Headache. 2008 Jul 1. [Epub ahead of print]

Headache Disability in Orofacial Pain Patients Is Related to Traumatic Life Events.

Branch MA.

National Naval Medical Center-Orofacial Pain Center, Bethesda, MD, USA.

Background.- Headache is commonly reported in patients presenting with orofacial  pain. It has only recently been demonstrated that headache-related disability is  high in orofacial pain patients. Traumatic life events (TLEs) such as sexual abuse, physical abuse, and post-traumatic stress disorder (PTSD) are also common  in orofacial pain patients and in the same patients reporting headache. In association with a previously reported study of headache disability in orofacial  pain patients, it was noted that Migraine Disability Assessment (MIDAS) scores appeared to be significantly higher in patients with TLEs. Objectives.- To investigate the relationship between TLEs and headache disability in a clinic population of orofacial pain patients. Design.- Retrospective study. Methods.- Four hundred and twenty-six consecutive orofacial pain patient records were reviewed, composed of new patients seen at the Orofacial Pain Center, National Naval Medical Center, Bethesda, MD, from November 2003 through December 2004. Results.- Of 426 orofacial pain patients reporting headache, 109 or 41.7% reported TLEs. In patients with TLEs, the mean MIDAS score was 28.81 +/- 37.2 compared with 13.5 +/- 17.9 for patients not reporting TLEs P < .000. MIDAS scores were significantly correlated with TLEs, Spearman correlation coefficient  0.272, P < .010. Conclusions.- This is the first study to demonstrate that headache disability is significantly higher in a group of orofacial pain patients with TLEs and is correlated with that report of traumatic events. These findings  clearly demonstrate the necessity for providers to consider a history of TLEs in  orofacial pain patients presenting with headache.

PMID: 18624710 [PubMed - as supplied by publi  sher]

Int J Clin Exp Hypn. 2008 Jul;56(3):334-56.

Hypnotizability as a potential risk factor for posttraumatic stress: a review of  quantitative studies.

Yard SS, DuHamel KN, Galynker II.

Beth Israel Medical Center, New York, New York, USA. samyard@u.washington.edu

The authors review the literature relating hypnotizability and posttraumatic stress. Sixty-seven abstracts containing the key terms ASD, acute stress, trauma, traumatic, or PTSD in combination with either hypnotic susceptibility or hypnotizability were reviewed. Six articles were found containing data on hypnotizability and posttraumatic stress symptoms. Each of the studies showed some relation between hypnotizability and posttraumatic stress, but, in all of them, hypnotizability was measured after the potentially traumatizing event. High hypnotizability might be a risk factor for both acute and chronic posttraumatic symptoms. However, this cannot be determined until prospective studies measure hypnotizability in individuals before and after a potentially traumatizing event, perhaps by targeting populations that are at risk for experiencing trauma.

PMID: 18569143 [PubMed - in process]

 

Int J Clin Exp Hypn. 2008 Jul;56(3):270-80.

Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial.

Abramowitz EG, Barak Y, Ben-Avi I, Knobler HY.

Israel Defense Forces, Mental Health Department, Israel. eitanmd@zahav.net.il

This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD. Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy were randomized to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all  sleep variables assessed.

PMID: 18569138 [PubMed - in process]

 

Int J Group Psychother. 2008 Jul;58(3):389-401.

Transgenerational transmission of trauma: guilt, shame, and the "heroic dilemma".

de Mendelssohn F.

Department of Psychoanalytic Studies, Sigmund Freud University. felix.de.mendelssohn@inode.at

PMID: 18573029 [PubMed - indexed for MEDLINE]

 

Int J Soc Psychiatry. 2008 Jul;54(4):293-302.

Trained volunteer-delivered mental health support to those bereaved by Asian tsunami--an evaluation.

Vijayakumar L, Kumar MS.

Voluntary Health Services, India. dr_svk@vsnl.com

INTRODUCTION: While mental health consequences following the Asian December 2004  tsunami have been studied, its impact on the survivors who lost close family members deserves attention. We investigated the usefulness of trained volunteer-delivered mental health support for the bereaved persons. METHOD: Non-randomized control design involving all adults aged 18 years or above who lost at least one close family member during tsunami from two geographically different coastal areas in Chennai, India. From the intervention and control sites, 45 and 57 participants were recruited respectively for the study. One year after baseline assessment, all 102 participants in intervention and control sites were interviewed. RESULTS: Participants receiving interventions on a consistent basis from trained volunteers were less likely to report depressive symptoms and  general psychological distress compared with participants who did not receive the above intervention. Regression analysis for predicting the effect of intervention on the difference between the baseline and follow-up in BDI as well as GHQ scores, found a significant association between intervention and the improvement  in BDI (adjusted beta (SE): -0.53 (2.44); p = 0.000) and GHQ (adjusted beta (SE): -0.52 (1.81); p = 0.001) scores. Suicidal attempts were also significantly less in the intervention group (FET p = 0.02). CONCLUSION: In settings where mental health professionals are limited in number, trained lay volunteers can offer empathetic listening, support and referrals that can be potentially beneficial.

Publication Types:      Controlled Clinical Trial

PMID: 18720890 [PubMed - indexed for MEDLINE]

 

Intensive Care Med. 2008 Jul;34(7):1289-93. Epub 2008 Apr 5.

Neuropsychological function in children following admission to paediatric intensive care: a pilot investigation.

Elison S, Shears D, Nadel S, Sahakian B, Garralda ME.

Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, UK.

OBJECTIVE: Little is known about neuropsychological status following acute severe paediatric illness. This pilot study explored the effects on memory function of severe acute paediatric illness and associations between memory functioning and psychiatric sequelae. DESIGN AND SETTING: Case control study of children after paediatric intensive care unit (PICU) discharge and healthy volunteers. PATIENTS  AND PARTICIPANTS: 16 PICU discharged children comprised of 11 boys and 5 girls (mean age 9.44 +/- 2.85 years) tested a mean of 4.8 +/- 1.4 months following hospital discharge, and 16 age- and sex-matched controls. MEASUREMENTS AND RESULTS: Visual-spatial memory and attention were assessed using the CANTAB battery (visual memory) and verbal memory with the Children Memory Scale; Intelligence Quotient was tested using the Wechsler Abbreviated Scale of Intelligence. Emotional and behavioural function was measured with the Strengths  and Difficulties Questionnaire and Impact of Event Scales. Children admitted to PICU displayed statistically poorer performance on tests of spatial memory (spatial working memory) sustained attention (rapid visual information) and verbal memory (word pairs learning and delayed recognition). Septic illness was specifically associated with poorer pattern recognition memory on the CANTAB. There were significant correlations in the PICU group between cognitive functioning and emotional/behaviour scores. CONCLUSIONS: Our results suggest impaired memory and attention in children following acute severe paediatric illness, a specific deficit in children with septic illness and links between memory anomalies and emotional/behavioural problems. The findings and their clinical significance require replication and clarification in a larger sample.

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

PMID: 18392607 [PubMed - indexed for MEDLINE]

 

Issues Ment Health Nurs. 2008 Jul;29(7):719-37.

From the front lines to the home front: a history of the development of psychiatric nursing in the U.S. during the World War II era.

Silverstein CM.

Summit Center for Ideal Performance, Ramsey, New Jersey, USA.

During World War II, psychiatric nurses learned valuable lessons on how to deal with the traumas of war. Using psychohistorical inquiry, this historian examined  primary and secondary sources, beyond the facts and dates associated with historical events, to understand why and how psychiatric nurse pioneers developed therapeutic techniques to address the psychosocial and physical needs of combatants. Not only is the story told about the hardships endured as nurses ministered to soldiers, but their attitudes, beliefs, and emotions, that is, how  they felt and what they thought about their circumstances, are explored. In this  study the lived experiences of two psychiatric nurses, Votta and Peplau, are contrasted to explicate how knowledge development improved care and how this knowledge had an impact on the home front in nursing practice and education, as well as in mental institutions and society, long after the war was won.

Publication Types:      Biography     Historical Article

Personal Name as Subject:      Votta LS     Peplau H

PMID: 18592423 [PubMed - indexed for MEDLINE]

 

J Affect Disord. 2008 Jul 1. [Epub ahead of print]

Escitalopram: An open-label study of bereavement-related depression and grief.

Hensley PL, Slonimski CK, Uhlenhuth EH, Clayton PJ.

Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States.

BACKGROUND: Approximately 8 million Americans suffer the loss of an immediate family member each year. Chronic depression may develop following bereavement-about 15% of the bereaved are depressed at 1 year. Several studies of psychotropic medications have demonstrated improvement in depression ratings, but little data exists for selective serotonin reuptake inhibitor treatment in bereavement-related depression. METHODS: Thirty adults were treated with escitalopram for 12 weeks in open fashion for a major depressive episode following loss of a close family member (parent, sibling, child, or spouse/significant other). Main outcome measures were the Hamilton Depression Rating Scale, the Montgomery-Asberg Rating Scale, the Texas Revised Inventory of  Grief, and the Inventory of Complicated Grief. RESULTS: Twenty-nine of thirty participants returned for at least one set of efficacy measures after starting medication. Nineteen subjects (66%) experienced a 50% or greater improvement on the Hamilton Depression Scale. Fifteen subjects (52%) achieved remission, defined as a final score of 7 or less on the Hamilton Depression Scale. Escitalopram significantly reduced depressive symptoms (P<0.001) over time. Subjects with uncomplicated grief and those with complicated grief improved similarly over time. Subjects with and without PTSD improved to a similar degree. Escitalopram was well tolerated. LIMITATIONS: Open-label design, psychotherapy was not controlled, relatively short treatment period, variation in grief scales make comparisons to other studies difficult, all subjects with complicated grief also  were clinically depressed, and gender discrepancy of sample. CONCLUSIONS: Escitalopram improved depressive, anxiety, and grief symptoms in individuals experiencing a major depressive episode related to the loss of a loved one.

