDLINE]

 

J Psychosom Res. 2007 Apr;62(4):495-500.

Posttraumatic symptoms were worst among quake victims with injuries following the Chi-chi quake in Taiwan.

Kuo HW, Wu SJ, Ma TC, Chiu MC, Chou SY.

Department of Public Health, China Medical University, Taiwan, ROC. wukuo@mail.cmu.edu.tw

OBJECTIVE: The aim of this study was to investigate the incidence of posttraumatic stress disorder (PTSD) and psychological health status among earthquake victims 1 year after the quake. METHOD: Two hundred and seventy-two quake victims from temporary housing units were interviewed. Posttraumatic symptoms was assessed using the Davidson Trauma Scale, Chinese version (DTS-C). Psychological health status was measured using the Chinese Health Questionnaire (CHQ). RESULTS: The percentage of posttraumatic symptoms was 16.5%. Fifty-seven percent of the victims were found to have psychological problems using the CHQ. Posttraumatic symptoms and psychological problems were more prevalent among women (22.2% and 64%), compared with men (9.2% and 47.9%). Posttraumatic symptoms and CHQ total scores were highest among 25- to 44-year-olds, and lowest in the over-60-year group. Based on linear and logistic regression models, age and injury were the only two factors that significantly affected posttraumatic symptoms and CHQ total scores. CONCLUSION: Consistent with the previous studies,  it is vitally important to continue providing psychological counseling and social support for quake victims, particularly victims who sustained an injury.

PMID: 17383502 [PubMed - indexed for MEDLINE]

 

J Sch Nurs. 2007 Apr;23(2):86-91.

Silent victims: children exposed to family violence.

Kolar KR, Davey D.

Department of Pediatrics, University of Mississippi Medical Center, Batson CARE Clinic at the Mississippi Children's Justice Center, Jackson, MS, USA.

Annually an estimated 3 million or more children are exposed to acts of domestic  violence between adults in their homes. These children are at risk for abuse themselves as well as other immediate and long-term problems, especially if they  have been exposed to repeated episodes of domestic violence. Multiple behavioral  manifestations, including anxiety, depression, and posttraumatic stress disorder, may be associated with violence exposure, and it is imperative that school nurses recognize these. All children should be screened for domestic violence exposure at regular intervals, and those who are at risk should have a more thorough health assessment. Planning for the safety of the child, nonoffending caregiver,  and siblings and the school nurse involved in the situation is of utmost importance.

Publication Types:      Review

PMID: 17394377 [PubMed - indexed for MEDLINE]

 

J Spec Pediatr Nurs. 2007 Apr;12(2):84-92.

Posttraumatic stress symptoms in the pediatric intensive care unit.

Ward-Begnoche W.

Section of Pediatric Psychology, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA. wardbegnochewendyl@uams.edu

PURPOSE: Children who experience acute injury or illness severe enough to result  in a pediatric intensive care unit (PICU) stay are at risk for posttraumatic stress symptoms, as are their parents. A distinction is made between injury-related traumatic events, illness-related traumatic events, and treatment-related traumatic events, all of which contribute to this risk. CONCLUSIONS: This paper reviews what the PICU experience is like for children and their parents, the emerging literature on posttraumatic stress symptoms in PICU patients and their parents, and current knowledge regarding risk and resiliency factors for these children. PRACTICE IMPLICATIONS: Children hospitalized in the PICU should be monitored for posttraumatic stress disorder during and after their stay. Risk and resiliency factors are a focus for practice and for future research.

Publication Types:      Review

PMID: 17371552 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):123-33.

Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults.

Davis JL, Wright DC.

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

Nightmares and sleep disturbance are fundamental concerns for victims of trauma.  This study examined the efficacy of a manualized cognitive-behavioral treatment (CBT) for chronic nightmares in trauma-exposed individuals via a randomized clinical trial. Participants were randomly assigned to a treatment group or wait-list control group, with 27 participants completing the treatment. At the 6-month follow-up assessment, 84% of treated participants reported an absence of  nightmares in the previous week. Significant decreases were also reported in symptoms of depression and posttraumatic stress, fear of sleep, and number of sleep problems, while sleep quality and quantity improved. The present study adds to the growing literature indicating this brief CBT as a first-line treatment for trauma-exposed individuals with chronic nightmares.

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

PMID: 17427914 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):107-21.

The Criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma.

Weathers FW, Keane TM.

Department of Psychology, Auburn University, Auburn, AL 36849, USA. weathfw@auburn.edu

The Criterion A problem in the field of traumatic stress refers to the stressor criterion for posttraumatic stress disorder (PTSD) and involves a number of fundamental issues regarding the definition and measurement of psychological trauma. These issues first emerged with the introduction of PTSD as a diagnostic  category in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980) and continue to generate considerable controversy. In this article, the authors provide an update on the Criterion A problem, with particular emphasis on the evolution of the DSM  definition of the stressor criterion and the ongoing debate regarding broad versus narrow conceptualizations of traumatic events.

Publication Types:      Review

PMID: 17427913 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):135-45.

Aggression among combat veterans: relationships with combat exposure and symptoms of posttraumatic stress disorder, dysphoria, and anxiety.

Taft CT, Vogt DS, Marshall AD, Panuzio J, Niles BL.

National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA. casey.taft@va.gov

Prior research has revealed heightened aggressive behavior among veterans with PTSD. This study tested a model examining the interrelationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, dysphoric symptoms, and  anxiety symptoms in predicting aggressive behavior in a sample of 265 male combat veterans seeking diagnostic assessment of PTSD. Combat exposure was indirectly associated with aggression primarily through its relationship with PTSD symptoms. Symptoms of PTSD were directly related to aggression, and indirectly related to aggression through dysphoric symptoms. Results highlight the role of PTSD symptoms and dysphoric symptoms with respect to aggressive behavior among this population, and suggest the relevance of aggression theory to the study of combat veterans.

PMID: 17427912 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):207-16.

Confirmatory factor analysis of posttraumatic stress symptoms in Cambodian refugees.

Palmieri PA, Marshall GN, Schell TL.

Department of Psychiatry, Summa Health System, Akron, OH, USA.

This study used confirmatory factor analysis to examine the factor structure of the Cambodian version of the Harvard Trauma Questionnaire in 488 Cambodian refugees residing in the United States. Five alternative conceptual models were compared. A model with four correlated factors reflecting symptoms of re-experiencing, avoidance, emotional numbing, and hyperarousal provided the best fit to these data. The avoidance and emotional numbing clusters demonstrated distinct associations with depression symptoms, providing some evidence of the construct validity of the four-factor solution.

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

PMID: 17427910 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):183-96.

Intrusive memories and ruminations related to violent crime among young offenders: phenomenological characteristics.

Evans C, Ehlers A, Mezey G, Clark DM.

Department of Psychological Medicine, St. George's Hospital Medical School, London, UK. ceri.evans@cdhb.govt.nz

Very little is known about the nature of perpetrator's memories of violent crime. The authors conducted semistructured interviews with a representative sample of 105 young offenders convicted of serious violence, assessing intrusive memories,  ruminations, and symptoms of posttraumatic stress disorder related to their violent crime. Forty-eight (46%) participants described significant intrusive memories of the assault, and 38 (36%) reported ruminations related to the assault. Ethnic origin and historical variables explained 19% of the variance of  posttraumatic stress disorder symptom severity; intrusion and rumination characteristics added an additional 48% explained variance. The intrusive memories tended to concern the moment when the event turned for the worse for the perpetrator. The findings have implications for risk assessment and therapeutic interventions for violent offenders.

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

PMID: 17427909 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):173-82.

Posttraumatic appraisals in the development and persistence of posttraumatic stress symptoms.

O'Donnell ML, Elliott P, Wolfgang BJ, Creamer M.

Australian Centre for Posttraumatic Mental Health, and Department of Psychiatry,  University of Melbourne-Parkville, Heidelberg West, Victoria 3081, Australia. mod@unimelb.edu.au

Cognitive models of posttraumatic stress disorder (PTSD) posit that appraisal plays an important role in the development and persistence of PTSD. This study examined posttraumatic appraisals and their relationship to the development and course of PTSD symptoms. Two hundred fifty-three injury survivors were assessed for PTSD symptoms and posttraumatic cognitions across a 12-month period. A path analytic modeling approach showed that posttraumatic appraisals were important direct and indirect predictors of later PTSD severity. The findings suggest that  appraisals made in the aftermath of trauma have a significant influence on subsequent psychological adjustment.

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

PMID: 17427908 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):161-72.

Quality of parental relationships among persons with a lifetime history of posttraumatic stress disorder.

Lauterbach D, Bak C, Reiland S, Mason S, Lute MR, Earls L.

Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, USA.  dlauterba@emich.edu

Several studies of combat veterans have examined the relationship between parental satisfaction and PTSD symptoms. These studies found that numbing is associated with substantial decrements in parent-child relationship quality. The  current study extends previous work by assessing the effect of PTSD on parent-child relationships in a nationally representative sample of civilian men  and women with PTSD resulting from a broad range of trauma. It was hypothesized that PTSD avoidance/numbing symptoms would be predictive of parent-child relationship quality and parent-child conflict. Moreover, these relationships are predicted to hold after controlling for a broad range of support-related variables and work/finance related variables. As hypothesized, after controlling  for number of children and respondent-initiated domestic violence, numbing was predictive of increased parent-child aggression.

PMID: 17427907 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Apr;20(2):197-206.

Emotional numbing weakens abused inner-city women's resiliency resources.

Johnson DM, Palmieri PA, Jackson AP, Hobfoll SE.

Summa-Kent State Center for the Treatment and Study of Traumatic Stress, Summa Health System, Akron, OH, USA. johnsod@summa-health.org

Conservation of resources theory (S. E. Hobfoll, 1988, 1999) hypothesizes that loss of resiliency resources can contribute to abused women's posttraumatic stress disorder (PTSD) symptoms, which, in turn, contribute to a further loss of  resources, which can make abused women even more vulnerable to future stressors.  This study investigates the impact of PTSD symptoms on abused women's future loss of resources-resources that women both value and need to aid their ongoing adjustment. Posttraumatic stress disorder symptoms contributed to future resource loss in abused women, even when controlling for the effects of prior resource loss and depression. Emotional numbing symptoms of PTSD accounted most for women's resource loss. Findings highlight the importance of research and intervention that more directly examines the link between emotions and resource loss.

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

PMID: 17427905 [PubMed - indexed for MEDLINE]

 

Obstet Gynecol. 2007 Apr;109(4):902-8.

Trauma and posttraumatic stress disorder in women with chronic pelvic pain.

Meltzer-Brody S, Leserman J, Zolnoun D, Steege J, Green E, Teich A.

Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. Samantha_Meltzer-Brody@med.unc.edu

OBJECTIVE: To examine the effect of abuse history, other major trauma, and posttraumatic stress disorder (PTSD) on medical symptoms and health-related daily functioning in women with chronic pelvic pain. METHODS: We administered a questionnaire to 713 consecutive women seen in a referral-based pelvic pain clinic. RESULTS: We found that 46.8% reported having either a sexual or physical  abuse history. A total of 31.3% had a positive screen for PTSD. Using regression  and path analysis, controlling for demographic variables, we found that a trauma  history was associated with worse daily physical functioning due to poor health (P<.001), more medical symptoms (P<.001), more lifetime surgeries (P<.001), more  days spent in bed (P<.001), and more dysfunction due to pain (P<.001). Furthermore, a positive screen for PTSD was highly related to most measures of poor health status (P<.001) and somewhat explained the trauma-related poor health status. CONCLUSION: The association of trauma with poor health may be due in part to the development of PTSD resulting from trauma. These findings demonstrate the  importance of screening for trauma and PTSD in women with chronic pelvic pain. LEVEL OF EVIDENCE: II.

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

PMID: 17400852 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2007 Apr;58(4):509-14.

Psychiatric disorders among adults seeking emergency disaster assistance after a  wildland-urban interface fire.

Marshall GN, Schell TL, Elliott MN, Rayburn NR, Jaycox LH.

RAND Corporation, 1776 Main St., Santa Monica, CA 90407, USA. grantm@rand.org

OBJECTIVE: This study estimated the prevalence of psychopathology at a three-month follow-up among persons seeking emergency relief services after a wildfire and identified a practical screener for use in these disaster assistance settings to aid early identification of persons at risk of subsequent psychopathology. METHODS: During the October 2003 California firestorm that occurred at the wildland-urban interface, 357 persons who were seeking assistance from adjacent American Red Cross and government relief centers were recruited for this study. Within days of mandatory evacuation, participants completed baseline  self-administered questionnaires assessing demographic characteristics, initial subjective reactions, and degree of fire exposure. At the three-month follow-up,  symptoms of posttraumatic stress disorder (PTSD) and major depression were measured via a mailed survey. RESULTS: At follow-up 33% showed evidence of probable major depression; 24% exhibited probable PTSD. On a bivariate basis, seven initial reaction and fire exposure items were significantly associated with subsequent psychopathology. Best-subsets logistic regression analyses revealed that property damage and physical injury were the best multivariate predictors of psychopathology at follow-up. No additional items provided a significant incremental improvement in prediction. CONCLUSIONS: Individuals seeking immediate emergency assistance related to the wildland-urban interface fire were at elevated risk of psychopathology in the weeks after the fire. A short, easily administered, two-item screener, composed of items assessing fire exposure severity, appears to hold promise for aiding early identification of persons at risk of postfire psychopathology. These findings may also have implications for other mass disasters.

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

PMID: 17412853 [PubMed - indexed for MEDLINE]

 

Psychoneuroendocrinology. 2007 Apr;32(3):215-26. Epub 2007 Feb 12.

Enhanced cortisol suppression in response to dexamethasone administration in traumatized veterans with and without posttraumatic stress disorder.

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

Department of Military Psychiatry, Central Military Hospital, Utrecht, The Netherlands. c.s.dekloet@umcutrecht.nl <c.s.dekloet@umcutrecht.nl>

BACKGROUND: While enhanced cortisol suppression in response to dexamethasone is one of the most consistent biological findings in posttraumatic stress disorder (PTSD), the relative contribution of trauma exposure to this finding remains unclear. METHODS: Assessment of diurnal salivary cortisol levels and 1600 h salivary cortisol before and after oral administration of 0.5mg dexamethasone in  veterans with PTSD, veterans without PTSD (trauma controls) and healthy controls. Assessment of 1600 h plasma cortisol, ACTH and corticotrophin binding globulin (CBG) in response to dexamethasone in PTSD patients and trauma controls. RESULTS: Both PTSD patients and trauma controls demonstrated significantly more salivary cortisol suppression compared to healthy controls. Salivary cortisol, plasma cortisol and ACTH suppression as well as CBG levels did not differ between PTSD patients and trauma controls. PTSD patients showed a reduced awakening cortisol response (ACR) compared to healthy controls that correlated significantly with PTSD symptoms. No significant differences were observed in ACR between PTSD patients and trauma controls. CONCLUSIONS: These data suggest that enhanced cortisol suppression to dexamethasone is related to trauma exposure and not specifically to PTSD. The correlation between the ACR and PTSD severity suggests  that a flattened ACR may be a result of clinical symptoms.

Publication Types:      Clinical Trial     Comparative Study     Research Support, Non-U.S. Gov't

PMID: 17296270 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2007 Apr;69(3):256-61. Epub 2007 Apr 9.

Tonic and phasic heart rate as predictors of posttraumatic stress disorder.

O'Donnell ML, Creamer M, Elliott P, Bryant R.

Australian Centre for Posttraumatic Mental Health, P.O. Box 5444, West Heidelberg, Victoria 3091, Australia. mod@unimelb.edu.au

OBJECTIVE: To examine the relationship between acute measures of a) heart rate (HR) immediately after traumatic injury, b) tonic (resting) HR at 1 week post injury, c) phasic (aroused) HR at 1 week post injury, and d) somatic symptoms of  arousal in the prediction of subsequent posttraumatic stress disorder (PTSD). Fear conditioning models propose that HR reactivity shortly after trauma may predict PTSD. METHOD: In a longitudinal study, consecutive injury survivors (n =  197) admitted to a hospital trauma service were assessed within 1 week and at 12  months post injury. HR was assessed by paramedics at the site of the trauma and pulse oximetry technology at 1 week post trauma. Somatic symptoms of arousal were measured using the somatic scale on the Beck Anxiety Inventory (BAI). PTSD was assessed using the Clinician Administered PTSD Scale at 12 months. RESULTS: At 12 months post injury, PTSD was diagnosed in 10% of participants. Only HR change scores (phasic - tonic HR) and BAI scores significantly predicted later PTSD. CONCLUSIONS: These findings question the clinical usefulness of tonic HR as a biological marker of later PTSD. The finding that HR reactivity (phasic - tonic)  predicts later PTSD has theoretical importance. The strongest predictor of later  PTSD was somatic arousal.