PMID: 18597854 [PubMed - as supplied by publi sher]

 

J Affect Disord. 2008 Jul;109(1-2):57-63. Epub 2008 Jan 24.

Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness?

Carballo JJ, Harkavy-Friedman J, Burke AK, Sher L, Baca-Garcia E, Sullivan GM, Grunebaum MF, Parsey RV, Mann JJ, Oquendo MA.

Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY 10032, United States.

BACKGROUND: Bipolar disorder (BD) is associated with a high prevalence of suicide attempt and completion. Family history of suicidal behavior and personal history  of childhood abuse are reported risk factors for suicide among BD subjects. METHODS: BD individuals with family history of suicidal behavior and personal history of childhood abuse (BD-BOTH), BD individuals with family history of suicidal behavior or personal history of childhood abuse (BD-ONE), and BD individuals with neither of these two risk factors (BD-NONE) were compared with regard to demographic variables and clinical measures. RESULTS: Almost 70% of the sample had a history of a previous suicide attempt. There were significantly higher rates of previous suicide attempts in the BD-BOTH and BD-ONE relative to the BD-NONE group. BD-BOTH were significantly younger at the time of their first  suicide attempt and had higher number of suicide attempts compared with BD-NONE.  BD-BOTH were significantly younger at the time of their first episode of mood disorder and first psychiatric hospitalization and had significantly higher rates of substance use and borderline personality disorders compared to BD-NONE. LIMITATIONS: Retrospective study. Use of semi-structured interview for the assessment of risk factors. CONCLUSIONS: BD individuals with a familial liability for suicidal behavior and exposed to physical and/or sexual abuse during childhood are at a greater risk to have a more impaired course of bipolar illness and greater suicidality compared to those subjects with either only one or none of these risk factors. Prospective studies are needed to confirm these findings.

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

PMID: 18221790 [PubMed - indexed for MEDLINE]

 

J Affect Disord. 2008 Jul;109(1-2):171-6. Epub 2007 Nov 19.

Non-psychotic psychiatric disorders after childbirth: prevalence and comorbidity  in a community sample.

Navarro P, García-Esteve L, Ascaso C, Aguado J, Gelabert E, Martín-Santos R.

Unit of Perinatal Psychiatry and Gender Research, Hospital Clínic Universitari de Barcelona, Barcelona, Spain. purinavarrogar@yahoo.es

BACKGROUND: Postnatal psychiatric morbidity is a frequent and serious complication of childbirth. The aim of the present study was to determine the prevalence and co-occurrence of DSM-IV psychiatric disorders in a community sample of postpartum Spanish mothers. METHODS: A two-phase cross-sectional study  was conducted in which all consecutive women attending the routine 6-week postnatal control visit at the Department of Obstetric and Gynecology of a university-affiliated hospital over a one year period were included. In the first phase, 1453 women were screened with the Edinburgh Postnatal Depression Scale (EPDS). In the second phase, 428 participants stratified according to employment  status and EPDS outcomes were randomly selected within each stratum for clinical  psychiatric evaluation using the Structured Clinical Interview for DSM-IV. Weighted prevalence estimates were obtained for DSM-IV disorders with or without  comorbidity. RESULTS: The overall 6-week prevalence rate for postpartum psychiatric disorders was 18.1% (95% CI 15.0-21.8) and 2.0% (95% CI 1.2-2.9) of postpartum women met criteria for more than one disorder. Mood disorders was the  most prevalent group (9.8%; 95% CI 7.9-12.1) followed by adjustment disorders (4.3%; 95% CI 3.0-6.3), and anxiety disorders (4%; 95% CI 3.0-6.3). Comorbidity was associated to major depressive disorder. LIMITATIONS: Underestimation of some disorders due to the cross-sectional design and the use of a screening instrument with good psychometric characteristics restricted to depression, anxiety, and adjustment disorders. CONCLUSIONS: In the context of a 6-week postnatal visit, a  high prevalence and heterogeneity of postnatal psychiatric morbidity in a community sample of Spanish women was found.

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

PMID: 18001842 [PubMed - indexed for MEDLINE]

 

J Am Acad Child Adolesc Psychiatry. 2008 Jul;47(7):755-62.

Prevalence and correlates of dating violence in a national sample of adolescents.

Wolitzky-Taylor KB, Ruggiero KJ, Danielson CK, Resnick HS, Hanson RF, Smith DW, Saunders BE, Kilpatrick DG.

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. kwolitzky@mail.utexas.edu

OBJECTIVE: Dating violence is an important but understudied public health concern in adolescents. This study sought to examine the lifetime prevalence of serious forms of dating violence in 12- to 17- year-olds, risk and protective factors associated with dating violence, and the relation between dating violence and mental health. METHOD: A nationally representative sample of adolescents (N = 3,614) completed a telephone-based interview that assessed serious forms of dating violence (i.e., sexual assault, physical assault, and/or drug/alcohol-facilitated rape perpetrated by a girlfriend, boyfriend, or other dating partner). RESULTS: Prevalence of dating violence was 1.6% (2.7% of girls,  0.6% of boys), equating to approximately 400,000 adolescents in the U.S. population. Risk factors included older age, female sex, experience of other potentially traumatic events, and experience of recent life stressors. Findings also suggested that dating violence is associated with posttraumatic stress disorder and major depressive episode after controlling for demographic variables, other traumatic stressors, and stressful events. CONCLUSIONS: These findings indicate that dating violence is a significant public health problem in  adolescent populations that should be addressed through early detection, prevention, and intervention.

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

PMID: 18520962 [PubMed - indexed for MEDLINE]

 

J Am Coll Health. 2008 Jul-Aug;57(1):69-76.

Prevalence, type, disclosure, and severity of adverse life events in college students.

Smyth JM, Hockemeyer JR, Heron KE, Wonderlich SA, Pennebaker JW.

Department of Psychology, Syracuse University, Syracuse, NY 13244, USA. jmsmyth@syr.edu

OBJECTIVE: Some information on the prevalence of adverse life experiences is available for the general population and college students, but the extent, nature, and severity of these events is unclear. PARTICIPANTS: The authors recruited undergraduate college students (N = 6,053) from diverse academic settings (public and private schools) and geographic locations. METHODS: They examined the prevalence, nature, severity, and disclosure of adverse events, in addition to reports of posttraumatic stress disorder (PTSD) symptomatology within the sample. RESULTS: Across multiple studies, prevalence rates of adverse events  ranged from 55.8% to 84.5%, replicating previous findings in larger samples. In a subset of undergraduate students (n = 97) who the authors interviewed in greater  depth, 9% reported symptoms of clinical PTSD and an additional 11% reported subclinical symptoms. CONCLUSIONS: Research using college samples for the study of stressful life events is a useful and reasonable strategy. The authors discuss implications for research, as well as screening and referral services at universities.

PMID: 18682348 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Jul 1. [Epub ahead of print]

Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress  and quality of life.

Kashdan TB, Morina N, Priebe S.

Department of Psychology, George Mason University, MS 3F5, Fairfax, VA 22030, United States.

Few studies have been conducted on psychological disorders other than post-traumatic stress disorder (PTSD) in war survivors. The aim of this study was to examine PTSD, social anxiety disorder (SAD), and major depressive disorder (MDD) and their associations with distress and quality of life in 174 Albanian civilian survivors of the Kosovo War. This included testing of conceptual models  suggesting that experiential avoidance might influence associations between anxiety and mood disorders with psychological functioning. Each of the three psychiatric disorders was associated with greater experiential avoidance and psychological distress, and lower quality of life. Being a refugee was associated with a higher likelihood of having SAD and MDD. We found evidence for experiential avoidance as a partial mediator of the respective effects of SAD and PTSD on quality of life; experiential avoidance did not mediate the effects of disorders on global distress. We also found support for a moderation model showing that only war survivors without SAD and low experiential avoidance reported elevated quality of life; people with either SAD or excessive reliance on experiential avoidance reported compromised, low quality of life. This is the  third independent study, each using a different methodology, to find empirical support for this moderation model [Kashdan, T. B., & Breen, W. E. (2008). Social  anxiety and positive emotions: a prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1-12; Kashdan, T. B., & Steger, M. F. (2006). Expanding the topography of social anxiety: an experience sampling assessment of positive emotions and events, and emotion suppression. Psychological Science, 17, 120-128]. Overall, we provided initial evidence for the importance of addressing  PTSD, SAD, MDD, and experiential avoidance in primarily civilian war survivors.

PMID: 18676121 [PubMed - as supplied by publi sher]

 

J Child Psychol Psychiatry. 2008 Jul;49(7):723-32. Epub 2008 Jul 1.

Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents.

Hodes M, Jagdev D, Chandra N, Cunniff A.

Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK. m.hodes@imperial.ac.uk

BACKGROUND: To investigate the level of posttraumatic stress and depressive symptoms, and background risk and protective factors that might increase or ameliorate this distress amongst unaccompanied asylum-seeking children and adolescents (UASC). METHODS: Cross-sectional survey carried out in London. Participants were 78 UASC aged 13-18 years, predominantly from the Balkans and Africa, compared with 35 accompanied refugee children. Measures included self-report questionnaires of war trauma, posttraumatic stress and depressive symptoms. RESULTS: UASC had experienced high levels of losses and war trauma, and posttraumatic stress symptoms. Predictors of high posttraumatic symptoms included low-support living arrangements, female gender and trauma events, and increasing  age only amongst the UASC. High depressive scores were associated with female gender, and region of origin amongst the UASC. CONCLUSION: UASC might have less psychological distress if offered high-support living arrangements and general support as they approach the age of 18 years, but prospective studies are required to investigate the range of risk and protective factors.

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

PMID: 18492037 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):575-87.

Unwanted intrusive thoughts and cognitive functioning in kindergarten and young elementary school-age children following Hurricane Katrina.

Sprung M.

Department of Psychology, University of Southern Mississippi, USA. Manuel.Sprung@uibk.ac.at

Seven months after Hurricane Katrina, 183 five- to eight-year-old children were surveyed about their own intrusive thoughts and tested on their level of cognitive functioning (knowledge about the mind and the mind's operations). Basic developmental research suggests that children who lack sufficient knowledge about the mind should have difficulties answering questions about intrusive thoughts. Hurricane-affected children reported relatively more intrusive thoughts with negative content than nonaffected children reported. An association between children's level of understanding of the mind and their ability to report on their own intrusive thoughts supports this hypothesis. Results point to a funneling of intrusive thoughts toward negative content following a traumatic event and highlight the importance of considering children's level of understanding of the mind when investigating intrusive thoughts in young children.

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

PMID: 18645748 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):564-74.

Social support, discrimination, and coping as predictors of posttraumatic stress  reactions in youth survivors of Hurricane Katrina.

Pina AA, Villalta IK, Ortiz CD, Gottschall AC, Costa NM, Weems CF.

Department of Psychology, Arizona State University. Tempe, AZ 871104, USA. Armando.Pina@asu.edu

This study examined the influence of aspects of the post-Hurricane Katrina recovery environment (i.e., discrimination, social support) and coping behaviors  on children's posttraumatic stress reactions (symptoms of posttraumatic stress disorder [PTSD], anxiety, and depression). Data corresponding to 46 youth (M = 11.43 years; 39% girls; 33% African American, 67% European American) revealed that greater helpfulness from extrafamilial sources of social support predicted lower levels of child-rated symptoms of PTSD, anxiety, and depression. A positive predictive relation was found between helpfulness from professional support sources and PTSD, perhaps suggesting that parents whose children were experiencing higher PTSD symptom levels sought professional support and reported  it to be helpful. Youths' avoidant coping behaviors predicted both PTSD and anxiety symptoms. Discrimination, active coping, and familial support did not predict any of the posttraumatic stress reactions assessed in this study.

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

PMID: 18645747 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):553-63.

The moderating effects of maternal psychopathology on children's adjustment post-Hurricane Katrina.

Spell AW, Kelley ML, Wang J, Self-Brown S, Davidson KL, Pellegrin A, Palcic JL, Meyer K, Paasch V, Baumeister A.

Louisiana State University, Lafayette, LA70508, USA. aspell@bellsouth.net

This study investigated the role of maternal psychopathology in predicting children's psychological distress in a disaster-exposed sample. Participants consisted of 260 children (ages 8-16) recruited from public schools and their mothers. These families were displaced from New Orleans because of Hurricane Katrina in 2005. Assessment took place 3 to 7 months postdisaster. Hierarchical regression analyses revealed that global maternal psychological distress and maternal posttraumatic stress disorder moderated the relation between child hurricane exposure and mother-reported child internalizing and externalizing symptoms.

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

PMID: 18645746 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):542-52.

PTSD symptoms and somatic complaints following Hurricane Katrina: the roles of trait anxiety and anxiety sensitivity.

Hensley L, Varela RE.

Tulane University, New Orleans, LA 70118, USA.

This study examined the relationships between trait anxiety and anxiety sensitivity and the outcome variables posttraumatic stress disorder (PTSD) symptoms and somatic complaints following a major hurricane. Sixth and seventh graders in the New Orleans area (N = 302) were surveyed 5 to 8 months following Hurricane Katrina. As expected, hurricane exposure was a significant predictor of PTSD symptoms and somatic symptoms. Also as hypothesized, certain factors of anxiety sensitivity interacted with trait anxiety to predict PTSD symptoms and somatic symptoms. Clinical implications of potential linkages among trait anxiety, dimensions of anxiety sensitivity and PTSD, and somatic symptoms are discussed.

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

PMID: 18645745 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):519-29.

Reactive aggression and posttraumatic stress in adolescents affected by Hurricane Katrina.

Marsee MA.

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

The current study tests a theoretical model illustrating a potential pathway to reactive aggression through exposure to a traumatic event (Hurricane Katrina) in  166 adolescents (61% female, 63% Caucasian) recruited from high schools on the Gulf Coast of Mississippi. Results support an association between exposure to Hurricane Katrina and reactive aggression via posttraumatic stress disorder (PTSD) symptoms and poorly regulated emotion. The proposed model fits well for both boys and girls; however, results suggest that minority youth in this sample  were more likely to experience emotional dysregulation in relation to posttraumatic stress than Caucasian youth. Further, results indicate that hurricane exposure, PTSD symptoms, and poorly regulated emotion are associated with reactive aggression even after controlling for proactive aggression. These findings have implications for postdisaster mental health services. Researchers examining mental health problems in youth after a significant disaster have traditionally focused on the presence of internalizing problems such as anxiety,  depression, and posttraumatic stress disorder (PTSD) symptoms, with very little empirical attention paid to the incidence of post-disaster externalizing problems such as aggression. Specific types of aggressive responses, particularly those that involve poorly regulated emotion (i.e., reactive aggression), have been shown to be associated with a history of trauma and thus may be especially common following a traumatic event such as a hurricane.

PMID: 18645743 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):508-18.

Reconsideration of harm's way: onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina.

Scheeringa MS, Zeanah CH.

Department of Psychiatry and Neurology, Institute of Infant and Early Childhood Mental Health, Tulane University, New Orleans, Louisiana 70005, USA. mscheer@tulane.edu

This study examined posttraumatic stress disorder (PTSD) and comorbid disorders in 70 preschool children (ages 3-6) and their caregivers following Hurricane Katrina. Children's rate of PTSD was 50.0% using age-modified criteria. The rate  of PTSD was 62.5% for those who stayed in the city and 43.5% in those who evacuated. Of those with PTSD, 88.6% had at least one comorbid disorder, with oppositional defiant disorder and separation anxiety disorder being most common.  Caregivers' rate of PTSD was 35.6%, of which 47.6% was new post-Katrina. No children and only 2 caregivers developed new non-PTSD disorders in the absence of new PTSD symptoms. Differences by race and gender were largely nonsignificant. Children's new PTSD symptoms correlated more strongly to caregivers with new symptoms compared to caregivers with old or no symptoms.

PMID: 18645742 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):495-507.

Evaluation of individual and group grief and trauma interventions for children post disaster.

Salloum A, Overstreet S.

University of South Florida, School of Social Work, 4202 E. Fowler Avenue, MGY 134, Tampa, FL 33620, USA. asalloum@cas.usf.edu

This study evaluated a community-based grief and trauma intervention for children conducted postdisaster. Fifty six children (7 to 12 years old) who reported moderate to severe levels of symptoms of posttraumatic stress were randomly assigned to group or individual treatment. Treatment consisted of a manualized 10-session grief- and trauma-focused intervention and a parent meeting. Measures  of disaster-related exposure, posttraumatic stress symptoms, depression, traumatic grief, and distress were administered at preintervention, postintervention, and 3 weeks postintervention. There was a significant decrease  in all outcome measures over time, and there were no differences in outcomes between children who participated in group intervention and those who participated in individual intervention. Results suggest that this intervention using either treatment modality may be effective for addressing childhood grief and trauma postdisaster.

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

PMID: 18645741 [PubMed - indexed for MEDLINE]

 

J Clin Child Adolesc Psychol. 2008 Jul;37(3):487-94.

Child and adolescent mental health research in the context of Hurricane Katrina:  an ecological needs-based perspective and introduction to the special section.

Weems CF, Overstreet S.

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

This article introduces the special section on child and adolescent mental health research in the context of Hurricane Katrina. We outline the purpose and intent of the special section and present an integrative perspective based on broad contextual theories of human development with which to think about the impact of  disasters like Katrina. The perspective emphasizes multiple levels of influence on mental health and normal development through the impairment of multiple human  needs. The perspective helps show the interconnections among the diverse theoretical and methodological paradigms that are utilized to understand the impact of disasters on youth and may help to guide future research.

Publication Types:      Introductory Journal Article

PMID: 18645740 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2008 Jul;69(7):1087-91.

Reduced posterior hippocampal volume in posttraumatic stress disorder.