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

PMID: 17420442 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2007 Apr;69(3):242-8. Epub 2007 Mar 30.

Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample.

Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ.

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. sareen@cc.umanitoba.ca

OBJECTIVE: To assess if posttraumatic stress disorder (PTSD), recognized as a common mental disorder in the general population and veteran samples, has a unique impact on comorbidity, disability, and suicidal behavior (after adjusting  for other mental disorders, especially depression). METHODS: Data came from the Canadian Community Health Survey Cycle 1.2 (n = 36,984; age > or = 15 years; response rate 77%). All respondents were asked if they had been given a diagnosis of PTSD by a healthcare professional. A select number of mental disorders were assessed by the Composite International Diagnostic Interview. Chronic physical health conditions, measures of quality of life, disability, and suicidal behavior were also assessed. RESULTS: The prevalence of PTSD as diagnosed by health professionals was 1.0% (95% CI = 0.90-1.15). After adjusting for sociodemographic factors and other mental disorders, PTSD remained significantly associated with several physical health problems including cardiovascular diseases, respiratory diseases, chronic pain conditions, gastrointestinal illnesses, and cancer. After  adjusting for sociodemographic factors, mental disorders, and severity of physical disorders, PTSD was associated with suicide attempts, poor quality of life, and short- and long-term disability. CONCLUSIONS: PTSD was uniquely associated with several physical disorders, disability, and suicidal behavior. Increased early recognition and treatment of PTSD are warranted.

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

PMID: 17401056 [PubMed - indexed for MEDLINE]

 

Psychiatr Res. 2007 Mar 30 [Epub ahead of print]

Diminished rostral anterior cingulate activity in response to threat-related events in posttraumatic stress disorder.

Kim MJ, Chey J, Chung A, Bae S, Khang H, Ham B, Yoon SJ, Jeong DU, Lyoo IK.

Department of Psychology, Seoul National University, Seoul, South Korea.

BACKGROUND: Previous brain imaging studies have reported hyperactivation of the amygdala and hypoactivation of the anterior cingulate in posttraumatic stress disorder (PTSD) patients, which is believed to be an underlying neural mechanism  of the PTSD symptoms. The current study specifically focuses on the abnormal activity of the rostral anterior cingulate, using a paradigm which elicits an unexpected processing conflict caused by salient emotional stimuli. METHODS: Twelve survivors (seven men and five women) of the Taegu subway fire in 2003, who later developed PTSD, agreed to participate in this study. Twelve healthy volunteers (seven men and five women) were recruited for comparison. Functional brain images of all participants were acquired using functional magnetic resonance imaging while performing a same-different judgment task, which was modified to elicit an unexpected emotional processing conflict. RESULTS: PTSD patients, compared to comparison subjects, showed a decreased rostral anterior cingulate functioning when exposed to situations which induce an unexpected emotional processing conflict. Moreover, PTSD symptom severity was negatively correlated to the level of decrease in the rostral anterior cingulate activity. CONCLUSIONS: The results of this study provide evidence that the rostral anterior cingulate functioning is impaired in PTSD patients during response-conflict situations that involve emotional stimuli.

PMID: 17400251 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2007 Mar 30;150(2):211-6. Epub 2007 Feb 14.

Baseline level of platelet-leukocyte aggregates, platelet CD63 expression, and soluble P-selectin concentration in patients with posttraumatic stress disorder:  a pilot study.

Vidović A, Vilibić M, Markotić A, Sabioncello A, Gotovac K, Folnegović-Smalc V, Dekaris D.

Department for Cellular Immunology, Institute of Immunology, Rockefellerova 10, HR-10 000 Zagreb, Croatia. avidovic@imz.hr

Platelets may have an important role in the development of cardiovascular disease (CVD) as a result of chronic stress. We conducted a pilot study to evaluate the effect of posttraumatic stress disorder (PTSD) on baseline platelet activation. Platelet-leukocyte aggregates (PLA) and CD63 expression were measured by flow cytometry, and soluble (s)P-selectin concentration was determined in sera of 20 Croatian male combat veterans with PTSD and 20 healthy civilians. Groups were matched in sex, age, body mass index (BMI) and traditional CVD risk factors. Our  data showed no differences in measured parameters. Other platelet activation markers should be determined and a larger sample size used in future studies.

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

PMID: 17303250 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2007 Mar 19 [Epub ahead of print]

Autobiographical memory and the self-memory system in posttraumatic stress disorder.

Sutherland K, Bryant RA.

University of New South Wales, Sydney, Australia.

This study investigated the relationship between perceptions of self and retrieval of autobiographical memories in posttraumatic stress disorder (PTSD). Civilian trauma survivors with and without PTSD (N=33) provided autobiographical  memories in response to positive and negative cue words. Participants also completed a measure of self-image derived from Higgins's [Higgins, E. T. (1987).  Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319-340] Selves Questionnaire. Participants with PTSD reported more trauma-focused memories in response to positive cues than non-PTSD participants.  Further, retrieval of trauma-focused memories in response to positive cues was strongly associated with perceptions that one's actual self was discrepant from one's ideal self. These findings are discussed in terms of the role of the self-memory system in adjustment to trauma.

PMID: 17467228 [PubMed - as supplied by publisher]

 

Drug Alcohol Depend. 2007 Mar 16;87(2-3):241-8. Epub 2006 Sep 27.

Changes in PTSD symptomatology during acute and protracted alcohol and cocaine abstinence.

Coffey SF, Schumacher JA, Brady KT, Cotton BD.

Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, Jackson, Mississippi 39216, USA. scoffey@psychiatry.umsmed.edu

Previous research with substance users has demonstrated, across a variety of psychiatric disorders, significant decreases in psychological symptoms during early substance abstinence. To build on this literature, the current study prospectively assessed trauma symptomatology over 28 days during acute and protracted cocaine and alcohol abstinence. Participants were 162 male and female  cocaine and/or alcohol dependent outpatients who reported a history of trauma. Trauma-related symptoms and substance use were assessed at 2, 5, 10, 14, 21, and  28 days following last substance use. For participants who were known to relapse, assessments began again after the last day of substance use. Latent growth modeling was employed to estimate changes in posttraumatic stress disorder (PTSD) symptoms. Consistent with studies of other psychiatric syndromes, PTSD symptoms declined across the 28-day study period regardless of withdrawal substance (i.e., cocaine or alcohol). The majority of change in trauma symptoms occurred within 2  weeks of last substance use. Moreover, while trauma symptoms for the PTSD participants were more severe than those reported by the non-PTSD participants, trauma symptoms declined across the study period at the same rate irrespective of PTSD status.

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

PMID: 17008029 [PubMed - indexed for MEDLINE]

 

Arch Intern Med. 2007 Mar 12;167(5):476-82.

Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.

Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C.

Department of Medicine, University of California, San Francisco, CA, USA. karen.seal@va.gov

BACKGROUND: Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for 2 years of free military service-related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. METHODS: US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. RESULTS: Of 103 788 OEF/OIF veterans seen at VA health care facilities, 25 658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32 010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most  initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24  years) were at greatest risk for receiving mental health or posttraumatic stress  disorder diagnoses compared with veterans 40 years or older. CONCLUSIONS: Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.

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

PMID: 17353495 [PubMed - indexed for MEDLINE]

 

Depress Anxiety. 2007 Mar 12 [Epub ahead of print]

Does the evocation of traumatic memories confound subsequent working memory performance in posttraumatic stress disorder (PTSD)?

Jelinek L, Moritz S, Randjbar S, Sommerfeldt D, Püschel K, Seifert D.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg‐Eppendorf, Hamburg, Germany.

The role of heightened arousal has been previously discussed as a contributor to  neurocognitive impairment in posttraumatic stress disorder (PTSD). To investigate whether psychological effects (distraction, re-location of resources) elicited by the evocation of traumatic memories impact on subsequent cognitive performance in PTSD, two parallel versions of a working memory task were administered to 33 trauma-exposed participants (15 with and 18 without PTSD). Between first and second working memory assessment a trauma-related interview was conducted including the narration of the trauma. Levels of working memory impairment in PTSD patients remained unchanged. This study provides preliminary evidence that neurocognitive impairment is not secondary to psychological effects induced by the evocation of traumatic memories. Nevertheless, it is recommended that future  PTSD research should devote more care to the order in which trauma-related and other dependent variables such as cognitive tests are presented to participants.  Depression and Anxiety 0:1-5, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17354268 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Mar 12 [Epub ahead of print]

Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder.

Strawn JR, Geracioti TD Jr.

Department of Psychiatry, University of Cincinnati, College of Medicine, Cincinnati, Ohio.

The catecholamine norepinephrine is a critical effector of the mammalian stress response and has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD)-a syndrome intrinsically related to the experience of extraordinary stress. Symptom-linked hypernoradrenergic derangements have been observed in PTSD and several studies have examined the potential therapeutic effects of agents that dampen the centrally hyperactive noradrenergic state. These agents include compounds that decrease norepinephrine release (e.g. centrally acting alpha(2) agonists such as clonidine) and those which block post-synaptic norepinephrine receptors (e.g. centrally acting alpha(1) or beta receptor antagonists such as prazosin or propranolol). In this article, we review studies of central noreadrenergic hyperactivity under both basal and challenge conditions and explore the evidence for these derangements as potential psychopharmacologic targets in patients with PTSD. Given the significant involvement of CNS norepinephrine hyperactivity in PTSD, and its link to intrusive and hyperarousal symptoms, it is not surprising that interventions directed at this system have therapeutic potential in PTSD. The utility of these  anti-adrenergics in the clinical treatment of PTSD remains to be determined, though it is possible that they may prove to have primary roles in a disorder that is only modestly responsive to antidepressant treatment. Depression and Anxiety 0:1-12, 2007. Published 2007 Wiley-Liss, Inc.

PMID: 17354267 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2007 Mar 12 [Epub ahead of print]

Learning and memory impairment in PTSD: relationship to depression.

Burriss L, Ayers E, Ginsberg J, Powell DA.

Shirley L. Buchanan Neuroscience Laboratory, Dorn VA Medical Center, Columbia, South Carolina.

Memory function was studied in combat veterans with posttraumatic stress disorder (PTSD), combat veterans without PTSD, and noncombat veterans. The Vocabulary and  Digit Span subtests of the WAIS and Logical Memory (LMS) and Verbal Paired Associates (VPAS) subtests of the Wechsler Memory Scale III were administered. Combat veterans with PTSD showed impaired memory on the LMS and VPAS compared to  combat veterans without PTSD or noncombat veterans. Veterans with PTSD also showed lower WAIS Vocabulary subtest scores-but not digit span subtest scores-than combat veterans without PTSD or noncombat veterans. Medication status, co-morbid diagnosis, and age all failed to account for these memory differences, but when self-assessed depression-as measured by the Zung Self-Rating Depression Scale-or anxiety-as measured by the Spielberger State-Trait Anxiety Scale-was statistically removed, group differences on these memory measures were no longer significant. However, using a stepwise regression  procedure, in which both anxiety and depression were employed to predict the LMS  and VPAS scores, only the Zung scale reliably predicated performance. The present results, showing that PTSD is associated with general learning and memory impairments, is an important finding, but the specific effects of depression as a mediator of these deficits should be further studied. Depression and Anxiety 0:1-9, 2007. Published 2007 Wiley-Liss, Inc.

PMID: 17352380 [PubMed - as supplied by publisher]

 

Swiss Med Wkly. 2007 Mar 10;137(9-10):151-6.

Posttraumatic stress disorder in a Swiss offender population.

Urbaniok F, Endrass J, Noll T, Vetter S, Rossegger A.

Psychiatric-Psychological Service, Zurich Department of Justice, Zurich, Switzerland.

QUESTIONS UNDER STUDY: Various studies have repeatedly shown an increased prevalence for Posttraumatic Stress Disorder (PTSD) in delinquents when compared  with the general population. Lifetime prevalence varies between 33% and 36%, and  point prevalence between 17% and 21%. The aim of this study was to examine whether these findings are applicable to offenders detained in Switzerland. METHODS: The sample consisted of 86 offenders. In order to control for over-reporting of traumatic life events three sub-samples (remand, sentenced/inpatient and sentenced/outpatient) administered by the Office of Corrections of the Canton of Zurich were examined. PTSD was diagnosed using the Posttraumatic Diagnostic Scale (PDS), a self-rating instrument for diagnosing PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, Version IV (DSM-IV). RESULTS: Point prevalence of PTSD was conservatively estimated at 27%. The three sub-samples did not differ in the prevalence of PTSD  when adjusted for potential demographic differences. Seventy-five percent of the  subjects had experienced at least one traumatic event that matched the criteria for a traumatic event according to the DSMIV. The Median number of traumatising life events according to the PDS was four in the examined sample. CONCLUSIONS: In this sample of male prisoners in Switzerland the prevalence of current PTSD was comparable to other international studies. The limitations and implications of these findings were discussed.

PMID: 17370156 [PubMed - indexed for MEDLINE]

 

Acad Emerg Med. 2007 Mar;14(3):202-9. Epub 2007 Jan 22.

Development of a brief mental health screen for intimate partner violence victims in the emergency department.

Houry D, Kemball RS, Click LA, Kaslow NJ.

Department of Emergency Medicine, Emory University, Atlanta, GA, USA. dhoury@emory.edu

BACKGROUND: Emergency physicians routinely treat victims of intimate partner violence (IPV) and patients with mental health symptoms, although these issues may be missed without routine screening. In addition, research has demonstrated a strong association between IPV victimization and mental health symptoms. OBJECTIVES: To develop a brief mental health screen that could be used feasibly in an emergency department to screen IPV victims for depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation. METHODS: The authors conducted a pretest/posttest validation study of female IPV victims to determine what questions from the Beck Depression Inventory II, Posttraumatic  Stress Diagnostic Scale, and Beck Scale for Suicide Ideation would predict moderate to severe levels of depressive symptoms, PTSD symptoms, and suicidal ideation. A principal components factor analysis was conducted to determine which questions would be used in the brief mental health screen. Scatter plots were then created to determine a cut point. RESULTS: Scores on the brief mental health screen ranged from 0 to 8. A cutoff score of 4 was used, which resulted in positive predictive values of 96% for the brief mental health screen for depression, 84% for PTSD symptoms, and 54% for suicidal ideation. In particular,  four questions about sadness, experiencing a traumatic event, the desire to live, and the desire to commit suicide were associated with moderate to severe mental health symptoms in IPV victims. CONCLUSIONS: The brief mental health screen provides a tool that could be used in an emergency department setting and predicted those IPV victims with moderate to severe mental health symptoms. Using this tool can assist emergency physicians in recognizing at-risk patients and referring these IPV victims to mental health services.

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

PMID: 17242384 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2007 Mar;32(3):634-9. Epub 2006 Jul 24.

Triggers for cocaine and alcohol use in the presence and absence of posttraumatic stress disorder.

Waldrop AE, Back SE, Verduin ML, Brady KT.

Division of Clinical Neuroscience, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Box 250861,  Charleston, SC 29425, USA. waldrop@musc.edu

The present study compared high-risk triggers and substance use situations among  72 (34 men, 38 women) individuals with alcohol (AD) or cocaine dependence (CD), with or without comorbid PTSD. Consistent with the self-medication hypothesis, individuals with PTSD reported significantly greater use of substances in response to negative situations, such as unpleasant emotions and physical discomfort, as compared to individuals without PTSD. CD individuals were significantly more likely than AD individuals to report using in temptation situations, regardless of PTSD status. Also, CD individuals with PTSD reported greater use of cocaine during pleasant times with others, as compared to those without PTSD. The findings highlight the importance of addressing individual-specific high-risk situations in relapse prevention.

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

PMID: 16863682 [PubMed - indexed for MEDLINE]

 

Aging Ment Health. 2007 Mar;11(2):175-91.

Assessing late-onset stress symptomatology among aging male combat veterans.

King LA, King DW, Vickers K, Davison EH, Spiro A 3rd.