Bonne O, Vythilingam M, Inagaki M, Wood S, Neumeister A, Nugent AC, Snow J, Luckenbaugh DA, Bain EE, Drevets WC, Charney DS.

Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel. bonne@hadassah.org.il

OBJECTIVE: Hippocampal volume is reduced in posttraumatic stress disorder (PTSD). In the present study, we sought to determine whether volume loss is homogenously  distributed or confined to a certain part of the structure. METHOD: Twenty-two adult outpatients with PTSD (11 after prolonged prepubertal trauma and 11 after single adult trauma) and 22 matched healthy subjects were scanned at the National Institute of Mental Health using high-resolution 3T magnetic resonance imaging between September 2003 and August 2004. PTSD diagnosis was conferred using the Structured Clinical Interview for DSM-IV. Volumes of whole, anterior, and posterior hippocampus and subiculum were compared between groups. RESULTS: Total  hippocampal volume was lower in patients with PTSD (p = .02), with a significant  diagnosis by hippocampal-subregion interaction (p = .02). Post hoc analysis revealed significantly smaller posterior hippocampi in PTSD (p = .006), with no difference in the volumes of anterior hippocampus or subiculum. No volume differences were found between PTSD participants with prolonged childhood abuse compared to single adult trauma exposure. CONCLUSIONS: The posterior hippocampus  has been associated with storage, processing, and retrieval of spatiotemporal memories, central to the protective function of fear conditioning. Volume deficit in the posterior hippocampus may indicate malfunction in this faculty, leading to the exaggerated conditioned fear response observed in PTSD.

PMID: 18572983 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2008 Jul;69(7):1033-45.

Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions.

Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF.

Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9304, USA.

OBJECTIVES: To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of narcissistic personality disorder (NPD) among men and women. METHOD: Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States. RESULTS: Prevalence of lifetime NPD was 6.2%, with rates greater for men  (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed  and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality  disorders among men. Dysthymic disorder was significantly and negatively associated with NPD. CONCLUSIONS: NPD is a prevalent personality disorder in the  general U.S. population and is associated with considerable disability among men, whose rates exceed those of women. NPD may not be as stable as previously recognized or described in the DSM-IV. The results highlight the need for further research from numerous perspectives to identify the unique and common genetic and environmental factors underlying the disorder-specific associations with NPD observed in this study.

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

PMID: 18557663 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Jul;64(7):891-904.

The use of symptom severity measured just before termination to predict child treatment dropout.

Chasson GS, Vincent JP, Harris GE.

McLean Hospital, Harvard Medical School, and University of Houston, Belmont, MA 02478, USA. gchasson@gmail.com

The current study examined indices of trauma-related symptom severity as predictors of dropout from exposure-based cognitive behavioral therapy in a sample of 99 child and adolescent trauma victims. The investigation incorporated  measures of symptom severity at two time points: pretreatment and just before termination. The results indicated that a model with symptom severity measured just before termination was significantly associated with the number of attended  sessions; however, a model with the symptom-severity indices measured at pretreatment was nonsignificant. In addition, a significant main effect indicated that increased avoidance behavior measured just before termination was related to fewer treatment sessions. Further analyses also suggested that higher severity of intrusion and depression measured just before termination was correlated with fewer treatment sessions. The results support the idea that more immediate distress may be related to treatment dropout. Implications for the research and practice of exposure therapy for child trauma are discussed. Copyright 2008 Wiley Periodicals, Inc.

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

PMID: 18459120 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Jul;196(7):513-21.

Treatment-seeking veterans of Iraq and Afghanistan: comparison with veterans of previous wars.

Fontana A, Rosenheck R.

New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut, USA. alan.fontana@va.gov

Differences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission. A series of analyses of covariance was used hierachically to control for program site and age. In analyses of contemporaneous veterans uncontrolled for age, Iraq/Afghanistan veterans differed most notably from Vietnam veterans by being younger, more likely to be female, less likely to be either married or separated/divorced, more often working, less likely to have ever been incarcerated, and less likely to report exposure to atrocities in the military. Regarding clinical status, Iraq/Afghanistan veterans were less often diagnosed with substance abuse disorders, manifested more violent behavior, and had lower rates of VA disability compensation because of PTSD. Differences are more muted in comparisons with Persian Gulf veterans, particularly in those involving noncontemporaneous samples, or those that controlled for age differences. Among recent war veterans with PTSD, social functioning has largely been left intact. There is a window of opportunity, therefore, for developing and focusing on treatment interventions that emphasize the preservation of these social assets.

Publication Types:      Comparative Study

PMID: 18626291 [PubMed - indexed for MEDLINE]

 

J Neuropsychiatry Clin Neurosci. 2008 Summer;20(3):309-16.

Cognitive dysfunctions associated with PTSD: evidence from World War II prisoners of war.

Hart J Jr, Kimbrell T, Fauver P, Cherry BJ, Pitcock J, Booe LQ, Tillman G, Freeman TW.

Center for BrainHealth, The University of Texas at Dallas, 2200 W. Mockingbird Lane, Dallas, TX 75235, USA. jhart@utdallas.edu

The authors aim to delineate cognitive dysfunction associated with posttraumatic  stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with  no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD  patients only when they have comorbid psychiatric diagnoses.

PMID: 18806234 [PubMed - in process]

 

J Neuropsychiatry Clin Neurosci. 2008 Summer;20(3):302-8.

Hippocampal and amygdalar volumes in breast cancer survivors with posttraumatic stress disorder.

Hara E, Matsuoka Y, Hakamata Y, Nagamine M, Inagaki M, Imoto S, Murakami K, Kim Y, Uchitomi Y.

Section of Psychiatry and Behavioral Science at Tokyo Medical and Dental University Graduate School, Tokyo.

Although smaller hippocampi and amygdalae were found in cancer survivors with intrusions, associations between cancer-related posttraumatic stress disorder (PTSD) and these volumes are unknown. The authors performed MRI volumetric analyses of these regions in 15 cancer survivors with PTSD, 15 cancer survivors without PTSD, and 15 healthy comparison subjects. The authors also examined the correlation between PTSD symptom scores of the Impact of Event Scale and these volumes in the PTSD group. These volumes were not significantly different among the groups, but the intrusion score was inversely associated with the hippocampal volume. Results suggest intrusions, not PTSD diagnosis, might be associated with  hippocampal volume.

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

PMID: 18806233 [PubMed - in process]

 

J Pain. 2008 Jul;9(7):588-96. Epub 2008 Mar 17.

The relation of post-traumatic stress symptoms to depression and pain in patients with accident-related chronic pain.

Roth RS, Geisser ME, Bates R.

Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan 48108, USA. randyr@umich.edu

Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in patients with a history of accident-related chronic pain and depression. However, little is known regarding the influence of PTSD in contributing to the affective  distress, pain experience, and disability associated with chronic pain in this population. This study used structural equation modeling to examine 3 models that assess these relations in a sample of chronic pain patients with accident-related pain. Subjects were assessed for pain experience, depressive symptoms, anxiety, PTSD symptoms, pain disability, and relevant demographic variables. Pearson correlations indicated that symptoms of depression were significantly related to  more severe pain, disability, and PTSD symptoms. PTSD symptoms were significantly associated with higher disability. The model of best fit indicated that after controlling for the influence of anxiety on the dependent measures, PTSD symptoms have a direct influence on severity of depressive symptoms, whereas depressive symptoms have a direct influence on pain intensity and an indirect impact on pain intensity by way of their effect on disability. These data point to the importance of unresolved PTSD symptoms in contributing to the level of depression, pain, and disability exhibited by chronic pain patients and highlight the need to consider directed and primary treatment of PTSD in pain rehabilitation programs. PERSPECTIVE: This study highlights the impact of symptoms of PTSD on levels of depression, disability, and pain in patients with pain secondary to physical injury. Our results suggest that pain rehabilitation programs provide directed interventions for PTSD symptoms among this population to improve pain treatment outcomes.

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

PMID: 18343728 [PubMed - indexed for MEDLINE]

 

J Psychiatr Pract. 2008 Jul;14(4):199-208.

The applicability of randomized controlled trials of psychosocial treatments for  PTSD to a veteran population.

Stirman SW.

VA Palo Alto Health Care System, Stanford University School of Medicine, Menlo Park, CA, USA. sws@mail.med.upenn.edu

The extent to which the results of randomized controlled trials can be expected to generalize to clinical populations has been the subject of much debate. To examine this issue among a population of individuals diagnosed with posttraumatic stress disorder (PTSD), the clinical characteristics of Veterans Affairs (VA) patients with PTSD were compared to the eligibility criteria for clinical trials  of psychosocial treatments for PTSD. Administrative data for 239,668 patients who received a diagnosis of PTSD within the VA healthcare system during the 2003 fiscal year were compared with inclusion and exclusion criteria of 31 clinical trials for PTSD. Based on available data, all patients appeared to be eligible for at least one study, and half (50%) were eligible for between 16 and 21 (50% or more) of the 31 studies examined. The studies for which the most veterans with PTSD would have been eligible targeted combat-related trauma or did not specify type of trauma in their eligibility criteria. Veterans who exhibited psychotic symptoms (3% of the sample) were ineligible for most, but not all, of the studies. However, most veterans with comorbid Axis I conditions, such as depression, anxiety disorders, and substance use disorders, were eligible for multiple studies. These findings, which indicate that the existing literature on  the efficacy of psychosocial treatment may inform the treatment of the majority of veterans who present with PTSD, have applications for the design of future clinical trials and for consultation of the literature regarding appropriate treatments for veterans with PTSD.

Publication Types:      Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 18664888 [PubMed - indexed for MEDLINE]

 

J Psychiatr Pract. 2008 Jul;14(4):195.

PTSD and Suicide.

Oldham J.

Publication Types:      Editorial     Introductory Journal Article

PMID: 18664887 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Jul;42(9):752-62. Epub 2007 Sep 24.

Magnetic resonance imaging volumes of the hippocampus in drug-naïve patients with post-traumatic stress disorder without comorbidity conditions.

Bossini L, Tavanti M, Calossi S, Lombardelli A, Polizzotto NR, Galli R, Vatti G,  Pieraccini F, Castrogiovanni P.

Department of Neuroscience, University of Siena School of Medicine, Viale Bracci  1, 53100 Siena, Italy. bossini2@unisi.it

Most brain imaging studies have showed smaller hippocampal volume in adults with  chronic PTSD; however, some other studies have not replicated this finding. Most  of these investigations included subjects with other psychiatric comorbidities, such as major depression or alcohol abuse. The prevalence of psychiatric comorbidities in PTSD is generally high and this makes it difficult, if not impossible, to disentangle the contribution of other disorders to hippocampal volume. Therefore, the main goal of the current study is to compare hippocampal volumes of healthy subjects and drug-naïve patients with PTSD caused by different types of mixed civilian traumas (i.e. car accident, physical abuse, sudden death  of a family member, assault or robbery, natural disaster and traumatic abortion)  and without comorbidity conditions. Magnetic resonance imaging (MRI) was used to  measure the hippocampi, total cerebrum, gray matter, white matter and cerebrospinal fluid volumes in 34 patients with single diagnosis of PTSD, and 34  case-matched non-PTSD comparison subjects. The patients with single diagnosis of  PTSD had an 11.8% smaller left hippocampus (p<0.001) and an 8.7% smaller right hippocampus (p=0.003) than the healthy controls. The results were controlled for  the total brain volume and for gray matter volumes. Subjects with PTSD also displayed lower overall gray matter volume (p=0.006). There were no significant correlations between hippocampal volumes and illness duration or severity of PTSD. The findings indicate the presence of smaller hippocampal volumes in drug-naïve patients with single diagnosis of PTSD, compared with healthy subjects.

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

PMID: 17892884 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Jul;42(8):689-93. Epub 2007 Sep 19.

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. cmuhtz@uke.uni-hamburg.de

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 (0.5 mg dexamethasone at 23:00,  100 microg CRH at 15:00). Plasma adenocorticotropic hormone (ACTH), cortisol and  blood pressure were measured every 15 min 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.

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

PMID: 17884095 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Jul;42(8):659-69. Epub 2007 Aug 14.

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. s.g.geuze@umcutrecht.nl

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.

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

PMID: 17698081 [PubMed - indexed for MEDLINE]

 

J Psychohist. 2008 Summer;36(1):72-84.

Traumatized Soldiers.

Fuchsman K.

University of Connecticut, USA. ken.fuchsman@uconn.edu

PMID: 19043999 [PubMed - indexed for MEDLINE]

 

J Psychopharmacol. 2008 Jul;22(5):469-72.

Glutamate and cortisol--a critical confluence in PTSD?

Reul JM, Nutt DJ.

Publication Types:      Editorial

PMID: 18701640 [PubMed - indexed for MEDLINE]

 

J Psychopharmacol. 2008 Jul;22(5):493-7. Epub 2008 Jan 21.

Ketamine aggravates symptoms of acute stress disorder in a naturalistic sample of accident victims.

Schönenberg M, Reichwald U, Domes G, Badke A, Hautzinger M.

Department of Clinical and Developmental Psychology, University of Tübingen, Tübingen, Germany. michael.schoenenberg@uni-tuebingen.de

The glutamatergic N-methyl-D-aspartate receptor antagonist ketamine produces transient dissociative states and alters cognitive functioning in healthy humans, thus resembling the core symptoms of acute and chronic post-traumatic stress disorder (PTSD). First evidence exists that the common use of the analgesic and sedative properties of ketamine during emergency care correlates with sustained symptoms of PTSD in accident victims. The aim of the present study was to examine whether ketamine administration after moderate accidental trauma modulates dissociation and other symptoms of acute stress disorder (ASD) in the direct aftermath of the event. Accident victims were screened within the third day after admission to hospital for symptoms of ASD (Peritraumatic Dissociative Experiences Questionnaire, ASD Scale) and prior stressful life events (Traumatic Life Events  Questionnaire). Subjects had received a single or fractionated dose of either racemic ketamine (n=13), opioids (n=24) or non-opioid analgesics (n=13) during initial emergency treatment. There were no significant differences between medication groups in demographic and clinical characteristics such as injury severity or prior traumatization. With respect to ASD symptomatology three days post-event there were significant associations between ketamine analgosedation and increased symptoms of dissociation, reexperiencing, hyperarousal and avoidance relative to the comparison groups.Growing evidence exists that ketamine might modulate or aggravate early post-traumatic stress reactions when given in the acute trauma phase, which in turn might contribute to long-lasting symptomatology.

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

PMID: 18208917 [PubMed - indexed for MEDLINE]

 

J Psychosom Res. 2008 Jul;65(1):81-6. Epub 2008 May 29.

Is anxiety sensitivity a predictor of PTSD in children and adolescents?

Kiliç EZ, Kiliç C, Yilmaz S.

Department of Child Psychiatry, Medical School, Ankara University, Ankara, Turkey.

OBJECTIVE: Anxiety sensitivity (AS) is the fear of the physical symptoms of anxiety and related symptoms. Longitudinal studies support AS as a vulnerability  factor for development of anxiety disorders. This study aimed to investigate AS as a vulnerability factor in the development of childhood posttraumatic stress disorder (PTSD) following traumatic experiences. METHODS: The study included 81 children 8-15 years of age who experienced the 1999 earthquake in Bolu, Turkey. The earthquake survivors were compared to a randomized group of age- and sex-matched controls 5 years after the earthquake. Both the subject and control groups were administered the Childhood Anxiety Sensitivity Index (CASI), State and Trait Anxiety Inventory for Children (STAI-C), and Child Depression Inventory (CDI), while the PTSD symptoms of the subjects were assessed using the Child Posttraumatic Stress Reaction Index (CPTS-RI). RESULTS: Subjects and controls did not differ significantly in CASI, STAI-C, or CDI scores. Multiple regression analysis showed that both trait anxiety and CASI scores predicted CPTS-RI scores  of the subjects; the prediction by CASI scores was over and above the effect of trait anxiety. CONCLUSION: The results of this study support the hypothesis that  AS may be a constitutional factor, which might increase the risk of PTSD following traumatic experiences.

Publication Types:      Comparative Study

PMID: 18582616 [PubMed - indexed for MEDLINE]

 

J Trauma Nurs. 2008 Jul-Sep;15(3):126-30.

Early detection of posttraumatic stress disorder in children.

McIntosh S, Mata M.

Department of Psychology, Hurley Medical Center, Flint, Michigan 48503, USA.

Surviving trauma patients are at an increased risk for developing posttraumatic stress disorder (PTSD) symptoms. An estimated 1 million American children develop some form (acute, chronic) of PTSD every year. The purpose of this study was to benchmark detection of PTSD in children at our trauma center against the national average and develop a guideline that would identify children who might need referral for screening prior to discharge. A collaborative effort among the trauma, rehabilitation, neuropsychology, and pediatric personnel resulted in a guideline to address early detection of PTSD in children. After implementation of the guideline, there was a 40% increase in detection of PTSD symptoms in identified children who were screened. We conclude that a systematic identification of PTSD triggers increases the detection rate of PTSD and opportunities for screening and intervention.

PMID: 18820561 [PubMed - in process]

 

Mil Med. 2008 Jul;173(7):xi-xiv.

Family's expressed emotion to returning citizen soldiers.

Rabstejnek CV.

PMID: 18700591 [PubMed - indexed for MEDLINE]

 

Nan Fang Yi Ke Da Xue Xue Bao. 2008 Jul;28(7):1114-6.

[Psychological stress in the earthquake survivors: the psychological aftermath of the Wenchuan earthquake]

[Article in Chinese]

Guo Y, Chen AM, Lin HC, Zhao LX.

Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.

OBJECTIVE: To investigate the psychological stress in the survivors of the May 12, 2008 Wenchuan earthquake transferred to Guangzhou for treatment, and explore  the association between the psychological stress and the physical injuries related to the earthquake to promote both the physical and psychological recoveries of the survivors. METHODS: Fifty-five earthquake survivors, including  27 with 28 without physical injuries, were transferred in our hospital 1 week after the earthquake. The Posttraumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C) and the Self Reporting Questionnaire (SRQ) were used to investigate the psychological stress in these survivors. RESULTS: The earthquake  caused serious psychological stress in these survivors, and 43.63% of the survivors had high PCL-C scores (50 or above) and 78.18% had high SRQ scores (over 7), with 41.82% having high scores for both PCL-C and SRQ. The survivors with physical injuries generally had high PCL-C and SRQ scores (49.780-/+14.503 and 12.110-/+4.619, respectively), which, however, were not statistically different from the scores of the survivors without injuries (44.460-/+13.206 and  10.460-/+5.000, respectively, P>0.05). The injured survivors showed high scores for the subscales of persistent avoidance symptoms and of anger and irritability, in which the item scores for "efforts to avoid activities or places that arouse recollections of the earthquake" and "feeling of detachment or estrangement from  others" were significantly different between the survivor with physical injuries  and those without (P=0.034 and 0.018, respectively). CONCLUSION: The Wenchuan earthquake causes serious psychological stress in the survivors, and the wounded  are more inclined to have persistent avoidance symptoms and enhanced irritability. In addition to the care of the physical injuries, psychological counseling and social support may help ameliorate the psychological trauma in the survivors and reduce the incidence of PTSD.