Departments of Psychology and Psychiatry, and National Center for PTSD, VA Boston Healthcare System, Boston University, 150 S. Huntington Avenue, Boston, MA 02130, USA. lking@bu.edu

This study's goal was to develop a measure of late-onset stress symptomatology (LOSS). LOSS is a phenomenon observed in aging combat veterans who (a) were exposed to highly stressful combat events in their early adult years, (b) have functioned successfully throughout midlife with no history of chronic stress-related disorders, but (c) begin to register increased combat-related thoughts, feelings, and reminiscences commensurate with the changes and challenges of aging. Several samples of older male combat veterans from World War II, the Korean Conflict, and the Vietnam War served as participants. We developed a LOSS Scale that demonstrated a high degree of internal consistency reliability  (coefficient alpha = 0.97). Scores were stable over brief intervals but were sensitive to developmental change over an extended period. Factor analysis suggested a single LOSS factor. Bivariate associations between LOSS score and other variables (e.g., indicators of contemporary life stressors, resilience, quality of life) were consistent with hypotheses, and there was support for the incremental validity of LOSS vis-ŕ-vis posttraumatic stress symptoms and symptoms of general distress. Discussion of the potential uses of the scale, future directions for psychometric research, and suggestions for generalizing the LOSS construct to other trauma populations are provided.

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

PMID: 17453551 [PubMed - indexed for MEDLINE]

 

Am J Geriatr Pharmacother. 2007 Mar;5(1):9-17.

Provider-patient communication about antidepressants among veterans with mental health conditions.

Sleath B, Tulsky JA, Peck BM, Thorpe J.

Cecil G. Sheps Center for Health Services Research and the Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7590, USA. Betsy_Sleath@unc.edu

BACKGROUND: Little is known about provider-patient communication regarding antidepressants in primary care settings. OBJECTIVE: The purpose of the study was to describe the extent to which veterans and their providers discuss anti-depressants during primary care visits, and to examine how patient characteristics are related to elements of this communication. METHODS: This study is a secondary analysis conducted of a data set of audiotaped clinic visits and previsit interviews with 253 adult male veterans seen in primary care. The study patients who were provided an initial antidepressant prescription or continued on an antidepressant on the day of the audiotaped visit and who had a diagnosis of depression, posttraumatic stress disorder, or bipolar disorder were  included in the current analysis. Audiotapes were coded using a reliable instrument. Descriptive and bivariate statistics were calculated. RESULTS: Forty  veterans (mean [SD] age, 58.9 [10.4] years) were eligible for study. Of these 40  veterans with a documented prescription for an antidepressant, 62.5% (n = 25) discussed these medications with their provider during the visits. If antidepressants were discussed, the provider initiated the discussion 68.0% (n =  17) of the time. Only 2 patients asked questions about their antidepressants. Thirty-two of the 40 veterans were continued users of anti-depressants; 8 began their antidepressant on the date of the audiotaped visit. Providers asked 15.6% of veterans (n = 5) on continued therapy how well their antidepressants were working and 6.3% of veterans (n = 2) on continued therapy about adverse effects.  Among continued users of antidepressants, 18.8% (n = 6) expressed a complaint about their antidepressant and 21.9% (n = 7) of patients expressed an adherence problem. CONCLUSIONS: To detect and prevent problems with antidepressant therapy, primary care clinics should consider having nonphysician health care personnel ask patients taking antidepressant medication at least one open-ended question about how the antidepressant is working, another about possible adverse effects or barriers to use, and a third about adherence.

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

PMID: 17608243 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Mar;164(3):509-15.

Pretrauma and posttrauma neurocognitive functioning and PTSD symptoms in a community sample of young adults.

Parslow RA, Jorm AF.

University of Melbourne, Orygen Research Centre, Locked Bag 10, Melbourne, Victoria 3052, Australia. rparslow@unimelb.edu.au

OBJECTIVE: The authors sought to assess whether neurocognitive deficits in people with the posttraumatic stress disorder (PTSD) symptoms of reexperiencing and arousal are a consequence of these symptoms or represent a preexisting vulnerability factor for developing these symptoms after exposure to a traumatic  event. METHOD: A random sample of 2,097 young adults who participated in a longitudinal epidemiological study in 1999 and 2000 were reinterviewed in 2003 and 2004 after a major natural disaster (a widespread fire) had occurred in the region. At both interviews, participants completed a number of neurocognitive tests covering immediate and delayed word recall, digit span, coding speed, and vocabulary. Five pre- and posttrauma neurocognitive measures for 1,599 participants who were exposed to the fire were examined to assess the extent to which development of the PTSD symptoms of reexperiencing and arousal was associated with change in neurocognitive skills. Analyses adjusted for a number of potential confounding factors. RESULTS: Higher levels of fire-related reexperiencing and arousal symptoms were associated with less improvement in word recall ability at the second interview. However, levels of these symptoms were more consistently associated with having poorer pretrauma scores on all five neurocognitive measures available for this study. CONCLUSIONS: The presence of the PTSD symptoms of reexperiencing and arousal may result in a relative decline  in some measures of verbal memory over time. The more robust finding from this study is that poorer performance on some neurocognitive tests may be a vulnerability factor for developing symptoms of PTSD, not only an outcome of PTSD symptoms.

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

PMID: 17329477 [PubMed - indexed for MEDLINE]

 

An Acad Bras Cienc. 2007 Mar;79(1):97-109.

Animal defense strategies and anxiety disorders.

Shuhama R, Del-Ben CM, Loureiro SR, Graeff FG.

Departamento de Neurologia, Psiquiatria e Psicologia Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirăo Preto, Universidade de Săo Paulo, Ribeirăo Preto, SP, 14048-900, Brasil.

Anxiety disorders are classified according to symptoms, time course and therapeutic response. Concurrently, the experimental analysis of defensive behavior has identified three strategies of defense that are shared by different  animal species, triggered by situations of potential, distal and proximal predatory threat, respectively. The first one consists of cautious exploration of the environment for risk assessment. The associated emotion is supposed to be anxiety and its pathology, Generalized Anxiety Disorder. The second is manifested by oriented escape or by behavioral inhibition, being related to normal fear and  to Specific Phobias, as disorders. The third consists of disorganized flight or complete immobility, associated to dread and Panic Disorder. Among conspecific interactions lies a forth defense strategy, submission, that has been related to  normal social anxiety (shyness) and to Social Anxiety Disorder. In turn, Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder do not seem to be directly related to innate defense reactions. Such evolutionary approach offers a reliable theoretical framework for the study of the biological determinants of anxiety disorders, and a sound basis for psychiatric classification.

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

PMID: 17401479 [PubMed - indexed for MEDLINE]

 

Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Mar;42(3):180-7.

[Psychiatric disorders in intensive care--part three: psychic reactions, affective and anxiety disorders]

[Article in German]

Krauseneck T, Krähenmann O, Heimendahl J, Schelling G, Padberg F.

Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Munich, Germany. Till.Krauseneck@med.uni-muenchen.de

Perpetual noise, pain, disturbed day-night-cycle, the inability to talk and the difficulty, especially during weaning, to differentiate alertness from sleep and  dream from reality are some of the burdens ICU patients are suffering from. Additional sedation and potential sedation gaps plus the medical treatment itself put strain on critically ill humans. Those external stimuli partly cannot be handled well by the patients. Some of these factors or a combination of them, combined with a predisposition and/or insufficient coping mechanisms can result in a wide range of psychiatric disorders. Often psychiatric symptoms appear unspecific and difficult to categorize. Firstly some psychopathological cardinal  symptoms are described and potential differential diagnoses are mentioned. After  that the following article focuses on sleep, adjustment, depressive and the spectrum of anxiety disorders (especially generalized anxiety disorders, panic disorders, acute stress disorder (ASD) and posttraumatic stress disorder (PTSD)). The article provides prevalences, etiology and risk factors as well as symptomatology, diagnostics and therapeutic options.Those disorders can be diagnosed in ICU but also after transferring to general ward. In our own experience the transfer period is a vulnerable phase for psychopathologic symptoms. As apart from the individual suffering the course of the somatic disease as well as the rehabilitation process are impaired and the disorders have a tendency to have a chronic course, close and early collaboration of ICU physicians and psychiatrists is mandatory.

Publication Types:      English Abstract

PMID: 17366437 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 Mar;64(3):361-8.

Pretrauma cognitive ability and risk for posttraumatic stress disorder: a twin study.

Kremen WS, Koenen KC, Boake C, Purcell S, Eisen SA, Franz CE, Tsuang MT, Lyons MJ.

Department of Psychiatry and Center for Behavioral Genomics, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA. wkremen@ucsd.edu

CONTEXT: Cognitive deficits are associated with posttraumatic stress disorder (PTSD), but whether such deficits reflect sequelae or risk factors is not fully resolved. OBJECTIVE: To determine, in a representative sample, whether preexposure cognitive ability is associated with risk for PTSD, and whether that  risk is genetically mediated. Design, Setting, and PARTICIPANTS: The co-twin-control study involved 2386 male Vietnam-era twin veterans with a mean (SD) age of 41.9 (2.7) years, a population-based sample of men who were in military service during this era. Cognitive ability scores were obtained just before military induction at a mean (SD) age of 19.7 (1.5) years. Participants included only individuals who were exposed to potentially traumatic events and underwent preexposure cognitive testing. MAIN OUTCOME MEASURES: Armed Forces Qualification Test (of cognitive ability) percentile scores and PTSD diagnosed by means of structured interviews. RESULTS: We found a significant dose-response relationship between preexposure cognitive ability and risk for PTSD. After controlling for confounders, the highest cognitive ability quartile had a 48% lower risk than the lowest ability quartile (P<.001). Non-PTSD-concordant pairs had the highest scores; PTSD-concordant pairs had the lowest scores; and PTSD-discordant pairs had intermediate scores. Differences in Armed Forces Qualification Test scores within twin pairs were significant only in PTSD-discordant pairs (P=.04) and were accounted for specifically by the discordant dizygotic pairs (P=.002). Genetic influences on preexposure cognitive  ability explained 5% of the variation in PTSD, but 100% of that relationship was  explained by common genes. CONCLUSIONS: Preexposure cognitive ability is a risk or a protective factor for PTSD. The variance in PTSD explained by preexposure cognitive ability is accounted for entirely by common genetic factors. Lower cognitive ability may be a marker of less adaptive coping against adverse mental  health consequences of exposure to potentially traumatic events. Further study of the potential mechanisms through which cognitive ability confers risk is needed.

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

PMID: 17339525 [PubMed - indexed for MEDLINE]

 

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

Comment in:     Arch Gen Psychiatry. 2007 Mar;64(3):275-6.    Arch Gen Psychiatry. 2008 Jan;65(1):115-6; author reply 116-7.

Torture vs other cruel, inhuman, and degrading treatment: is the distinction real or apparent?

Başoğlu M, Livanou M, Crnobarić C.

Section of Trauma Studies, Institute of Psychiatry, King's College, University of London, De Crespigny Park, Denmark Hill, London, England. spjumeb@iop.kcl.ac.uk

CONTEXT: After the reports of human rights abuses by the US military in Guantanamo Bay, Iraq, and Afghanistan, questions have been raised as to whether certain detention and interrogation procedures amount to torture. OBJECTIVE: To examine the distinction between various forms of ill treatment and torture during captivity in terms of their relative psychological impact. DESIGN AND SETTING: A  cross-sectional survey was conducted with a population-based sample of survivors  of torture from Sarajevo in Bosnia and Herzegovina, Banja Luka in Republica Srpska, Rijeka in Croatia, and Belgrade in Serbia. PARTICIPANTS: A total of 279 survivors of torture accessed through linkage sampling in the community (Banja Luka, Sarajevo, and Rijeka) and among the members of 2 associations for war veterans and prisoners of war (Belgrade). MAIN OUTCOME MEASURES: Scores on the Semi-structured Interview for Survivors of War, Exposure to Torture Scale, Structured Clinical Interview for DSM-IV, and Clinician-Administered PTSD (posttraumatic stress disorder) Scale for DSM-IV. RESULTS: Psychological manipulations, humiliating treatment, exposure to aversive environmental conditions, and forced stress positions showed considerable overlap with physical torture stressors in terms of associated distress and uncontrollability. In regression analyses, physical torture did not significantly relate to posttraumatic stress disorder (odds ratio, 1.41, 95% confidence interval, 0.89-2.25) or depression (odds ratio, 1.41, 95% confidence interval, 0.71-2.78).  The traumatic stress impact of torture (physical or nonphysical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors. CONCLUSIONS: Ill treatment during captivity, such  as psychological manipulations, humiliating treatment, and forced stress positions, does not seem to be substantially different from physical torture in terms of the severity of mental suffering they cause, the underlying mechanism of traumatic stress, and their long-term psychological outcome. Thus, these procedures do amount to torture, thereby lending support to their prohibition by  international law.

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

PMID: 17339516 [PubMed - indexed for MEDLINE]

 

Assessment. 2007 Mar;14(1):22-34.

Effect of symptom information and intelligence in dissimulation: an examination of faking response styles by inmates on the Basic Personality Inventory.

Steffan JS, Kroner DG, Morgan RD.

Texas Tech University, USA.

This study employed the Basic Personality Inventory (BPI) to differentiate various types of dis-simulation, including malingered psychopathology and faking  good, by inmates. In particular, the role of intelligence in utilizing symptom information to successfully malinger was examined. On admission to a correctional facility, 161 inmates completed the BPI under standard instructions and then again under instructions to fake good (n = 55) or to malinger psychotic (n = 35), posttraumatic stress disorder (n = 36), or somatoform (n = 35) psychopathology. Unlike symptom information, intelligence evidenced some support for increasing inmates' effectiveness in malingering, although there was no relationship between higher intelligence and using symptom information to successfully evade detection. Overall, the BPI was more effective in detecting malingered psychopathology than faking good. Implications for the detection of dissimulation in correctional and forensic settings are discussed.

PMID: 17314177 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Mar;45(3):549-62.

Gay male sexual assault survivors: the relations among internalized homophobia, experiential avoidance, and psychological symptom severity.

Gold SD, Marx BP, Lexington JM.

Department of Psychology, Temple University, Weiss Hall, Philadelphia PA 19122, USA. sarigold@temple.edu

This study explored the relations among internalized homophobia (IH), experiential avoidance, and psychological symptom severity in a community sample  of 74 gay male sexual assault survivors. Results indicated that IH is associated  with both depressive and posttraumatic stress disorder (PTSD) symptom severity. IH accounted for more variance than assault severity in predicting both PTSD and  depression symptom severity. IH and experiential avoidance similarly predicted PTSD symptom severity. In comparison with IH, however, experiential avoidance is  a stronger predictor of depression symptom severity. Results also showed that experiential avoidance partially mediated the relation between IH and both depressive and PTSD symptom severity. The implications of these findings are discussed and suggestions for future research are provided.

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

PMID: 17258041 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Mar;45(3):601-6. Epub 2006 May 18.

PTSD symptom trajectories: from early to chronic response.

O'Donnell ML, Elliott P, Lau W, Creamer M.

Department of Psychiatry, University of Melbourne, Parkville Vic. 3052, Australia. mod@unimelb.edu.au

This study aimed to identify posttraumatic stress disorder (PTSD) symptom trajectories across the first 12 months following traumatic injury. Three hundred and seven consecutively admitted injury survivors were assessed for severity of PTSD symptoms just prior to discharge, and at 3 and 12 months postinjury. Growth  modeling was used to determine the curve that best fit the trajectory for each symptom cluster over the 12-month period. Individuals with 12-month PTSD showed significantly higher re-experiencing, arousal, and avoidance symptoms at eight days posttrauma relative to those without, and these symptoms escalated over time. Those without PTSD maintained their relatively low symptom levels. These findings highlight that individuals who will go onto develop PTSD have a distinctly different symptom course than those who recover.

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

PMID: 16712783 [PubMed - indexed for MEDLINE]

 

Behav Ther. 2007 Mar;38(1):58-71. Epub 2006 Sep 25.

Internalizing and externalizing subtypes in female sexual assault survivors: implications for the understanding of complex PTSD.

Miller MW, Resick PA.