Publication Types:      English Abstract

PMID: 18676240 [PubMed - in process]

 

Nervenarzt. 2008 Jul;79(7):845-54; quiz 855.

[Simple and complex post-traumatic stress disorders. Diagnostic and therapeutic approaches]

[Article in German]

Roestel C, Kersting A.

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 11, 48149 Münster. roestec@mednet.uni-muenster.de

The prevalence rates of post-traumatic stress disorders are high in the general population (5-10%). The main diagnostic criteria include the experience of an event of extraordinary threat and the persistence of specific symptoms such as intrusion, avoidance, and physiological hyperarousal. Long-lasting traumata may lead to the development of complex syndromes or irreversible personality alterations. Chronic manifestations, psychiatric comorbidities, and psychosocial  deficits are special risks in the course of post-traumatic stress disorders. Severe traumata are associated with complex neurobiological changes. Psychotherapeutic approaches are established as a three-stage model: stabilisation, trauma reorientation, and psychosocial reintegration. The additional use of psychotropic drugs should be oriented to the specific symptomatology.

Publication Types:      English Abstract

PMID: 18408907 [PubMed - indexed for MEDLINE]

 

Neurobiol Learn Mem. 2008 Jul;90(1):28-35. Epub 2008 Mar 7.

Systemic inhibition of mammalian target of rapamycin inhibits fear memory reconsolidation.

Blundell J, Kouser M, Powell CM.

Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8813, USA.

BACKGROUND: Established traumatic memories have a selective vulnerability to pharmacologic interventions following their reactivation that can decrease subsequent memory recall. This vulnerable period following memory reactivation is termed reconsolidation. The pharmacology of traumatic memory reconsolidation has  not been fully characterized despite its potential as a therapeutic target for established, acquired anxiety disorders including posttraumatic stress disorder (PTSD). The mammalian target of rapamycin (mTOR) kinase is a critical regulator of mRNA translation and is known to be involved in various forms of synaptic plasticity and memory consolidation. We have examined the role of mTOR in traumatic memory reconsolidation. METHODS: Male C57BL/6 mice were injected systemically with the mTOR inhibitor rapamycin (1-40mg/kg), at various time points relative to contextual fear conditioning training or fear memory retrieval, and compared to vehicle or anisomycin-treated groups (N=10-12 in each  group). RESULTS: Inhibition of mTOR via systemic administration of rapamycin blocks reconsolidation of an established fear memory in a lasting manner. This effect is specific to reconsolidation as a series of additional experiments make  an effect on memory extinction unlikely. CONCLUSIONS: Systemic rapamycin, in conjunction with therapeutic traumatic memory reactivation, can decrease the emotional strength of an established traumatic memory. This finding not only establishes mTOR regulation of protein translation in the reconsolidation phase of traumatic memory, but also implicates a novel, FDA-approved drug treatment for patients suffering from acquired anxiety disorders such as PTSD and specific phobia.

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

PMID: 18316213 [PubMed - indexed for MEDLINE]

 

Neuroimage. 2008 Jul 1;41(3):675-81. Epub 2008 Mar 20.

Thinner prefrontal cortex in veterans with posttraumatic stress disorder.

Geuze E, Westenberg HG, Heinecke A, de Kloet CS, Goebel R, Vermetten E.

Research Centre, Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands. s.g.geuze@umcutrecht.nl <s.g.geuze@umcutrecht.nl>

Structural neuroimaging studies in posttraumatic stress disorder (PTSD) have focused primarily on structural alterations in the medial temporal lobe, and only a few have examined grey matter reductions in the cortex. Recent advances in computational analysis provide new opportunities to use semi-automatic techniques to determine cortical thickness, but these techniques have not yet been applied in PTSD. Twenty-five male veterans with PTSD and twenty-five male veterans without PTSD matched for age, year and region of deployment were recruited. All the subjects were scanned using MRI. Subjects' brains were aligned using cortex-based alignment in a region of interest based approach. Individual cortical thickness maps were calculated from the MR images. Regions of interest examined included the bilateral superior frontal gyri, bilateral middle frontal gyri, bilateral inferior frontal gyri, bilateral superior temporal gyri, and bilateral middle temporal gyri. In a large number of patients and controls, IQ scores and memory scores were also obtained. Individual cortical thickness maps were calculated from the MR images. Veterans with PTSD revealed reduced cortical  thickness in the bilateral superior and middle frontal gyri, the left inferior frontal gyrus, and the left superior temporal gyrus. Veterans with PTSD performed significantly worse on memory measures compared to control veterans. Cortical thickness correlated with memory measures in the veterans without PTSD, but not in the veterans with PTSD. Cortical thinning in these regions may thus correspond to functional abnormalities observed in patients with PTSD.

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

PMID: 18445532 [PubMed - indexed for MEDLINE]

 

Nicotine Tob Res. 2008 Jul;10(7):1149-57.

Ad lib smoking in post-traumatic stress disorder: an electronic diary study.

Beckham JC, Wiley MT, Miller SC, Dennis MF, Wilson SM, McClernon FJ, Calhoun PS.

Durham Veterans Administration Medical Center, Durham, NC 27705, USA. beckham@duke.edu

Using ambulatory methods for 1 week of monitoring, this study investigated the association between smoking and situational cues in 22 smokers with post-traumatic stress disorder (PTSD) and 23 smokers without PTSD. Generalized estimating equations contrasted 1,759 smoking and 1,088 nonsmoking situations by  group status controlling for multiple covariates. PTSD smokers reported higher stress and PTSD symptoms across daily activities. For all smokers, higher nicotine dependence, craving, food and caffeine consumption, and being outside were related to smoking. PTSD smokers were more likely to smoke when experiencing PTSD symptoms, anxiety, and stress. Following smoking, smokers with PTSD reported a significant reduction in negative affect. These results are consistent with previous ambulatory findings regarding mood in smokers, and underscore that in smokers with PTSD, PTSD symptom variables as well as stress and anxiety are significantly associated with ad lib smoking.

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

PMID: 18629724 [PubMed - indexed for MEDLINE]

 

Perspect Psychiatr Care. 2008 Jul;44(3):211-5.

Perspectives in psychiatric consultation liaison nursing. Care of the wounded soldier by a PCLN team.

Carroll DW.

Brooke Army Medical Center, Fort Sam Houston, TX, USA. david.carroll@amedd.army.mil

PMID: 18577128 [PubMed - indexed for MEDLINE]

 

Perspect Psychiatr Care. 2008 Jul;44(3):146-58.

Combat stress casualties in Iraq. Part 1: behavioral health consultation at an expeditionary medical group.

Peterson AL, Baker MT, McCarthy KR.

Department of Psychiatry, University of Texas Health Science Center, and Center for Clinical Health Psychology Research, Wilford Hall Medical Center, San Antonio, TX, USA. petersona3@uthscsa.edu

PURPOSE: We review the role of military mental health professionals in consulting with inpatient medical patients and staff at a combat hospital and aeromedical evacuation staging facility in Iraq. CONCLUSIONS: Behavioral health consultation  with medical and surgical patients during hospitalization and prior to aeromedical evacuation can help identify patients with combat stress exposure that may require future mental health follow-up. PRACTICE IMPLICATIONS: Extensive use of civilian mental health practitioners including nurse psychotherapists and  psychiatric nurse practitioners will be needed to provide psychiatric care for the large number of U.S. veterans who return from deployment with combat stress related disorders.

Publication Types:      Case Reports     Review

PMID: 18577120 [PubMed - indexed for MEDLINE]

 

Perspect Psychiatr Care. 2008 Jul;44(3):143-5.

The aftermath of war: spiritual distress.

Paquette M.

Publication Types:      Editorial     Introductory Journal Article

PMID: 18577119 [PubMed - indexed for MEDLINE]

 

Prehosp Disaster Med. 2008 Jul-Aug;23(4):322-7.

Understanding the health of refugee women in host countries: lessons from the Kosovar re-settlement in Canada.

Redwood-Campbell L, Thind H, Howard M, Koteles J, Fowler N, Kaczorowski J.

Department of Family Medicine, McMaster University, Hamilton, Ontario Canada. redwood@mcmaster.ca

INTRODUCTION: Refugees from Kosovo arrived in several Canadian cities after humanitarian evacuations in 1999. Approximately 500 arrived in Hamilton, Canada.  Volunteer sponsors from community organizations assisted the families with settlement, which included providing them access to healthcare services. HYPOTHESIS/PROBLEM: It was anticipated that women, in particular, would have unmet health needs relating to trauma and a lack of healthcare access after experiencing forced migration. METHODS: This study describes the results of a self-administered survey regarding women's health issues and experiences with health services after the arrival of refugees. It also describes the sponsor group's experience related to women's health care. The survey was administered to a random sample of 85 women refugees, and focus groups with 14 sponsors. Women self-completed questionnaires about their health, which included the Harvard Trauma Questionnaire for post-traumatic stress disorder (PTSD) and use of preventive health services. Sponsor groups participated in a focus group discussing healthcare needs and experiences of their assigned refugee families. Themes pertaining to women's issues were identified from the focus groups. RESULTS: Preventive screening rates were low, only 1/19 (5.3%) women > or = 50-years-old had ever received a mammogram; 34.1% (28/82) had ever received a Pap test); and PTSD was prevalent (25.9%, 22/85). Sponsor groups identified challenges relating to prenatal care needs, finding family physicians, language barriers to health care services, cultural influences ofwomen's healthcare decision-making, mental health concerns, and difficulties accessing dental care,  eye care, and prescriptions. CONCLUSIONS: Many women refugees from Kosovo had unmet health needs. Culturally appropriate population level screening campaigns and integration of language and interpretation services into the healthcare sector on a permanent basis are important policy actions to be adequately prepared for newcomers and women in displaced situations. These needs should be anticipated during the evacuation period by host countries to aid in planning the provision of health resources more efficiently for refugees and displaced people  going to host countries.

PMID: 18935946 [PubMed - indexed for MEDLINE]

 

Prehosp Disaster Med. 2008 Jul-Aug;23(4):314-21.

Building integrated mental health and medical programs for vulnerable populations post-disaster: connecting children and families to a medical home.

Madrid PA, Sinclair H, Bankston AQ, Overholt S, Brito A, Domnitz R, Grant R.

National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University, New York, New York 10032, USA. pam2109@columbia.edu

INTRODUCTION: Hurricane Katrina, a Category 3 hurricane, made landfall in August  2005. Approximately 1,500 deaths have been directly attributed to the hurricane,  primarily in Louisiana and Mississippi. In New Orleans, Louisiana, most of the healthcare infrastructure was destroyed by flooding, and > 200,000 residents became homeless. Many of these internally displaced persons received transitional housing in trailer parks ("villages") under the auspices of the [US] Federal Emergency Management Agency (FEMA). PROBLEM: The FEMA villages are isolated from  residential communities, lack access to healthcare services, and have become unsafe environments. The trailers that house families have been found to be contaminated with formaldehyde. METHODS: The Children's Health Fund, in partnership with the Mailman School of Public Health at Columbia University, began a program ("Operation Assist") to provide health and mental health services within a medical home model. This program includes the Baton Rouge Children's Health Project (BRCHP), which consists of two mobile medical units (one medical and one mental health). Licensed professionals at the FEMA villages and other isolated communities provide care on these mobile units. Medical and psychiatric  diagnoses from the BRCHP are summarized and case vignettes presented. RESULTS: Immediately after the hurricane, prescription medications were difficult to obtain. Complaints of headache, nosebleeds, and stomachache were observed at an unusually frequent degree for young children, and were potentially attributable to formaldehyde exposure. Dermatological conditions included eczema, impetigo, methicillin-resistant staphylococcus aureus (MRSA) abscesses, and tinea corporis  and capitis. These were especially difficult to treat because of unhygienic conditions in the trailers and ongoing formaldehyde exposure. Signs of pediatric  under-nutrition included anemia, failure to thrive, and obesity. Utilization of initial mental health services was low due to pressing survival needs and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. CONCLUSIONS: There is a critical and long-term need for medical and mental health services among affected populations  following a disaster due to natural hazards. Most patients required both medical  and mental health care, which underscores the value of co-locating these services.

PMID: 18935945 [PubMed - indexed for MEDLINE]

 

Psychiatry. 2008 Summer;71(2):134-68.

Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations.

Schottenbauer MA, Glass CR, Arnkoff DB, Tendick V, Gray SH.

Department of Psychology, The Catholic University of America, Washington, DC, USA. ms713249@gmail.com

Post-traumatic stress disorder (PTSD) represents a frequent consequence of a variety of extreme psychological stressors. Lists of empirically supported treatments for PTSD usually include cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), but nonresponse and dropout rates in these treatments often are high. We review the treatment dropout and nonresponse rates in 55 studies of empirically supported treatments for PTSD, review the literature for predictors of dropout and nonresponse, discuss methodological inconsistencies in the literature that make comparisons across studies difficult, and outline future directions for research. Dropout rates ranged widely and may have depended, at least in part, on the nature of the study population. It was not uncommon to find nonresponse rates as high as 50%. Standard methods of reporting dropout and nonresponse rates are needed for reporting outcomes. We suggest guidelines for collecting data to help identify characteristics and predictors of dropouts and nonresponders.

Publication Types:      Review

PMID: 18573035 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2008 Jul;70(6):668-76. Epub 2008 Jul 2.

A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention.

Boscarino JA.

Center for Health Research, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA 17822, USA. jaboscarino@geisinger.edu

OBJECTIVE: To examine prospectively early-age heart disease (HD) among a national random sample of 4328 male Vietnam veterans, who did not have HD at baseline in 1985. Studies have suggested that posttraumatic stress disorder (PTSD) may result in cardiovascular disease. However, many past studies had important methodological limitations to their designs. METHOD: Using Cox regressions, we assessed PTSD, age, race, intelligence, family history, obesity, smoking, alcohol abuse, antisocial personality, and depression in predicting HD mortality at follow-up in December 31, 2000. The men were <65 years old at follow-up. RESULTS: Using two PTSD measures, a Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III) measure (D-PTSD) and one developed by Keane (K-PTSD), we found that among Vietnam theater and era veterans combined (era veterans had no Vietnam service), having PTSD was associated with HD mortality for D-PTSD (hazard ratio (HR) = 2.25, p = .045) and approached significance for K-PTSD (HR = 2.16, p = .066). However, having higher PTSD symptoms on either scale was associated with mortality, with a 5-point increase associated with approximately 20% increase in  mortality risk (all p < .05). Controlling for lifetime depression only slightly altered the results. The effects for theater veterans alone were stronger (D-PTSD: HR = 2.58, p = .025; K-PTSD: HR = 2.73, p = .022). Among theater veterans, controlling for lifetime depression or combat exposure made little difference. CONCLUSION: PTSD was prospectively associated with HD mortality among veterans free of HD at baseline. This study suggests that early-age HD may be an  outcome after military service among PTSD-positive veterans.

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

PMID: 18596248 [PubMed - indexed for MEDLINE]

 

Soc Sci Med. 2008 Jul;67(2):238-52. Epub 2008 May 28.

Abortion and anxiety: what's the relationship?

Steinberg JR, Russo NF.

Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, United  States. steinberg.julia@gmail.com

Using data from the United States National Survey of Family Growth (NSFG) and the National Comorbidity Survey (NCS), we conducted secondary data analyses to examine the relationship of abortion, including multiple abortions, to anxiety after first pregnancy outcome in two studies. First, when analyzing the NSFG, we  found that pre-pregnancy anxiety symptoms, rape history, age at first pregnancy outcome (abortion vs. delivery), race, marital status, income, education, subsequent abortions, and subsequent deliveries accounted for a significant association initially found between first pregnancy outcome and experiencing subsequent anxiety symptoms. We then tested the relationship of abortion to clinically diagnosed generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social anxiety disorder, using NCS data. Contrary to findings from our analyses of the NSFG, in the NCS analyses we did not find a significant relationship between first pregnancy outcome and subsequent rates of  GAD, social anxiety, or PTSD. However, multiple abortions were found to be associated with much higher rates of PTSD and social anxiety; this relationship was largely explained by pre-pregnancy mental health disorders and their association with higher rates of violence. Researchers and clinicians need to learn more about the relations of violence exposure, mental health, and pregnancy outcome to avoid attributing poor mental health solely to pregnancy outcomes.

PMID: 18468755 [PubMed - indexed for MEDLINE]

 

Soc Sci Med. 2008 Jul;67(2):218-27. Epub 2008 Apr 29.

Debating war-trauma and post-traumatic stress disorder (PTSD) in an interdisciplinary arena.

Kienzler H.

Anthropology, McGill University, 855 Sherbrooke Street West, Room 717, Montreal,  Quebec, Canada. hanna.kienzler@mail.mcgill.ca

Researchers have tried to determine and verify the effects of violent conflicts on the mental health of those affected by focusing on war trauma, posttraumatic stress disorder (PTSD), and other trauma-related disorders. This, in turn, led to the development of different kinds of theories and aid programs that aim at preventing and treating the consequences of violence and mental health. Until now, there is no agreement on the public health value of the concept of PTSD and  no agreement on the appropriate type of mental-health care. Instead, psychiatrists have engaged in sometimes fierce discussions over the universality  of war trauma, PTSD, and other trauma-related disorders. The two most polar positions are those who try to validate PTSD as a universal and cross-culturally  valid psychopathological response to traumatic distress which may be cured or ameliorated with (Western) clinical and psychosocial therapeutic measures, and those who argue that the Western discourse on trauma only makes sense in the context of a particular cultural and moral framework and, therefore, becomes problematic in the context of other cultural and social settings. Although these  positions seem mutually exclusive, their debates have led to the development of less radical approaches toward war-trauma and PTSD. The purpose of this literature review is to analyse the discourses on and debates over war-trauma and PTSD in the psychiatric literature in order to establish a better understanding for the diverse conceptualizations, interpretations and proposed healing strategies. Moreover, I discuss the cultural construction and conceptualization of war-trauma and PTSD from an anthropological perspective and show how anthropologists contribute to psychiatric debates so as to ensure more sophisticated diagnoses and healing strategies in culturally diverse contexts.