National Center for PTSD, VA Boston Healthcare System, and Boston University, MA  02130, USA. mark.miller5@va.gov

This study replicated and extended findings of internalizing and externalizing subtypes of posttraumatic psychopathology (Miller, M. W., Greif, J. L., & Smith,  A. A. (2003). Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: Internalizing and externalizing subtypes. Psychological Assessment, 15, 205-215; Miller, M. W., Kaloupek, D. G., Dillon, A. L., & Keane, T.M. (2004). Externalizing and internalizing subtypes of combat-related PTSD: A replication and extension using the PSY-5 Scales. Journal  of Abnormal Psychology, 113, 636-645) to a female sample of rape survivors with chronic PTSD. Cluster analyses of Schedule for Nonadaptive and Adaptive Personality (Clark, L. A. (1996). SNAP-Schedule for Nonadaptive and Adaptive Personality: Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press.) temperament scale profiles from 143 women with PTSD partitioned the sample into a simple PTSD cluster, defined by normal range personality scores and moderate symptomatology, and 2 more "complex" clusters distinguished by more severe tendencies towards externalizing or internalizing psychopathology. Externalizers were characterized by disinhibition, substance dependence, and Cluster B personality disorder features; internalizers by low positive temperament, high rates of major depressive disorder, and elevations on  measures of schizoid and avoidant personality disorder.

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

PMID: 17292695 [PubMed - indexed for MEDLINE]

 

Behav Ther. 2007 Mar;38(1):39-48. Epub 2006 Sep 22.

Virtual Reality Exposure Therapy for PTSD symptoms after a road accident: an uncontrolled case series.

Beck JG, Palyo SA, Winer EH, Schwagler BE, Ang EJ.

SUNY Buffalo, Department of Psychology, University at Buffalo, NY 14260, USA. jgbeck@buffalo.edu

This report examined whether Virtual Reality Exposure Therapy (VRET) could be used in the treatment of posttraumatic stress disorder (PTSD) symptoms in the aftermath of a serious motor vehicle accident. Six individuals reporting either full or severe subsyndromal PTSD completed 10 sessions of VRET, which was conducted using software designed to create real-time driving scenarios. Results  indicated significant reductions in posttrauma symptoms involving reexperiencing, avoidance, and emotional numbing, with effect sizes ranging from d=.79 to d=1.49. Indices of clinically significant and reliable change suggested that the magnitude of these changes was meaningful. Additionally, high levels of perceived reality ("presence") within the virtual driving situation were reported, and patients reported satisfaction with treatment. Results are discussed in light of  the possibility for VRET to be useful in guiding exposure in the treatment of PTSD following road accidents.

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

PMID: 17292693 [PubMed - indexed for MEDLINE]

 

Clin Obstet Gynecol. 2007 Mar;50(1):154-65.

Psychologic aspects of early pregnancy loss.

Carter D, Misri S, Tomfohr L.

Departments of Psychiatry, Faculty of Medicine, University of British Columbia, Canada. dcarter@cw.bc.ca

Early pregnancy loss is a complicated psychologic event that occurs in 12% to 24% of recognized pregnancies. Women who have experienced miscarriage often have common bereavement reactions and while the intensity and experience of these reactions diminishes over time for most women, a substantial minority will develop long-term psychiatric consequences. Depression, symptoms of anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder are the most commonly reported psychologic reactions to miscarriage. The course and impact of  these disorders on a grieving mother and her partner are discussed and treatment  recommendations are made. The psychologic effects of therapeutic abortion are also be briefly discussed.

PMID: 17304032 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2007 Mar-Apr;48(2):178-85. Epub 2006 Dec 8.

Traumatic experiences and posttraumatic stress disorders: differences between treatment-seeking early- and late-onset alcoholic patients.

Dom G, De Wilde B, Hulstijn W, Sabbe B.

Psychiatric Centre Brothers Alexians, 2530 Boechout, Belgium. geert.dom@skynet.be

Childhood traumatic experiences have been suggested to relate to early-onset alcoholism and to negatively influence the severity and course of alcohol use disorders. Early-onset alcoholic (n = 54) and late-onset alcoholic (n = 65) inpatients were compared as to the severity of their childhood traumatic experiences, prevalence of current and lifetime posttraumatic stress disorder (PTSD), and depressive symptoms. The early-onset alcoholic patients had a higher  number and more severe childhood traumatic experiences compared with the late-onset alcoholic patients. More female than male alcohol-dependent patients had lifetime PTSD diagnosis. Finally, specifically within the female alcoholic patients the severity of early childhood experiences was positively associated with the severity of current substance use and related problems. Within early-onset alcoholic treatment-seeking populations, active screening for childhood traumatic experiences and current PTSD is advised in view of treatment  planning.

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

PMID: 17292709 [PubMed - indexed for MEDLINE]

 

Conscious Cogn. 2007 Mar;16(1):170-7. Epub 2006 Apr 18.

Traumatic memories of war veterans: not so special after all.

Geraerts E, Kozarić-Kovacić D, Merckelbach H, Peraica T, Jelicic M, Candel I.

Department of Experimental Psychology, Maastricht University, Maastricht, The Netherlands. E.Geraerts@Psychology.Unimaas.NL

Several authors have argued that traumatic experiences are processed and remembered in a qualitatively different way from neutral events. To investigate this issue, we interviewed 121 Croatian war veterans diagnosed with posttraumatic stress disorder (PTSD) about amnesia, intrusions (i.e., flashbacks and nightmares), and the sensory qualities of their most horrific war memories. Additionally, they completed a self-report scale measuring dissociative experiences. In contrast to what one would expect on the basis of theories emphasizing the special status of traumatic memories, amnesia, and high frequency intrusions were not particularly typical for our sample of traumatized individuals. Moreover, traumatic memories were not qualitatively different from neutral memories with respect to their stability and sensory qualities. The severity of PTSD symptoms was not significantly correlated with dissociative experiences. Our findings do not support the existence of special memory mechanisms that are unique to experiencing traumatic events.

PMID: 16621608 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2007 Mar;20(2):168-73.

Psychosomatic obstetrics and gynecology--a neglected field?

Chandra PS, Ranjan S.

National Institute of Mental Health and Neurosciences, Bangalore, India. prabhasch@gmail.com

PURPOSE OF REVIEW: The purpose of the review was to evaluate recent studies in the field of psychosomatic obstetrics and gynecology for new directions in research. RECENT FINDINGS: Psychosomatic obstetrics and gynecology covers a wide  canvas, and the present review shows extensive research in some areas and large gaps in others. There have been significant developments in the field of pregnancy-related psychiatric morbidity, particularly anxiety states and posttraumatic stress disorder; however, there is a need for better and more specific measurement and screening methods. Among gynecological conditions there  have been advances in research on chronic pelvic pain and gynecological cancers,  but most other gynecological conditions have been neglected. What is encouraging  is the increasing amount of research from the developing world and the focus on common reproductive conditions based on community studies. In addition, in light  of the recent findings and concerns related to hormone replacement therapy, research on mood disorders related to menopause is increasing, with refinement in measurements, definitions, and treatment methods. SUMMARY: While studies on prevalence and risk factors abound, what is missing are well conducted intervention studies. The next phase of research should focus on preventive and intervention studies that are easily adaptable the world over.

Publication Types:      Review

PMID: 17278917 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2007 Mar-Apr;29(2):169-71.

Emergence flashback in a patient with posttraumatic stress disorder.

Crosby SS, Mashour GA, Grodin MA, Jiang Y, Osterman J.

Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA. scrosby@bu.edu

PMID: 17336667 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2007 Mar-Apr;29(2):117-22.

Survivors of violence-related facial injury: psychiatric needs and barriers to mental health care.

Wong EC, Marshall GN, Shetty V, Zhou A, Belzberg H, Yamashita DD.

RAND Corporation, PO BOX 2138, Santa Monica, CA 90407, USA. ewong@rand.org

OBJECTIVE: This study examined mental health needs, receptivity to psychosocial aftercare, and barriers to care among survivors of violence-related facial injuries. METHODS: Face-to-face interviews were conducted with 25 consecutively treated individuals at a hospital-based specialty outpatient clinic one month after a violence-related facial injury. To participate in the study, patients had to screen positive for an alcohol use disorder (AUD), major depression or posttraumatic stress disorder (PTSD). Participants were questioned about receptivity to an aftercare program and perceived barriers to care. RESULTS: Of those screened for study eligibility (n=62), a substantial proportion met probable criteria for AUD (31%), PTSD (34%) and major depression (35%). Among those completing the core interview (n=25), 80% met probable criteria for two or  more psychiatric disorders. The majority (84%) expressed interest in psychosocial aftercare. However, barriers such as cost, insufficient information about counseling and obtaining services, transportation and preferences for self-reliance were commonly endorsed. CONCLUSIONS: Survivors of violence-related  facial injuries have substantial mental health needs and appear receptive to psychosocial aftercare. However, significant treatment barriers must be addressed. Findings underscore the value of a collaborative care model for treating violence-related facial trauma patients seeking care in specialty outpatient oral and maxillofacial clinics.

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

PMID: 17336660 [PubMed - indexed for MEDLINE]

 

J Cardiopulm Rehabil Prev. 2007 Mar-Apr;27(2):86-91.

Prevalence of anxiety disorders in men and women with established coronary heart  disease.

Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R.

Centers for Behavioral and Preventive Medicine, Brown Medical School, The Miriam  Hospital, Providence, RI, USA. John_Todaro@brown.edu

PURPOSE: Anxiety has been associated with the development and recurrence of coronary heart disease (CHD). The objective of this study was to estimate the prevalence of anxiety disorders in men and women with established CHD. METHODS: One hundred fifty CHD patients were evaluated via a semistructured, psychiatric interview to assess both current and lifetime prevalence rates of anxiety disorders. RESULTS: Approximately 36.0% (n = 54) of cardiac patients met the diagnostic criteria for at least 1 current anxiety disorder, and 45.3% (n = 68) presented with an anxiety disorder at some point in their lifetime. Social phobia and generalized anxiety disorder were the most prevalent anxiety disorders observed, with current prevalence rates of 21.3% and 18.7%, respectively, and a lifetime prevalence of 26%. In addition, the current prevalence rate of specific  phobia was approximately 14.7%, whereas 15.3% met the lifetime criteria. Lower prevalence rates for panic disorder (current = 4.7%, lifetime = 5.3%), agoraphobia (current = 3.3%, lifetime = 4.7%), posttraumatic stress disorder (current = 0%, lifetime = 1.5%), and obsessive compulsive disorder (current = 0%, lifetime = 0.7%) were observed. Female cardiac patients evidenced significantly higher current (women = 58.3% vs. 25.5%, P < .001) and lifetime (women = 70.8% vs. men = 33.3%, P < .001) rates of anxiety disorders compared with their male counterparts. CONCLUSIONS: A considerable number of CHD patients evidence a significant history of anxiety. Greater efforts to identify and treat anxiety in  outpatient cardiology and cardiac rehabilitation settings are needed.

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

PMID: 17558244 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2007 Mar;63(3):199-211.

Relative impact of adverse events and screened symptoms of posttraumatic stress disorder and depression among active duty soldiers seeking mental health care.

Gahm GA, Lucenko BA, Retzlaff P, Fukuda S.

Department of Psychology, Madigan Army Medical Center, USA. gregory.gahm@us.army.mil

Symptoms of depression and posttraumatic stress are among the most studied psychological difficulties among soldiers. Such symptoms have been linked to a history of adverse events among both civilians and combat veterans. There is a paucity of research on this topic that can be applied to an active duty clinical  population. Intake screening data were reviewed for 1,626 soldiers presenting to  an outpatient mental health clinic to identify variables, including history of potentially traumatic experiences, associated with screened symptoms of posttraumatic stress disorder (PTSD) and depression. Demographics such as age, gender, and military rank, as well as number of adverse childhood experiences were significant predictors of screened PTSD and depression. A history of deployment to a combat zone predicted screened PTSD, but not depression. The role of childhood abuse as a risk factor is discussed and highlighted in the etiology  of symptoms for soldiers seeking mental health care. (c) 2007 Wiley Periodicals,  Inc.

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

PMID: 17115432 [PubMed - indexed for MEDLINE]

 

Pediatr Psychol. 2007 Mar;32(2):223-9. Epub 2006 Apr 26.

Brief report: the risk of posttraumatic stress disorder in mothers of children diagnosed with pediatric cancer and type I diabetes.

Stoppelbein L, Greening L.

Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216-4505, USA. lstoppelbein@psychiatry.umsmed.edu

OBJECTIVE: To evaluate the risk of and predictors of enduring and late-onset posttraumatic stress disorder (PTSD) among mothers of children diagnosed with type I diabetes and cancer. METHOD: Mothers (N = 99) of children diagnosed with cancer or diabetes for at least 12 months completed a structured clinical interview for PTSD and self-report measures of PTSD, depression, anxiety, and stressful life events. RESULTS: There was no significant difference in the rate of PTSD between the two groups. Overall, fewer mothers (7%) met criteria for PTSD on the structured clinical interview than those on a self-report measure of PTSD  (17%). Mothers who reported more depressive symptoms, anxiety, and stressful life events tended to report significantly more PTSD symptoms. CONCLUSIONS: The findings extend prior research regarding the prevalence rate and predictors of PTSD and PTSD symptoms in pediatric populations. It is recommended that clinicians exercise caution when interpreting prevalence rates for PTSD that are  derived from self-report measures.

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

PMID: 16641479 [PubMed - indexed for MEDLINE]

 

J Psychiatr Pract. 2007 Mar;13(2):72-8.

Pharmacologic reduction of CNS noradrenergic activity in PTSD: the case for clonidine and prazosin.

Boehnlein JK, Kinzie JD.

Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA. boehnlei@ohsu.edu

This article reviews the neurobiologic rationale for and presents clinical guidance concerning the use of medications that reduce central nervous system noradrenergic activity in the treatment of intrusive symptoms of posttraumatic stress disorder. The authors reviewed neurobiological studies, nonclinical studies using animal models, clinical case reports, open-label drug studies, and  blinded, placebo-controlled drug studies. This review of the basic science and clinical literature, and the authors' clinical experience with culturally and demographically diverse populations, indicate that clonidine and prazosin can play a useful role in treating sleep disturbance and hyperarousal in posttraumatic stress disorder, with minimal adverse effects and low financial cost.

Publication Types:      Case Reports

PMID: 17414682 [PubMed - indexed for MEDLINE]

 

J Urban Health. 2007 Mar;84(2):142-52.

Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina.

DeSalvo KB, Hyre AD, Ompad DC, Menke A, Tynes LL, Muntner P.

Section of General Internal Medicine and Geriatrics, Tulane University School of  Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA. kdesalv@tulane.edu

On August 29, 2005, Hurricane Katrina made landfall resulting in catastrophic damage and flooding to New Orleans, LA, and the Gulf Coast, which may have had significant mental health effects on the population. To determine rates and predictors of symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) in New Orleans residents following Hurricane Katrina, we conducted a web-based survey 6 months after Hurricane Katrina made landfall. Participants included 1,542 employees from the largest employer in New Orleans. The prevalence of PTSD symptoms was 19.2%. Predictors of PTSD symptoms in a multivariate-adjusted regression model included female sex, non-black race, knowing someone who died in the storm, not having property insurance, having had  a longer evacuation, a much longer work commute compared to before Hurricane Katrina, and currently living in a newly purchased or rented house or in a temporary trailer. Despite universal health coverage and the benefits of an employee assistance program for all employees, only 28.5% of those with PTSD symptoms had talked to a health professional about the events of Hurricane Katrina or issues encountered since the storm. A significant burden of PTSD symptoms was present 6 months following Hurricane Katrina among a large group of  adults who had returned to work in New Orleans. Given their key role in the economic redevelopment of the region, there is a tremendous need to identify those in the workforce with symptoms consistent with PTSD and to enhance treatment options. The strong relationship between displacement from one's pre-Katrina residence and symptoms of PTSD suggests a need to focus resource utilization and interventions on individuals living in temporary housing.

PMID: 17226081 [PubMed - indexed for MEDLINE]

 

J Womens Health (Larchmt). 2007 Mar;16(2):262-71.

Age at sexual assault and posttraumatic stress disorder among women: prevalence,  correlates, and implications for prevention.

Masho SW, Ahmed G.

Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia 23298-0212, USA. swmasho@vcu.edu

BACKGROUND: Posttraumatic stress disorder (PTSD) is a debilitating psychiatric condition that can occur in people who experience extremely stressful or traumatic life events. Sexual assault is one of the most traumatic stressors in life. Although several studies have investigated the association between history  of sexual assault and PTSD, studies on the impact of age at first sexual assault  on PTSD are limited. METHODS: A cross-sectional telephone survey was conducted among 1,769 adult female residents of Virginia. A detailed screening questionnaire was used to ascertain the occurrence and age at first sexual assault. The DSM-IV diagnostic criteria were used to define PTSD. RESULTS: The prevalences of PTSD among women with no history of sexual assault, those victimized for the first time before the age of 18, and those assaulted for the first time at >or=18 were 8.1%, 35.3%, and 30.2%, respectively. Multivariate logistic regression model showed an increased risk of PTSD among women assaulted  at a younger age. Compared with women reporting no history of sexual assault, women who were victimized before age 18 were 3.8 times more likely to suffer from PTSD (OR = 3.75, 95% CI 2.33-6.53). The risk of PTSD among women victimized as adults was 2.9 times higher compared with women who reported no history of sexual assault (OR = 2.89, 95% CI 1.46-5.74). CONCLUSIONS: The risk of PTSD is slightly  higher among those assaulted before the age of 18 compared with those who were assaulted at age >or=18. The adverse effect of sexual assault as a risk for PTSD  is a major public health concern. Primary prevention strategies should be in place to detect sexual assault victims and prevent the occurrence of PTSD.

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

PMID: 17388743 [PubMed - indexed for MEDLINE]

 

Pediatrics. 2007 Mar;119(3):509-16.

Comment in:     Pediatrics. 2007 Jul;120(1):232-4; author reply 234-5.

Stress predicts brain changes in children: a pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus.

Carrion VG, Weems CF, Reiss AL.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA. vcarrion@stanford.edu

OBJECTIVE: Does stress damage the brain? Studies of adults with posttraumatic stress disorder have demonstrated smaller hippocampal volumes when compared with  the volumes of adults with no posttraumatic stress disorder. Studies of children  with posttraumatic stress disorder have not replicated the smaller hippocampal findings in adults, which suggests that smaller hippocampal volume may be caused  by neurodevelopmental experiences with stress. Animal research has demonstrated that the glucocorticoids secreted during stress can be neurotoxic to the hippocampus, but this has not been empirically demonstrated in human samples. We  hypothesized that cortisol volumes would predict hippocampal volume reduction in  patients with posttraumatic symptoms. PATIENTS AND METHODS: We report data from a pilot longitudinal study of children (n = 15) with history of maltreatment who underwent clinical evaluation for posttraumatic stress disorder, cortisol, and neuroimaging. RESULTS: Posttraumatic stress disorder symptoms and cortisol at baseline predicted hippocampal reduction over an ensuing 12- to 18-month interval. CONCLUSIONS: Results from this pilot study suggest that stress is associated with hippocampal reduction in children with posttraumatic stress disorder symptoms and provide preliminary human evidence that stress may indeed damage the hippocampus. Additional studies seem to be warranted.

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

PMID: 17332204 [PubMed - indexed for MEDLINE]

 

Psychol Bull. 2007 Mar;133(2):183-204.

Gender differences in posttraumatic stress disorder.

Olff M, Langeland W, Draijer N, Gersons BP.

Centre for Psychological Trauma, Academic Medical Centre/De Meren, Department of  Psychiatry, University of Amsterdam, Amsterdam, Netherlands. m.olff@amc.uva.nl

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peri-traumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice.

Publication Types:      Review

PMID: 17338596 [PubMed - indexed for MEDLINE]

 

Schizophr Res. 2007 Mar;91(1-3):210-6. Epub 2007 Feb 5.

Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among  veterans with schizophrenia.

Calhoun PS, Stechuchak KM, Strauss J, Bosworth HB, Marx CE, Butterfield MI.

VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (116B), 508 Fulton Street, Veterans Affairs Medical Center, Durham, NC 27705, USA. Patrick.Calhoun2@va.gov

The present study examined the prevalence of war zone exposure, interpersonal trauma and post-traumatic stress disorder (PTSD) in veterans with primary schizophrenia hospitalized on a VA inpatient psychiatric unit. Data were collected on a sample of male veterans (N=165) with a primary diagnosis of schizophrenia or schizoaffective disorder, who were consecutively admitted to a VAMC inpatient psychiatric unit. The prevalence of interpersonal trauma exposure  and comorbid PTSD were assessed. Analyses also explored differences between those patients who had been identified with PTSD to those who screened positive but had not been previously identified as having PTSD. Ninety-six percent of the sample endorsed interpersonal trauma or exposure to a war zone. The prevalence of PTSD was 47% (n=78), although only 14% (n=11) of those who screened positive for PTSD  had a diagnosis of PTSD in their medical record. Among those screening positive,  having a chart diagnosis of PTSD was associated with more severe PTSD symptoms and combat exposure. Results suggest that PTSD is highly prevalent and under-diagnosed among veterans with schizophrenia. Increased assessment of trauma and PTSD in this population is warranted.

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

PMID: 17276658 [PubMed - indexed for MEDLINE]

 

Stress. 2007 Mar;10(1):3-12.

GABA(A) receptor neurotransmission dysfunction in a mouse model of social isolation-induced stress: possible insights into a non-serotonergic mechanism of  action of SSRIs in mood and anxiety disorders.

Matsumoto K, Puia G, Dong E, Pinna G.

Division of Medicinal Pharmacology, University of Toyama, Institute of Natural Medicine, 2630 Sugitani (Medical Campus), Toyama, 930-0194, Japan. mkinzo@ms.toyama-mpu.ac.jp

Protracted social isolation in laboratory animals causes stress, which induces a  variety of behavioral abnormalities including increased aggressiveness, anxiety-related behaviors, cognitive deficits and hyper locomotion. Many of these disorders are similar to the symptoms found in psychiatric disorders, such as depression, anxiety, premenstrual dysphoria and posttraumatic stress disorders (PTSD). Recent studies have demonstrated that male mice that have been socially isolated for more than 4 weeks show: (a) reduced responsiveness of GABA(A) receptors (GABA(A)-R) to the administrations of GABA mimetic drugs at GABA(A)-R;  (b) downregulated biosynthesis of 3alpha,5alpha-tetrahydroprogesterone (3alpha,5alpha-THP) (allopregnanolone: ALLO), a neurosteroid with a potent positive allosteric modulatory effect on the action of GABA on GABA(A)-R; and (c) alterations in the expression of GABA(A)-R subunits (i.e. a decrease of alpha1/alpha2 and gamma2 subunits and an increase of alpha4 and alpha5 subunits). The selective serotonin reuptake inhibitor (SSRI) fluoxetine (FLX) and its congener norfluoxetine (Nor-FLX), when administered systemically at nmol/kg doses, normalize the reduced content of brain ALLO and the reduced responsiveness of GABA(A)-R to GABA mimetic drugs (i.e. pentobarbital) and also attenuate aggressive behavior in socially isolated mice in a stereospecific manner. Although these compounds inhibit ex vivo serotonin reuptake into brain tissue, their SSRI activities require high micromol/kg dose ranges and are not stereospecific. These studies suggest that in socially isolated mice, abnormalities of GABA(A)-R signal transduction are attributable to the downregulation of ALLO production and to a switch in heteropentameric GABA(A)-R subunit assembly composition. Hence, the normalization of ALLO biosynthesis may be a new target for the development of drugs effective for psychiatric disorders  related to neurosteroid biosynthesis downregulation.

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

PMID: 17454962 [PubMed - indexed for MEDLINE]

 

Support Care Cancer. 2007 Mar;15(3):309-17. Epub 2006 Oct 5.

Factors related to posttraumatic stress in adolescent survivors of childhood cancer and their parents.

Ozono S, Saeki T, Mantani T, Ogata A, Okamura H, Yamawaki S.

Department of Pediatrics and Child Health, Kurume University School of Medicine,  Kurume, Japan.

GOALS OF WORK: The purpose of this study was to investigate factors related to severe posttraumatic stress symptoms (PTSS) in adolescent survivors of childhood  cancer and their parents. MATERIALS AND METHODS: Eighty-nine families (88 adolescent survivors of childhood cancer, 87 mothers, 72 fathers) completed a self-report questionnaire. Multivariate logistic regression analyses were performed using the following risk factors for severe PTSS: trait anxiety, family functioning, demographic and medical variables. MAIN RESULTS: Severe PTSS were reported by 10.9% (n=9) of the survivors, 20.7% (n=18) of the mothers, and 22.2%  (n=16) of the fathers. Preliminary analyses found significant correlations of PTSS between mother-survivor (Spearman's gamma=0.377, p<0.01) and mother-father (Spearman's gamma=0.483, p<0.01). The results of multivariate analyses indicated  that higher trait anxiety [odds ratio (OR):1.16; 95% confidence interval (CI): 1.03-1.31; p<0.05] and having medical sequelae (OR: 5.85; 95% CI:1.02-33.72; p<0.05) were significant factors related to PTSS for survivors. For mothers, the  significant PTSS-related factors were: higher trait anxiety (OR:1.13; 95% CI:1.04-1.23; p<0.01); 5- to 9-year interval from the first diagnosis to the present investigation, compared to more than a 10-year interval (OR: 6.45; 95% CI:1.67-24.89; p<0.01); and a relatively lower rating on "roles" of family functioning (OR: 12.34; 95% CI:1.11-136.97; p<0.05). For fathers, trait anxiety was a significant related factor (OR: 1.07; 95% CI:1.01-1.14; p<0.05). CONCLUSIONS: Survivors and their parents suffered from PTSS after long interval from completion of treatment, and PTSS-related factors varied for each family member. Appropriate allocation of responsibility for family functioning may promote the ability to decrease PTSS, especially for mothers.

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

PMID: 17021857 [PubMed - indexed for MEDLINE]

 

Womens Health Issues. 2007 Mar-Apr;17(2):101-6.

Epidemiology and consequences of women's revictimization.

Kimerling R, Alvarez J, Pavao J, Kaminski A, Baumrind N.

VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. Rachel.kimerling@med.va.gov

This study uses Kraemer's approach for nonrandom comorbidity to identify the parameters of revictimization among women, using a diverse, population-based sample. Participants (n = 11,056) are from the California Women's Health Survey.  Women were asked about childhood and adult violence and current symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. Logistic regressions adjusted for age, ethnicity, education, and poverty indicate that women who experienced childhood physical or sexual abuse were 5.8 (95% confidence interval, 5.2-6.4) times more likely to experience adult physical or sexual victimization. Revictimization affected 12% of women, and these women were substantially more likely to report current symptoms of anxiety, depression, and  PTSD than women exposed to violence only in childhood or only as an adult. Revictimization is a methodologically distinct concept and is a potent risk factor for adult mental health problems. Prevention should target women exposed to both physical and sexual assault.

PMID: 17403467 [PubMed - indexed for MEDLINE]

 

JAMA. 2007 Feb 28;297(8):820-30.

Comment in:     JAMA. 2007 Jun 27;297(24):2694-5; author reply 2695.

Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial.

Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston  V, Orsillo SM, Haug R, Turner C, Bernardy N.

National Center for PTSD, VA Medical Center, White River Junction, Vt 05009, USA. Paula.Schnurr@Dartmouth.edu

CONTEXT: The prevalence of posttraumatic stress disorder (PTSD) is elevated among women who have served in the military, but no prior study has evaluated treatment for PTSD in this population. Prior research suggests that cognitive behavioral therapy is a particularly effective treatment for PTSD. OBJECTIVE: To compare prolonged exposure, a type of cognitive behavioral therapy, with present-centered therapy, a supportive intervention, for the treatment of PTSD. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial of female veterans (n=277) and active-duty personnel (n=7) with PTSD recruited from 9 VA medical centers, 2 VA readjustment counseling centers, and 1 military hospital from August 2002 through October 2005. INTERVENTION: Participants were randomly assigned to receive prolonged exposure (n = 141) or present-centered therapy (n = 143), delivered according to standard protocols in 10 weekly 90-minute sessions. MAIN OUTCOME MEASURES: Posttraumatic stress disorder symptom severity was the primary outcome. Comorbid symptoms, functioning, and quality of life were secondary outcomes. Blinded assessors collected data before and after treatment and at 3- and 6-month follow-up. RESULTS: Women who received prolonged exposure experienced greater reduction of PTSD symptoms relative to women who received present-centered therapy (effect size, 0.27; P = .03). The prolonged exposure group was more likely than the present-centered therapy group to no longer meet PTSD diagnostic  criteria (41.0% vs 27.8%; odds ratio, 1.80; 95% confidence interval, 1.10-2.96; P = .01) and achieve total remission (15.2% vs 6.9%; odds ratio, 2.43; 95% confidence interval, 1.10-5.37; P = .01). Effects were consistent over time in longitudinal analyses, although in cross-sectional analyses most differences occurred immediately after treatment. CONCLUSIONS: Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00032617.

Publication Types:      Comparative Study     Multicenter Study     Randomized Controlled Trial     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17327524 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2007 Feb 28;154(2):191-8. Epub 2007 Jan 26.

Smaller right hippocampus in war veterans with posttraumatic stress disorder.

Pavić L, Gregurek R, Rados M, Brkljacić B, Brajković L, Simetin-Pavić I, Ivanac G, Pavlisa G, Kalousek V.

Radiology Department, University Hospital Dubrava, Avenija Gojka Suska 6, Zagreb, Croatia. ladislav.pavic@zg.htnet.hr

Chronic stress can putatively cause damage in the human hippocampus, but evidence of damage has not been consistently shown in studies on hippocampal morphology in posttraumatic stress disorder (PTSD). We compared hippocampal volumes in PTSD patients and normal subjects. Using a 3D T1-weighted GRE magnetic resonance imaging sequence, we measured hippocampal volumes in 15 war veterans with combat-related chronic PTSD and 15 case-matched normal controls. Although war veterans, our PTSD subjects were not professional soldiers and were mobilized shortly before they were exposed to a very specific combat-related trauma over a  3-day period. In our study, the period between traumatic exposure and imaging was considerably shorter, on average, 9 years, compared with at least two decades in  previous studies on subjects with combat-related PTSD. Moreover, our subjects were free of any comorbidity, treatment or medication. The right hippocampus was  significantly smaller in PTSD subjects than in healthy controls. The left hippocampus was also smaller in PTSD subjects than in controls, but the difference was not significant. In all PTSD subjects, the right hippocampus was smaller than the left (on average, 7.88%). Our results show smaller volume of the right hippocampus in PTSD patients than in normal subjects.

PMID: 17258898 [PubMed - indexed for MEDLINE]

 

Depress Anxiety. 2007 Feb 22 [Epub ahead of print]

Trauma and posttraumatic stress disorder in treatment-resistant obsessive-compulsive disorder.

Gershuny BS, Baer L, Parker H, Gentes EL, Infield AL, Jenike MA.

Department of Psychology, Skidmore College, Saratoga Springs, New York.

Prior research has indicated a seemingly unique relation between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) that appears to relate to negative treatment outcome for OCD. However, to date, the prevalence of trauma and PTSD in individuals seeking treatment for OCD is unclear. To begin to address this gap, this study assessed history of traumatic experiences and current PTSD in individuals seeking treatment for treatment-resistant OCD. Trauma predictors of PTSD severity also were examined in this sample. Participants included 104 individuals diagnosed with treatment-resistant OCD who sought treatment over the course of 1 year from OCD specialty treatment facilities. Data were collected via naturalistic retrospective chart reviews of pre-treatment clinical intake files. Findings revealed that 82% of participants reported a history of trauma. Over 39% of the overall sample met criteria for PTSD, whereas almost 50% of individuals with a trauma history met criteria for PTSD. Interpersonal traumas and greater frequency of traumas were most predictive of PTSD severity, and individuals diagnosed with  OCD and additional major depressive disorder (MDD) or borderline personality disorder (BPD) appeared at particular risk for a comorbid PTSD diagnosis. PTSD may be relatively common in individuals diagnosed with treatment-resistant OCD; and interpersonal traumas, MDD, and BPD may play a relatively strong predictive role in PTSD diagnosis and severity in such OCD patients. 0:1-3, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17318836 [PubMed - as supplied by publisher]

 

Addict Behav. 2007 Feb;32(2):214-27. Epub 2006 Apr 27.

Posttraumatic stress symptoms and smoking to reduce negative affect: an investigation of trauma-exposed daily smokers.

Feldner MT, Babson KA, Zvolensky MJ, Vujanovic AA, Lewis SF, Gibson LE, Monson CM, Bernstein A.

Prevention Sciences Division of the Intervention Sciences Laboratory, University  of Arkansas, Department of Psychology, 216 Memorial Hall, Fayetteville, AR 72701, USA. mfeldne@uark.edu

The present investigation examined the relations among posttraumatic stress symptoms and smoking motives. Participants included 100 daily smokers recruited from the community and university settings who reported exposure to at least one  traumatic event that met criterion A for posttraumatic stress disorder. Consistent with prediction, higher levels of posttraumatic stress symptoms were associated with smoking to reduce negative affect; this relation was observed after controlling for variance accounted for by number of cigarettes smoked per day and gender. Results are discussed in terms of the implications of smoking to  regulate affect among daily smokers who have been exposed to traumatic events.

PMID: 16644135 [PubMed - indexed for MEDLINE]

 

AIDS Care. 2007 Feb;19(2):220-5.

Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS.

Israelski DM, Prentiss DE, Lubega S, Balmas G, Garcia P, Muhammad M, Cummings S,  Koopman C.

Stanford University School of Medicine, San Mateo, CA, USA.

Considerable evidence suggests that people with HIV disease are significantly more distressed than the general population, yet psychiatric disorders are commonly under-detected in HIV care settings. This study examines the prevalence  of three stress-related psychiatric diagnoses--depression, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD), among a vulnerable population of HIV-infected patients. Among approximately 350 patients attending two county-based HIV primary care clinics, 210 participants were screened for diagnostic symptom criteria for depression, PTSD, and ASD. Standardized screening measures used to assess for these disorders included the Beck Depression Inventory, the Posttraumatic Stress Checklist, and the Stanford Acute Stress Questionnaire. High percentages of HIV-infected patients met screening criteria for depression (38 per cent), PTSD (34 per cent), and ASD (43 per cent). Thirty eight percent screened positively for two or more disorders. Women were more likely to meet symptom criteria for ASD than men (55 per cent vs. 38 per cent, OR=1.94, CI95 per cent=1.1-3.5). ASD was detected more commonly among African-American and white participants (51 per cent and 50 per cent respectively), compared with other ethnic groups. Latinos were least likely to express symptoms of ASD (OR=0.52, CI95 per cent=0.29-0.96). Of the 118 patients with at least one of these disorders, 51 (43 per cent) reported receiving no concurrent mental health treatment. Patients with HIV/AIDS who receive public healthcare are likely to have high rates of acute and posttraumatic stress disorders and depression. These data suggest that current clinical practices could be improved with the use of appropriate tools and procedures to screen and  diagnose mental health disorders in populations with HIV/AIDS.

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

PMID: 17364402 [PubMed - indexed for MEDLINE]

 

Am J Hematol. 2007 Feb;82(2):171-2.

Posttraumatic stress disorder in children affected by sickle-cell disease and their parents.

Hofmann M, de Montalembert M, Beauquier-Maccotta B, de Villartay P, Golse B.

Department of Child Psychiatry, Hopital Necker-Enfants Malades, Paris, France.

Children affected with sickle-cell disease experience painful crises that may be  life threatening, or felt as if they were. We evaluated by semistructured interviews and questionnaires the presence of posttraumatic stress disorder in 11 children affected by sickle-cell disease and having suffered at least one hospitalization for a painful crisis, and in their parents (10 mothers, 1 father). Three children (27%) and four parents (40%) were diagnosed with the disorder. It was not correlated to the disease severity but, in parents, to a feeling of powerlessness over the child's illness (P = 0.04). (c) 2006 Wiley-Liss, Inc.

PMID: 16924639 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Feb;164(2):318-27.

Increased amygdala and insula activation during emotion processing in anxiety-prone subjects.

Stein MB, Simmons AN, Feinstein JS, Paulus MP.

Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Dr., Suite B-218, La Jolla, CA 92037, USA. mstein@ucsd.edu

OBJECTIVE: Increased amygdala reactivity during processing of certain types of emotional stimuli (e.g., fear, anger) has been observed in patients with anxiety  disorders such as social phobia and posttraumatic stress disorder (PTSD). It is uncertain whether this heightened amygdala reactivity is specific to treatment-seeking patients with anxiety disorders or is a general feature of individuals with increased anxiety-related temperamental traits. METHOD: Thirty-two physically healthy subjects 18-21 years old were recruited from a large pool of college students. Of these, 16 were chosen on the basis of scoring  in the upper-15th percentile on a measure of trait anxiety (anxiety-prone group), and 16 were chosen on the basis of scoring in the normative range (40th-60th percentile). Subjects participated in functional magnetic resonance imaging (fMRI) during an emotion face assessment task that has been shown to reliably engage amygdala and associated limbic structures. RESULTS: Anxiety-prone subjects had significantly greater bilateral amygdala and insula activation to emotional faces than did the anxiety-normative comparison subjects. Higher scores on several measures assessing anxiety proneness (e.g., neuroticism, trait anxiety, and anxiety sensitivity) were associated with greater activation of the amygdala  (predominantly left-sided) and the anterior insula (bilateral). CONCLUSIONS: Increased amygdala and insula reactivity to certain types of emotional processing is seen in young adults with increased anxiety-related temperamental traits. Therefore, this brain emotion-processing profile may be a functional endophenotype for proneness to (certain kinds of) anxiety disorders.

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

PMID: 17267796 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Feb;164(2):230-5.

Comment in:     Am J Psychiatry. 2007 Feb;164(2):189-91.

Physiologic reactivity despite emotional resilience several years after direct exposure to terrorism.

Tucker PM, Pfefferbaum B, North CS, Kent A, Burgin CE, Parker DE, Hossain A, Jeon-Slaughter H, Trautman RP.

Department of Psychiatry, OUHSC, WP 3440, P.O. Box 26901, Oklahoma City, OK 73190, USA. phebe-tucker@ouhsc.edu

OBJECTIVE: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast. METHOD: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews. The two groups were compared on both psychometric and physiologic assessments. RESULTS: Posttraumatic stress but not depressive symptoms were significantly more prevalent in the survivor group than in the comparison group, although symptoms were below levels considered clinically relevant. Despite apparent emotional resilience or recovery, blast survivors had  significantly greater autonomic reactivity to trauma reminders on all measures than comparison subjects. CONCLUSIONS: The results suggest that physiologic assessment may capture long-term effects of terrorism that are not identified by  psychometric instruments. The consequences of autonomic reactivity despite emotional resilience years after experiencing trauma are unknown but theoretically could range from facilitating a protective vigilance toward future  disasters to more maladaptive avoidance behaviors, somatic symptoms, or medical problems.

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

PMID: 17267785 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Feb;45(2):341-58. Epub 2006 May 6.

Enhanced perceptual priming for neutral stimuli occurring in a traumatic context: two experimental investigations.

Michael T, Ehlers A.

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. tanja.michael@unibas.ch

Intrusive memories in posttraumatic stress disorder are often triggered by stimuli that are perceptually similar to those present shortly before or during the trauma. The present study aims to examine the possible role of perceptual priming in this phenomenon. It further investigates whether the degree of perceptual priming is associated with dissociation and whether both perceptual priming and intrusive memories can be reduced through elaboration. Two experiments measured perceptual priming for neutral stimuli that immediately preceded a "traumatic" event. Volunteers (N=46, 92) watched a series of "traumatic" and neutral picture stories, and completed a blurred object identification (perceptual priming) memory task, and a recognition memory task. Participants in Experiment 1 were selected to score either high or low on the Trait Dissociation Questionnaire [Murray, Ehlers, & Mayou (2002). Dissociation and posttraumatic stress disorder: Two prospective studies of motor vehicle accident survivors. British Journal of Psychiatry, 180, 363-368]. They also completed a state dissociation measure in the session. Experiment 2 randomly allocated participants to an experimental condition designed to increase elaboration or to a control condition. This experiment also included a measure of intrusive memories. Both experiments found enhanced perceptual priming for the stimuli that immediately preceded the "traumatic" stories compared to those preceding neutral stories. Participants with high trait dissociation showed relatively stronger perceptual perceptual priming. The degree of perceptual priming for stimuli from the "traumatic" stories also correlated with state dissociation (Experiment 1). Experimental manipulation of the elaboration of the  stories showed that elaboration reduced the enhanced perceptual priming effect and the relative probability of reexperiencing symptoms (Experiment 2). The results support the role of perceptual priming in intrusions after traumatic events.

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

PMID: 16678789 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2007 Feb;45(2):395-403. Epub 2006 Mar 20.

The role of self-blame for trauma as assessed by the Posttraumatic Cognitions Inventory (PTCI): a self-protective cognition?

Startup M, Makgekgenene L, Webster R.

School of Behavioural Sciences, University of Newcastle, Callaghan, NSW 2308, Australia. mike.startup@newcastle.edu.au

The Posttraumatic Cognitions Inventory (PTCI) assesses cognitions hypothesised to be associated with poor recovery from traumatic experiences and the maintenance of PTSD. The validity of the PTCI has received good support but doubts have been  raised about its Self-BLAME subscale. The main aim of the present study was to test the ability of the PTCI subscales to discriminate between traumatised individuals with and without PTSD and to predict posttraumatic symptom severity.  Participants (N=63) who had experienced a traumatic event were recruited via the  media and completed the PTCI and self-report measures of PTSD and depression symptoms. Full criteria for a diagnosis of PTSD were met by 37 but not by the other 26. There were significant differences between these two groups on the total PTCI score and the Negative Cognitions About SELF and the Negative Cognitions About the WORLD subscales, but not on the Self-BLAME subscale. The two groups were discriminated by the PTCI subscales with 65% accuracy and the multiple correlation (R=.68) between the subscales and posttraumatic symptom severity was highly significant. However, in these analyses, higher scores on the Self-BLAME subscale were associated with less risk of a diagnosis of PTSD and with less posttraumatic symptomatology. Possible interpretations of these results, in terms of statistical suppressor effects and the protective role of behavioural self-blame, are discussed.

PMID: 16546119 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2007 Feb 1;61(3):382-8. Epub 2006 Aug 22.

Posttraumatic stress disorder: memory and learning performance in children and adolescents.

Yasik AE, Saigh PA, Oberfield RA, Halamandaris PV.

Psychology Department, Pace University, New York, NY 10038, USA. ayasik@pace.edu

BACKGROUND: Despite the wealth of information in adult posttraumatic stress disorder (PTSD) literature, few studies have explored the memory and learning performance of trauma-exposed youth. This study examined if memory deficits are associated with PTSD or with trauma exposure in the absence of PTSD. METHODS: Youth exposed to traumatic incidents underwent clinical interviews to diagnose PTSD and exclude major comorbid disorders. Youth with conditions that could impede performance on a memory scale (e.g., limited intellectual functioning, current substance abuse, psychopharmacological treatment) were excluded. Three groups of participants were identified (PTSD positives [n = 29], traumatized PTSD negatives [n = 62], and nontraumatized control subjects [n = 40]). Participants completed the Wide Range Assessment of Memory and Learning (WRAML). RESULTS: Youth with PTSD evidenced significantly lower scores on the WRAML General Memory, Verbal Memory, and Learning indices compared with nontraumatized control subjects. With the exception of Verbal Memory, youth with and without PTSD performed comparably on all other indices. Nonsignificant differences were noted  on the Visual Memory Index. CONCLUSIONS: General memory and verbal memory impairments as evidenced in adult populations were observed among this sample of  youth. Given the developmental trajectory of memory capabilities, the implications of such early trauma exposure and memory deficits are considered.

PMID: 16920073 [PubMed - indexed for MEDLINE]

 

Can J Psychiatry. 2007 Feb;52(2):103-10.

Mental health treatment seeking by military members with posttraumatic stress disorder: findings on rates, characteristics, and predictors from a nationally representative Canadian military sample.

Fikretoglu D, Brunet A, Guay S, Pedlar D.

Douglas Hospital Research Centre, McGill University, Montreal, Quebec. deniz.fikretoglu@mail.mcgill.ca

OBJECTIVE: The goal of this study was to identify rates, characteristics, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD). METHOD: Our sample was drawn from the 2002  Canadian Community Health Survey-Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable. RESULTS: About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors,  medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without. CONCLUSIONS: Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors  of treatment seeking, comorbid depression most increased the likelihood of seeking treatment.

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

PMID: 17375866 [PubMed - indexed for MEDLINE]

 

Eur Arch Psychiatry Clin Neurosci. 2007 Feb;257(1):40-6.

Predicting treatment outcome on three measures for post-traumatic stress disorder.

Karatzias A, Power K, McGoldrick T, Brown K, Buchanan R, Sharp D, Swanson V.

Faculty of Health Life and Social Sciences, School of Community Health, Napier University, Comely Bank Campus, Crewe Road South Edinburgh, EH4 2LD Scotland, UK. t.karatzias@napier.ac.uk

The aim of the present study was to investigate predictors of treatment outcome for Posttraumatic Stress Disorder (PTSD) after treatment completion and at 15-months follow-up (n = 48), in a trial of Eye Movement Desensitisation and Reprocessing (EMDR) versus Imaginal Exposure and Cognitive Restructuring (E+CR).  Factors associated with treatment outcome were investigated using regression analyses with the mean change scores in three assessor and self-rated PTSD symptomatology measures, including the Clinician-Administered PTSD Scale (CAPS),  the Impact of Events Scale (IES) and the PTSD Symptom Checklist (PCL) from pre- to post-treatment and pre-treatment to follow-up as the dependent variables and demographics, trauma, clinical and personality measures as independent variables. Irrespective to outcome measures and assessment points it was found that four variables were able to predict significantly treatment outcome. These included baseline PTSD symptomatology, number of sessions, gender and therapy type. Overall, our results showed that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome, as significant  predictors were found to be sample-specific and outcome measure-specific. Clinical relevance of the present results and directions for future research are  discussed.

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

PMID: 16915361 [PubMed - indexed for MEDLINE]

 

Gynecol Oncol. 2007 Feb;104(2):381-9. Epub 2006 Oct 5.

Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes.

Hodgkinson K, Butow P, Fuchs A, Hunt GE, Stenlake A, Hobbs KM, Brand A, Wain G.

Department of Gynecologic Cancer, Westmead Hospital, Westmead, and Department of  Psychological Medicine, University of Sydney, NSW 2006, Australia. khodgkinson@student.usyd.edu.au

OBJECTIVES: To assess the long-term psychosocial outcomes and supportive care needs of gynecologic cancer survivors. METHODS: Women who had received care in a  tertiary-based gynecologic cancer center 1-8 years earlier and who were disease-free were invited to complete a mailed self-report questionnaire to assess psychosocial outcomes and supportive care needs. RESULTS: In total, 199 survivors participated in the study. Survivors reported normal quality of life and relationship adjustment although functioning was at the lower end of the range; over two-thirds (68%) reported positive outcomes. However, nearly one-third (29%) reported clinical levels of anxiety and the most frequently endorsed need concerned fear of disease recurrence (24%). About one-fifth (19%) reported symptoms that indicated posttraumatic stress disorder (PTSD) and this rose to close to one-third (29%) for survivors of advanced stage disease. Nearly  90% of survivors reported supportive care needs and the diagnosis of anxiety or PTSD resulted in a four-fold increase in unmet needs. Needs most frequently concerned "existential survivorship" (e.g., spiritual beliefs, decision making, the meaning of life) and "comprehensive cancer care" (e.g., team care, communication, local health care services). Years since diagnosis was not related to distress or need levels. CONCLUSIONS: All members of the care team need to be  aware that significant psychosocial morbidity may occur many years after the successful treatment of a gynecologic malignancy and may be associated with elevated supportive care needs. Comprehensive and extended supportive care services are required to address anxiety and trauma responses and investigate strategies to meet ongoing needs in order to improve long-term psychosocial outcomes.

PMID: 17027072 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2007 Feb;68(2):201-6.

Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study.

Tucker P, Trautman RP, Wyatt DB, Thompson J, Wu SC, Capece JA, Rosenthal NR.

Department of Psychiatry and Behavioral Sciences, Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City 73104, USA. phebe-tucker@ouhsc.edu

OBJECTIVE: This double-blind, placebo-controlled trial assessed efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder (PTSD). METHOD: Outpatients (18-64 years) with DSM-IV non-combat-related PTSD and Clinician-Administered PTSD Scale (CAPS) scores >or= 50 were eligible. Topiramate was started at 25 mg/day and titrated by 25-50 mg/week to 400 mg/day or maximum tolerated dose. Data were collected between April 26, 2002, and February 4, 2004. Primary efficacy, change in total CAPS score, and secondary efficacy measures were assessed by analysis of covariance in the intent-to-treat (ITT) population with last observation carried forward. RESULTS: The ITT population comprised 38 patients with mean +/- SD baseline total CAPS scores of 88.3 +/- 13.8 (topiramate, N = 19) and 91.1 +/- 13.7 (placebo, N = 19). Although a decrease in  total CAPS score was noted (topiramate, -52.7; placebo, -42.0), this difference was not statistically significant (p = .232). Topiramate-treated patients exhibited significant reductions in reexperiencing symptoms (CAPS cluster B: topiramate, 74.9%; placebo, 50.2%; p = .038) and Treatment Outcome PTSD scale (topiramate, 68.0%; placebo, 41.6%; p = .025). Reductions approaching statistical significance, based on a nominal p value, were noted in mean total Clinical Global Impressions-Improvement Scale scores (topiramate, 1.9 +/- 1.2; placebo, 2.6 +/- 1.1; p = .055). CONCLUSION: These preliminary results suggest that further, adequately powered studies of topiramate for the treatment of civilian PTSD are warranted.

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

PMID: 17335317 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2007 Feb;75(1):154-9.

Predisaster trait anxiety and negative affect predict posttraumatic stress in youths after hurricane Katrina.

Weems CF, Pina AA, Costa NM, Watts SE, Taylor LK, Cannon MF.

Department of Psychology, University of New Orleans, New Orleans, LA 70148, USA.  cweems@uno.edu

On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and  further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety  disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths. Copyright 2007 APA, all rights reserved.

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

PMID: 17295574 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2007 Feb;75(1):134-44.

Intrusive memories in perpetrators of violent crime: emotions and cognitions.

Evans C, Ehlers A, Mezey G, Clark DM.

Department of Psychological Medicine, St. George's Hospital Medical School, London, England. ceri.evans@cdhb.govt.nz

The authors investigated factors that may determine whether perpetrators of violent crime develop intrusive memories of their offense. Of 105 young offenders who were convicted of killing or seriously harming others, 46% reported distressing intrusive memories, and 6% had posttraumatic stress disorder. Intrusions were associated with lower antisocial beliefs before the assault, greater helplessness, fear, dissociation, data-driven processing and lack of self-referent processing during the assault, more disorganized assault narratives, and greater negative view of the self, negative interpretations of intrusive memories, perceived permanent change, and self-blame. In a logistic regression analysis, the cognitive and emotional variables explained substantial  variance over and above demographic factors. The results suggest that cognitive factors that predict reexperiencing symptoms in victims of crime generalize to perpetrators. Copyright 2007 APA, all rights reserved.

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

PMID: 17295572 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2007 Feb;22(2):250-8.

Current psychopathology in previously assaulted older adults.

Acierno R, Lawyer SR, Rheingold A, Kilpatrick DG, Resnick HS, Saunders BE.

Medical University of South Carolina, National Crime Victims Research and Treatment Center, Charleston, SC 29425, USA. acierno@musc.edu

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall  rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and reexperiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more  likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.

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

PMID: 17202579 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Feb;195(2):179-82.

Interactive effects of memory structuring and gender in preventing posttraumatic  stress symptoms.

Gidron Y, Gal R, Givati G, Lauden A, Snir Y, Benjamin J.

Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands.

This study retested effects of a Memory Structuring Intervention (MSI) and the moderating role of gender in relation to posttraumatic stress disorder (PTSD) symptoms. Thirty-four traffic accident victims with high pulse rates were randomly assigned to MSI or supportive listening (control) phone conversations soon after accidents. Based on converging clinical and neuroscience research, the MSI taught chronological organization, labeling emotions/sensations, and describing causality. PTSD symptoms were assessed 3 months later. No overall group differences were found. However, a group by gender interaction revealed that, for women, the MSI was associated with less PTSD symptoms than the control  treatment, while the opposite pattern was seen in men. Limitations and possible explanations for these findings are discussed.

Publication Types:      Randomized Controlled Trial

PMID: 17299308 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Feb;195(2):144-51.

Psychological distress and burden among female partners of combat veterans with PTSD.

Manguno-Mire G, Sautter F, Lyons J, Myers L, Perry D, Sherman M, Glynn S, Sullivan G.

VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Little Rock, Arkansas, USA.

Psychological distress among cohabitating female partners of combat veterans with posttraumatic stress disorder (PTSD) was examined in a cross-sectional study using a modified version of the Health Belief Model. A convenience sample of 89 cohabitating female partners of male veterans in outpatient PTSD treatment was interviewed by telephone using a structured interview. Partners endorsed high levels of psychological distress with elevations on clinical scales at or exceeding the 90th percentile. Severe levels of overall psychological distress, depression, and suicidal ideation were prevalent among partners. Multivariate analyses revealed that perceived threat, recent mental health treatment, and level of involvement with veterans predicted global partner psychological distress. Partner burden was predicted by partner self-efficacy, perceived threat, barriers to mental health treatment, and partner treatment engagement. These findings are compelling since they demonstrate that partners of veterans with combat-related PTSD experience significant levels of emotional distress that warrant clinical attention. Psychological distress and partner burden were each associated with a unique combination of predictors, suggesting that although these constructs are related, they have distinct correlates and potentially different implications within the family environment. Future research should examine these constructs separately using causal modeling analyses to identify modifiable targets for interventions to reduce psychological distress among partners of individuals with PTSD.

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

PMID: 17299302 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2007 Feb;195(2):137-43.

The subjective experience of trauma and subsequent PTSD in a sample of undocumented immigrants.

Rasmussen A, Rosenfeld B, Reeves K, Keller AS.

New York University School of Medicine, Bellevue/NYU Program for Survivors of Torture, Bellevue Hospital Center, New York, NY 10016, USA.

Although a subjective component of trauma is commonly recognized in diagnosing posttraumatic stress disorder (PTSD), there are few studies that specifically address Criterion A2, and none addressing this issue among undocumented immigrants. We assessed 212 arriving undocumented immigrants with diverse trauma  histories to investigate concordance between objective and subjective factors of  trauma (Criteria A1 and A2) and across different types of trauma and PTSD. Concordance between Criteria A1 and A2 varied, with highest rates found for political violence. Interpersonal violence in general was associated with higher  rates of PTSD. We identified a dose-response effect for PTSD, but this was not dependent on other events (i.e., other doses) meeting Criterion A2. Discussion focuses on Criterion A within the phenomenology of PTSD and the need to gauge subjective interpretations of trauma events among this population.

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

PMID: 17299301 [PubMed - indexed for MEDLINE]

 

J Pers Assess. 2007 Feb;88(1):90-8.

Validity of the Personality Assessment Inventory Aggression scales and Violence Potential index in veterans with PTSD.

Crawford EF, Calhoun PS, Braxton LE, Beckham JC.

Durham VA Medical Center, Durham, North Carolina, USA.

In this study, we examined the validity of the Personality Assessment Inventory (PAI; Morey, 1991) Aggression (AGG) scales and Violence Potential index (VPI) in  399 male combat veterans presenting for formal evaluation of posttraumatic stress disorder (PTSD). The AGG scales exhibited convergence with other measures of hostility and violence and demonstrated discriminant validity with alternative constructs. When we examined reports of interpersonal violence in the past year,  the AGG composite scale displayed substantial incremental validity over the effects of PTSD severity, demographics, a simple dichotomous question regarding violence in the past 30 days, and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scales measuring aggression. The VPI, however, added no unique explanatory power over the AGG composite scale.

Publication Types:      Validation Studies

PMID: 17266419 [PubMed - indexed for MEDLINE]

 

J Trauma. 2007 Feb;62(2):410-8; discussion 418.

Chronic posttraumatic stress disorder after facial injury: a 1-year prospective cohort study.

Glynn SM, Shetty V, Elliot-Brown K, Leathers R, Belin TR, Wang J.

Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA. sglynn@ucla.edu

BACKGROUND: This study examined the prevalence, severity, and predictors of persistent traumatic stress symptoms in socioeconomically disadvantaged adults after orofacial injury. METHODS: A 1-year prospective study of 336 socioeconomically disadvantaged adults treated for orofacial injury at a Level I  trauma center was conducted. Univariate analyses were performed on early measures of injury characteristics, prior trauma exposure, coping resources, and psychosocial functioning to select potential predictors of 1-year posttraumatic stress disorder (PTSD) scores; independence of variable contribution was then evaluated in multiple regression analyses. RESULTS: A substantial number of patients (23%) continued to experience significant PTSD symptomatology at 12 months. Predictors of PTSD symptoms at 12 months included current and lifetime mental health and social service needs, lifetime social service use, prior trauma exposure, sum of stressful life events in the year preceding injury, patient report of pain severity and inadequate social support at 10 days postdischarge, and PTSD scores at 1 month. One-month PTSD symptoms, unmet social service need, and need for more instrumental and emotional support were independent predictors  of 12-month PTSD outcomes. Limitations include loss to follow up, use of self-report measures, and the possibility of additional traumatization in the follow-up year influencing symptom levels. CONCLUSIONS: Many socioeconomically disadvantaged adults manifest negative psychological outcomes even 1 year after an orofacial injury. Poor social support and unmet social service needs immediately after the injury, as well as high PTSD symptoms at 1 month postinjury, are strongly associated with the risk of developing chronic PTSD. The surgical management of orofacial injuries in disadvantaged individuals should integrate case management that addresses psychosocial sequelae and patient service needs.

PMID: 17297333 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Feb;20(1):15-25.

Use of mental health treatment among veterans filing claims for posttraumatic stress disorder.

Sayer NA, Clothier B, Spoont M, Nelson DB.

Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN  55417, USA. nina.sayer@med.va.gov

This study examines predictors of current mental health service use in a sample of 154 veterans filing claims for Veterans Affairs (VA) disability benefits based on Posttraumatic Stress Disorder (PTSD). Our conceptual framework was the behavioral model that classifies predictors of service utilization into predisposing (background), enabling (e.g., insurance) and need (e.g., symptoms) factors. Slightly more than half of the PTSD claimants were receiving mental health treatment at the time of claim initiation. Mean symptom levels were clinically significant in both users and nonusers of mental health treatment. In  a multivariate logistic regression analysis, mental health treatment use was associated with younger age, marriage, and dependence on public insurance. Implications for future research are discussed.

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

PMID: 17345650 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Feb;20(1):27-38.

Risk and resilience factors for posttraumatic stress symptomatology in Gulf War I veterans.

Vogt DS, Tanner LR.

Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare  System, Boston, MA, USA. Dawne.Vogt@va.gov

What factors distinguish war-exposed veterans who experience posttraumatic stress symptomatology (PTSS) from those who do not? This study used structural equation  modeling procedures to examine the complex interplay among predeployment, war-zone, and postdeployment factors as they relate to PTSS in a sample of Gulf War I veterans. A primary goal was to determine to what extent previously documented associations among Vietnam veterans would replicate in this more contemporary veteran cohort. Results supported a multivariate etiological perspective on PTSS, with war-zone factors accounting for the largest proportion  of variance in PTSS. The majority of hypothesized associations held, suggesting that the mechanisms underlying PTSS may be similar across veteran cohorts.

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

PMID: 17345645 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Feb;20(1):3-13.

The consistency of combat exposure reporting and course of PTSD in Vietnam War veterans.

Koenen KC, Stellman SD, Dohrenwend BP, Sommer JF Jr, Stellman JM.

Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.

Self-reports of traumatic events are often used in clinical and epidemiologic studies. Nevertheless, research suggests combat exposure reports may be biased by posttraumatic stress disorder (PTSD) symptom severity, leading to an inflated dose-response relation between combat exposure and PTSD. The authors examined the consistency in combat exposure reports and their relation to PTSD symptoms in Vietnam Veteran American Legionnaires who responded to two mailed surveys (1984,  1998; N = 1,462). Combat exposure reports were highly reliable (test-retest correlation = 0.87). However, changes in exposure reporting were related to changes in PTSD symptoms, specifically reexperiencing symptoms. The effect size of the dose-response relation attributable to changes in reporting was smaller for continuous than categorical measures. Findings are discussed in relation to recent controversies over veterans' combat exposure reports.

PMID: 17345644 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Feb;20(1):89-95.

The increasing internationalization of mainstream posttraumatic stress disorder research: a bibliometric study.

Figueira I, da Luz M, Braga RJ, Cabizuca M, Coutinho E, Mendlowicz MV.

Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

The aim of this study was to quantify changes in the national contributions to research related to posttraumatic stress disorder (PTSD) from 1983 through 2002.  Using the Web of Science database (Thomson Scientific, Philadelphia, PA), we classified articles according to the year of publication and the country of the authors. The number of publishing countries increased from 7 between 1983 and 1987 to 39 between 1998 and 2002. Meanwhile, the U.S. output share declined from  87.6% in the first period to 62.4%. Although the number of countries publishing on PTSD has steadily increased, research is still dominated qualitatively and quantitatively by developed countries. These findings suggest a growing international acceptance of this diagnostic category. However, the immaturity of  PTSD research is demonstrated by the concentration of publications in a few countries.

PMID: 17343266 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2007 Feb;20(1):53-62.

Conduct disorder, war zone stress, and war-related posttraumatic stress disorder  symptoms in American Indian Vietnam veterans.

Dillard D, Jacobsen C, Ramsey S, Manson S.

Research Department, Southcentral Foundation, Anchorage, AK 99508, USA. ddillard@scf.cc

This study examined whether conduct disorder (CD) was associated with war zone stress and war-related post-traumatic stress disorder (PTSD) symptoms in American Indian (AI) Vietnam veterans. Cross-sectional lay-interview data was analyzed for 591 male participants from the American Indian Vietnam Veterans Project. Logistic regression evaluated the association of CD with odds of high war zone stress and  linear regression evaluated the association of CD and PTSD symptom severity. Childhood CD was not associated with increased odds of high war zone stress. Conduct disorder was associated with elevated war-related PTSD symptoms among male AI Vietnam Veterans independent of war zone stress level and other mediators. Future efforts should examine reasons for this association and if the  association exists in other AI populations.

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

PMID: 17343265 [PubMed - indexed for MEDLINE]

 

Perspect Psychiatr Care. 2007 Feb;43(1):55-9.

Pharmacologic management of posttraumatic stress disorder.

Antai-Otong D.

Publication Types:      Review

PMID: 17295860 [PubMed - indexed for MEDLINE]

 

Psychol Sci. 2007 Feb;18(2):127-9.

Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder.

Felmingham K, Kemp A, Williams L, Das P, Hughes G, Peduto A, Bryant R.

Brain Dynamics Centre, Westmead Millennium Institute, Westmead Hospital, Westmead, New South Wales, Australia. kfelmingham@med.usyd.edu.au

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

PMID: 17425531 [PubMed - indexed for MEDLINE]

 

Telemed J E Health. 2007 Feb;13(1):65-7.

Acute-phase trauma intervention using a videoconference link circumvents compromised access to expert trauma care.

Todder D, Matar M, Kaplan Z.

Ministry of Health Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. dtoder@netvision.net.il

In order to effectively reduce the risk of developing acute stress disorder (ASD) and/or posttraumatic stress disorder (PTSD) in the aftermath of traumatic stress  exposure, interventions must be offered early on. Therefore, access to expert assistance can have significant effects on prognosis. Conditions which compromise accessibility and prevent direct physical access, such as existed in the Gush Katif settlements in the Gaza Strip during the El-Aqsa Intifada, render the provision of expert care in real-time difficult. These problematic conditions led to an attempt to offer acute trauma care using videoconference (VC) telemedicine. This paper presents two cases in which a VC link was used to provide specialist care in cases of acute sequelae of trauma rapidly and in a safe and accessible environment. The authors discuss the potential benefits and some limitations of early trauma interventions using a VC link to access civilian population whose access to care is compromised by prevailing conditions.

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

PMID: 17309357 [PubMed - indexed for MEDLINE]

 

Physiol Behav. 2007 Jan 30;90(1):103-7. Epub 2006 Oct 17.

Hyperarousal does not depend on trauma-related contextual memory in an animal model of Posttraumatic Stress Disorder.

Siegmund A, Wotjak CT.

Max Planck Institute of Psychiatry, Neuronal Plasticity Group, Kraepelinstr. 2, D-80804 Munich, Germany.

Both classical fear conditioning and fear sensitization have been implicated in the development of Posttraumatic Stress Disorder (PTSD), but little is known about their interaction or interdependency. Therefore, we administered the NMDA receptor antagonist AP5 or vehicle bilaterally into the dorsal hippocampus of C57BL/6N mice 15 min before administration of an electric footshock. One month later mice were tested for their conditioned fear reaction to the shock context (associative fear memory) and for their sensitized fear response to a neutral tone in a new context (hyperarousal). AP5-treated animals exhibited only half as  much conditioned, but equal amounts of sensitized fear, compared to vehicle-treated mice, demonstrating that hyperarousal does not depend on associative fear memory about the aversive encounter, but solely on sensitization induced by the inescapable footshock. This result points to the need for a 'desensitization' approach in PTSD therapy, as sensitization and classical conditioning seem to be independent processes in this psychiatric disorder.

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

PMID: 17049568 [PubMed - indexed for MEDLINE]

 

Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):131-5. Epub 2006 Sep 27.

Psychopharmacologic treatment of aggressive preschoolers: a chart review.

Staller JA.

Division of Child and Adolescent Psychiatry, SUNY Upstate Medical University, Syracuse, NY 13210, USA.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in  a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists--treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.

PMID: 17007977 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2007 Jan 15;149(1-3):303-8. Epub 2006 Nov 16.

Psychological distress among American Red Cross disaster workers responding to the terrorist attacks of September 11, 2001.

Long ME, Meyer DL, Jacobs GA.

Disaster Mental Health Institute, Department of Clinical Psychology, The University of South Dakota, 414 East Clark Street, SDU 114, Vermillion, SD 57069-2390, USA. Mary.Long@usd.edu

This study investigated American Red Cross disaster workers' symptoms of distress and posttraumatic stress resulting from exposure to disaster stimuli during their response to the September 11, 2001 terrorist attacks. A sample of 3055 Red Cross  disaster workers was surveyed 1 year after the terrorist attacks regarding demographic characteristics, function during the response, and exposure to disaster stimuli. Participants were grouped by function and self-reported exposure, with the hypothesis that workers in Direct Services and/or those reporting to be directly exposed to disaster stimuli would experience greater levels of posttraumatic stress symptoms and distress than workers in indirect services or reporting no exposure. Findings revealed that while there were significant differences between both Function and Exposure groups on dependent measures, the multivariate eta2 was very small for both and did not meet medium effect size criteria. The results indicated that workers directly exposed to disaster stimuli reported no more distress than those who were not directly exposed.

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

PMID: 17113159 [PubMed - indexed for MEDLINE]

 

Depress Anxiety. 2007 Jan 3 [Epub ahead of print]

Sensory filtering phenomenology in PTSD.

Stewart LP, White PM.

Department of Psychology, University of Oregon, Eugene, Oregon.

Disrupted sensory filtering, or problems with suppressing irrelevant environmental sensory stimuli, has been reported in individuals with posttraumatic stress disorder (PTSD). However, the relationship of sensory filtering deficits to specific PTSD symptoms versus an association with general trauma exposure is unclear. These relationships were examined by administering self-report measures of trauma exposure, PTSD, and sensory gating phenomenology to undergraduate participants with PTSD (n=32), with trauma history but without PTSD (n=144), and with minimal trauma history (n=153). Subjects with PTSD reported greater filtering disruption than individuals in the trauma only and low trauma groups, who did not differ. Individuals endorsing reexperiencing and numbing symptoms, and females endorsing hypervigilance, reported disrupted sensory filtering phenomenology. These results suggest that impaired filtering differentiates between individuals with PTSD symptoms and asymptomatic individuals exposed to multiple traumas and low-trauma controls. Depression and Anxiety 0:1-8, 2007. (c) 2007 Wiley-Liss, Inc.

PMID: 17203460 [PubMed - as supplied by publisher]

 

Am J Geriatr Psychiatry. 2007 Jan;15(1):79-83. Epub 2006 Oct 11.

Impact of early lifetime trauma in later life: depression among Holocaust survivors 60 years after the liberation of Auschwitz.

Trappler B, Cohen CI, Tulloo R.

Outpatient Division, Kingsboro Psychiatric Center, Brooklyn, NY, USA. kbmdbtt@omh.state.ny.us

RATIONALE: Holocaust survivors, who experienced trauma 60 years ago, provide an opportunity to explore the impact of early lifetime trauma in later life and, in  particular, the interplay of depression and posttraumatic stress disorder (PTSD). In this study, the authors contrast depressed Holocaust survivors (HD), nondepressed Holocaust survivors (HND), and older depressed persons (CD). METHODS: The sample consisted of 36 consecutive Holocaust survivors (mean age: 79 years) treated in a primary care practice, among whom 20 (56%) were diagnosed as  having a major depressive disorder and 16 as nondepressed; 18 depressed non-Holocaust Jewish primary care patients served as controls (mean age: 84 years). The authors examined nine clinical and social variables. The Kruskal-Wallis, Mann-Whitney U, and chi(2) tests were used to contrast the groups. The authors used a conservative significance level of .01. RESULTS: In contrast to the CD group, the HD group was significantly older, more likely to report PTSD and guilt symptoms, to have higher Beck Anxiety Inventory (BAI) and Brief Psychiatric Rating Scale (BPRS) scores, and to have more impaired social functioning. In contrast to the HND group, the HD group was significantly more likely to report PTSD and guilt feelings, to have higher Hamilton Depression Scale (HAM-D), BAI, and BPRS scores, and to have more impaired social functioning. In contrast to the CD group, the HND group was significantly more likely to have PTSD symptoms and to have lower HAM-D and BPRS scores. CONCLUSIONS: The prevalence of depression and PTSD symptoms were very high among  survivors. Depressed survivors had significantly worse psychologic and social functioning than depressed controls. Depressed survivors had more PTSD symptoms than nondepressed survivors, although it is unclear as to the causal direction of the relationship between depression and PTSD.

Publication Types:      Comparative Study

PMID: 17035355 [PubMed - indexed for MEDLINE]

 

Am J Orthopsychiatry. 2007 Jan;77(1):76-85.

Adolescent exposure to recurrent terrorism in Israel: posttraumatic distress and  functional impairment.

Pat-Horenczyk R, Abramovitz R, Peled O, Brom D, Daie A, Chemtob CM.

The Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem,  Israel. rpat@herzoghospital.org

This study examines the impact of exposure to ongoing terrorism on 695 Israeli high school students. Exposure was measured using a questionnaire developed for the security situation in Israel. Posttraumatic symptoms were measured using the  UCLA PTSD Index for DSM-IV--Adolescent Version (N. Rodriguez, A. Steinberg, & R.  S. Pynoos, 1999), functional impairment and somatic complaints were assessed using items derived from the Diagnostic Interview Schedule for Children (C. P. Lucas et al., 2001), and depression was measured with the Brief Beck Depression Inventory (A. T. Beck & R. W. Beck, 1972). According to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), the prevalence of probable posttraumatic stress disorder was 7.6%. Girls reported greater severity of posttraumatic symptoms, whereas boys exhibited greater functional impairment in social and family domains. School-based screening appears to be an effective means of identifying adolescents who have been exposed to terror and are experiencing posttraumatic stress symptomatology and psychosocial impairment.

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

PMID: 17352588 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Jan;164(1):150-3.

Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans.

Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC.

Department of Psychiatry and Behavioral Sciences, Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA. charles.hoge@us.army.mil

OBJECTIVE: Studies of soldiers from prior wars conducted many years after combat  have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied. METHOD: The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq. RESULTS: Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured. CONCLUSIONS: The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important  implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns  should be evaluated for PTSD.

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

PMID: 17202557 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Jan;164(1):119-25.

Childhood antecedents of exposure to traumatic events and posttraumatic stress disorder.

Storr CL, Ialongo NS, Anthony JC, Breslau N.

Department of Mental Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.

OBJECTIVE: The authors prospectively examined childhood antecedents of exposure to traumatic events to estimate the risk of posttraumatic stress disorder (PTSD)  among those exposed to trauma. METHOD: Two consecutive cohorts of children entering first grade of a public school system in a large mid-Atlantic city in the mid-1980s were followed into young adulthood (mean age=21). Exposure to traumatic events and PTSD were assessed in 75% of the original cohort (N=1,698).  Childhood assessments, conducted upon entry into the first grade, included standardized measures of reading readiness, teacher ratings of behavioral problems, and child self-reports about depression and anxiety. Family characteristics were assessed by parental report. RESULTS: Young adults who had been rated by their first grade teacher as having aggressive/disruptive behavior  problems were more likely to experience traumatic assaultive violence events (e.g., being mugged/threatened with a weapon, badly beaten-up) (relative risk=2.6) but not PTSD following trauma exposure. Youths with high levels of self-rated depressive and anxious feelings in first grade were more likely to experience PTSD once exposed to trauma (relative risk=1.5). Youths who scored in  the highest quartile on a reading test in the first grade were at lower risk for  exposure to assaultive violence traumas. CONCLUSIONS: Childhood behavioral and depressive/anxious problems may influence the risk for PTSD directly by increasing the vulnerability to the PTSD effects of trauma exposure, and indirectly by increasing the likelihood of exposure to assaultive violence.

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

PMID: 17202553 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Jan;164(1):82-90.

Comment in:     Am J Psychiatry. 2007 Aug;164(8):1267; author reply 1267-8.    Am J Psychiatry. 2007 Jan;164(1):7-8.    Am J Psychiatry. 2007 Jun;164(6):974-5; author reply 975.

Treatment of acute posttraumatic stress disorder with brief cognitive behavioral  therapy: a randomized controlled trial.

Sijbrandij M, Olff M, Reitsma JB, Carlier IV, de Vries MH, Gersons BP.

Academic Medical Center of the University of Amsterdam, Department of Psychiatry, Center for Psychological Trauma, Tafelbergweg 25, 1105 BC, Amsterdam. e.m.sijbrandij@amc.uva.nl

OBJECTIVE: The purpose of this study was to evaluate the efficacy of brief cognitive behavioral therapy for patients with acute posttraumatic stress disorder (PTSD) resulting from various types of psychological trauma. METHOD: The authors randomly assigned 143 patients with acute PTSD (irrespective of the time  criterion), within 3 months after experiencing a traumatic incident, to either brief cognitive behavioral therapy (N=79) or a waiting list comparison group (N=64). Cognitive behavioral therapy consisted of four weekly sessions containing education, relaxation exercises, imaginal exposure, in vivo exposure, and cognitive restructuring. Main outcome measure was PTSD score measured by structured interview; secondary outcomes were anxiety and depression measured by  questionnaire. Assessments took place before the intervention and 1 week and 4 months after the intervention. RESULTS: Symptoms of PTSD, anxiety, and depression decreased in both groups over time. One week after the intervention, the cognitive behavioral therapy group had significantly fewer symptoms of PTSD than  the comparison group, but this difference was smaller and no longer significant 4 months after the intervention. Similar results were found for anxiety and depression scores. Subgroup analyses showed that cognitive behavioral therapy led to significantly lower PTSD scores at 4 months in patients with baseline comorbid major depression and in patients who were included within the first month after the traumatic incident both at 1 week and at 4 months. CONCLUSIONS: Brief early cognitive behavioral therapy accelerated recovery from symptoms of acute PTSD but did not influence long-term results. Brief early cognitive behavioral therapy showed enhanced efficacy in patients with baseline comorbid depression and patients who were included within 1 month after their traumatic experience.

Publication Types:      Comparative Study     Randomized Controlled Trial     Research Support, Non-U.S. Gov't

PMID: 17202548 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2007 Jan;164(1):66-72.

Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: provoking danger under continuous threat?

Pat-Horenczyk R, Peled O, Miron T, Brom D, Villa Y, Chemtob CM.

Israel Center for the Treatment of Psychotrauma, Herzog Hospital, the Hebrew University of Jerusalem, Israel 91035. rpat@herzoghospital.org

OBJECTIVE: This study aimed to assess 1) the relationship between risk-taking behaviors and exposure to terrorism, 2) the relationship between posttraumatic symptoms and risk-taking behaviors, and 3) gender differences in the type and frequency of risk-taking behaviors and their differential associations with posttraumatic symptoms. METHOD: The participants were 409 Israeli adolescents 15  to 18 years of age. Exposure to terrorism was assessed with a questionnaire developed specifically for the Israeli security situation. Posttraumatic symptoms were measured with the University of California at Los Angeles Reaction Index. Functional impairment was measured with the Diagnostic Interview Schedule for Children. Risk-taking behavior-and the adolescents' perceptions of such behavior-was assessed with a self-report questionnaire. RESULTS: Israeli adolescents exposed to continuous threats of terrorist attacks reported high levels of risk-taking behaviors. The severity of risk-taking was associated with  greater terrorism exposure. Adolescents suffering from posttraumatic symptoms reported more risk-taking behaviors than nonsymptomatic adolescents. Although there was no gender difference in the degree of exposure to terrorism, boys reported taking more risks than girls. The association between posttraumatic symptoms and risk-taking behaviors was stronger in boys than girls. Functional impairment, gender, avoidance symptoms, level of exposure, and degree of fear predicted the severity of risk-taking behaviors. CONCLUSIONS: Clinicians and educators should be aware of the strong link between posttraumatic distress and risk-taking behaviors. Risk-taking behaviors may be a manifestation of functional impairment and posttraumatic distress, especially for boys exposed to terrorism.

Publication Types:      Comparative Study

PMID: 17202546 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2007 Jan;97(1):99-101. Epub 2006 Nov 30.

Prevalence of posttraumatic stress disorder in a coastal fishing village in Tamil Nadu, India, after the December 2004 tsunami.

Kumar MS, Murhekar MV, Hutin Y, Subramanian T, Ramachandran V, Gupte MD.

National Institute of Epidemiology, Indian Council of Medical Research, Chennai,  India.

Two months after the December 2004 tsunami in Tamil Nadu, India, we surveyed adults aged 18 years or older in a severely affected coastal village using structured interviews and the Harvard Trauma Questionnaire. The prevalence of posttraumatic stress disorder was 12.7% (95% confidence interval [CI]=9.4%, 17.1%), and odds of posttraumatic stress disorder were higher among individuals with no household incomes, women, and those injured during the tsunami. In addition to promoting feelings of safety, interventions aimed toward populations  affected by the December 2004 tsunami need to focus on income-generating activities. Also, there is a need to target initiatives toward women and those individuals injured during the tsunami, given that these groups are more likely to experience posttraumatic stress disorder.

PMID: 17138927 [PubMed - indexed for MEDLINE]

 

Annu Rev Public Health. 2007;28:55-68.

First responders: mental health consequences of natural and human-made disasters  for public health and public safety workers.

Benedek DM, Fullerton C, Ursano RJ.

Center for the Study of Traumatic Stress, Uniformed Services University School of Medicine, Bethesda, MD 20814-4799, USA. dbenedek@usuhs.mil

First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences  as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed.

Publication Types:      Review

PMID: 17367284 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2007 Jan;64(1):109-16.

Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study.

Kubzansky LD, Koenen KC, Spiro A 3rd, Vokonas PS, Sparrow D.

Harvard School of Public Health, Veterans Affairs Normative Aging Study, Veterans Affairs Boston Health Care System, Boston University School of Medicine, 677 Huntington Avenue, Boston, MA 02115, USA. lkubzans@hsph.harvard.edu

CONTEXT: Various correlates of posttraumatic stress disorder (PTSD), such as high levels of sympathetic activation and hypothalamic-pituitary-adrenal axis dysregulation, have been linked to arterial damage and coronary heart disease (CHD) risk. While psychological disturbance is frequently found among patients with cardiac disease, whether psychological problems precede or occur as a result of having a potentially fatal disease is not clear. To our knowledge, no prospective studies to date have evaluated whether PTSD is associated with increased risk of CHD. OBJECTIVE: To test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using 2 different measures of PTSD. DESIGN: Prospective cohort study. SETTING: Community-dwelling men from the Greater Boston, Mass, area who served in the military. PARTICIPANTS: Data are from the Veterans Affairs Normative Aging Study. Men who completed either the Mississippi  Scale for Combat-Related PTSD in 1990 (n = 1002) or the Keane PTSD scale in 1986  (n = 944) were included in the study. MAIN OUTCOME MEASURE: Incident CHD occurring during follow-up through May 2001. RESULTS: Levels of PTSD symptoms in  this cohort were low to moderate. Men with preexisting CHD at baseline were excluded, and PTSD was measured with the Mississippi Scale for Combat-Related PTSD. For each SD increase in symptom level, men had age-adjusted relative risks  of 1.26 (95% confidence interval, 1.05-1.51) for nonfatal myocardial infarction and fatal CHD combined and 1.21 (95% confidence interval, 1.05-1.41) for all of the CHD outcomes combined (nonfatal myocardial infarction, fatal CHD, and angina). Findings were replicated using the Keane PTSD scale and somewhat strengthened after controlling for levels of depressive symptoms. CONCLUSIONS: To our knowledge, this is the first study to demonstrate a prospective association between PTSD symptoms and CHD even after controlling for depressive symptoms. These results suggest that a higher level of PTSD symptoms may increase the risk  of incident CHD in older men.

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

PMID: 17199060 [PubMed - indexed for MEDLINE]