Publication Types:      Review

PMID: 18450348 [PubMed - indexed for MEDLINE]

 

Soc Sci Med. 2008 Jul;67(2):205-17. Epub 2008 Apr 16.

The sequelae of political violence: assessing trauma, suffering and dislocation in the Peruvian highlands.

Pedersen D, Tremblay J, Errázuriz C, Gamarra J.

McGill University, 6875 LaSalle Boulevard, Montreal, Quebec, Canada. duncan.pedersen@mcgill.ca

In this article, we begin with a qualitative mapping of the multiple ways indigenous peoples in the Peruvian highlands construct their emotions, symptoms and specific disorders when confronted with an adverse environment of sustained political violence, multiple stressors and massive exposure to traumatic experiences. Second, we address the issue of magnitude (point prevalence) and distribution of mental health problems such as depression and anxiety, and sequelae of exposure to violence-related stressors as reported in the selected populations, by reviewing the quantitative results of a cross-sectional survey. Third, we examine the pathways and linkages between the social context (drawn from ethnography and secondary sources) and the collective experience, such as massive exodus, forced displacement, resilience and accommodation strategies for  coping and survival. When assessing the overall mental health impact of exposure  to protracted forms of extreme violence in civilian populations, we argue for the need to move beyond the limited notion of post-traumatic stress disorder, which is a useful but restrictive medical category failing to encompass the myriad of signals of distress, suffering and affliction, as well as other culture bound trauma-related disorders and long-term sequelae of traumatic experiences. Lastly, following the concluding remarks, we discuss some implications the results of the study may have at various levels, not only for the victims and survivors of massive exposure to traumatic events, but also their families and communities, as well as for interventions carried out by humanitarian and emergency relief organizations, and specialised agencies engaged in the promotion of social justice, prevention of human rights abuses, and mental health rehabilitation programs at both national and international levels.

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

PMID: 18423959 [PubMed - indexed for MEDLINE]

 

Subst Use Misuse. 2008 Jul;43(8-9):1202-17.

Drug dependence and associated risks among female street-based sex workers in the greater Sydney area, Australia.

Roxburgh A, Degenhardt L, Copeland J, Larance B.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia. a.roxburgh@unsw.edu

BACKGROUND: This study examines drug use and dependence and associated risks among female street-based sex workers. METHODS: Cross-sectional data collected from 72 women between April and August 2005 in Sydney, Australia, via face-to-face interviews. SAMPLE: The average age was 34 years. RESULTS: Risk factors associated with developing problematic drug use were prevalent. Child sexual abuse, leaving home before the age of 16, and exposure to multiple traumas was common. Depression and posttraumatic stress disorder were also prevalent. A substantial minority reported cocaine dependence which was associated with engaging in sex and injecting risk behaviors. CONCLUSIONS: More targeted interventions for this group are needed. Research on the value of extending existing outreach services to further reduce the harms associated with sex work and drug use is indicated. The study's limitations are noted.

Publication Types:      Comparative Study

PMID: 18649239 [PubMed - indexed for MEDLINE]

 

Trauma Violence Abuse. 2008 Jul;9(3):131-43.

My back pages: reflections on thirty years of domestic violence research.

Dutton DG.

University of British Columbia.

Publication Types:      Review

PMID: 18541698 [PubMed - indexed for MEDLINE]

 

Turk Psikiyatri Derg. 2008 Summer;19(2):113-23.

[Health services use for earthquake-related psychological problems: results from  the 1999 earthquakes in Turkey]

[Article in Turkish]

Kiliç C.

Hacettepe U Tip Fak., Psikiyatri AD., Ankara. cengiz.kilic@superonline.com

OBJECTIVE: Although psychological disorders after traumas are associated with increased rates of services use, the majority of traumatized people do not receive psychological help. This study reports on the health services use of the  survivors of the 1999 earthquake in Turkey. METHOD: A random sample of 2007 survivors was assessed in two sites, using self-report measures of traumatic stress, depression and use of health services. RESULTS: Less than half (42%) of those with a post-earthquake psychological problem (13.7% of the total sample) reported contacting services after the earthquake. Health services use for psychological problems was predicted by past psychiatric illness, depressive complaints after the earthquake and material loss, but not by demographic variables or traumatic stress symptoms. CONCLUSION: The results show that earthquake survivors who need treatment might not be receiving it. They also show the importance of outreach programs in post-disaster circumstances.

Publication Types:      English Abstract

PMID: 18561043 [PubMed - indexed for MEDLINE]

 

Zh Vyssh Nerv Deiat Im I P Pavlova. 2008 Jul-Aug;58(4):486-92.

[The anxyolytic effect of mild hypobaric hypoxia in a model of post-traumatic stress disorder in rats]

[Article in Russian]

Rybnikova EA, Mironova VI, Tiul'kova EI, Samoĭlov MO.

The impact of mild hypobaric hypoxia on the development of anxiety-like state in  rats in experimentally simulated human post-traumatic stress disorder was studied. Three-trial exposure to mild hypobaric hypoxia (360 mm Hg for 2 hours daily, for 3 days) in preconditioning or post-conditioning mode performed, respectively, before or after exposure to severe traumatic stress in the "stress-restress" model produced a significant anxiolytic effect on the rat open-field and plus-maze behavior. Anxiolytic effect of modem antidepressant Paxil (20 mg/kg daily, for 3 days) was weaker. This drug produced side-effects on particular behavioral characteristics in the open field. The conclusion was made  on the efficacy of mild hypobaric hypoxia and the possibility of its implementation as a medication-free tool for prophylaxis and correction of post-traumatic stress disorder.

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

PMID: 18825947 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 Jun 30;159(3):376-81. Epub 2008 May 6.

A short DSM-IV screening scale to detect posttraumatic stress disorder after a natural disaster in a Chinese population.

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

School of Public Health, Central South University, Xiangya Road 110, Changsha, Hunan 410078, PR China. Liu_aizhong@hotmail.com

The objective of the study was to construct a short screening scale for posttraumatic stress disorder (PTSD). We used data from our previous study on PTSD among flood victims in 1998 and 1999 in Hunan, China, which was a representative population sample of 27,267 subjects from 16 to 94 years old. Multistage sampling was used to select the subjects from the flood areas and PTSD was ascertained with the Diagnostic and Statistical Manual of Mental Disorders: 4th Edition (DSM-IV). We randomly assigned 80% (n=21,762) of study subjects to construct the screening scale (construct model) and the remaining 20% (n=5505) to test the model. Logistic regression analysis and receiver operating characteristic analysis were used to select a subset of items (symptoms) from the full scale that would effectively predict PTSD. A seven-symptom screening scale for PTSD was selected. A score of 3 or more on this scale was used to define positive cases of PTSD, with a sensitivity of 87.9%, specificity of 97.9%, positive predictive value of 81.3%, and negative predictive value of 98.7%. The short screening scale developed in this study is highly valid, reliable, and predictable. It is an efficient tool to screen PTSD in epidemiological and clinical studies.

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

PMID: 18462805 [PubMed - indexed for MEDLINE]

 

Yonsei Med J. 2008 Jun 30;49(3):372-82.

Symptoms of posttraumatic stress disorder and mental health in women who escaped  prostitution and helping activists in shelters.

Jung YE, Song JM, Chong J, Seo HJ, Chae JH.

Department of Psychiatry, The Catholic University of Korea, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea.

PURPOSE: This study compared the mental symptoms, especially symptoms of posttraumatic stress disorder (PTSD), of women who escaped prostitution, helping  activists at shelters, and matched control subjects. MATERIALS AND METHODS: We assessed 113 female ex-prostitutes who had been living at a shelter, 81 helping activists, and 65 control subjects using self-reporting questionnaires on demographic data, symptoms related to trauma and PTSD, stress-related reactions,  and other mental health factors. RESULTS: Female ex-prostitutes had significantly higher stress response, somatization, depression, fatigue, frustration, sleep, smoking and alcohol problems, and more frequent and serious PTSD symptoms than the other 2 groups. Helping activists also had significantly higher tension, sleep and smoking problems, and more frequent and serious PTSD symptoms than control subjects. CONCLUSION: These findings show that engagement in prostitution may increase the risks of exposure to violence, which may psychologically traumatize not only the prostitutes themselves but also the people who help them, and that the effects of the trauma last for a long time. Future research is needed to develop a method to assess specific factors that may contribute to vicarious trauma of prostitution, and protect field workers of prostitute victims from vicarious trauma.

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

PMID: 18581585 [PubMed - indexed for MEDLINE]

 

J Affect Disord. 2008 Jun 18. [Epub ahead of print]

Patterns of hospitalisation for depressive and anxiety disorders across the lifespan in Australia.

Draper B, Low LF.

School of Psychiatry, University of NSW, Sydney, Australia.

BACKGROUND: Hospitalisation rates for anxiety and depressive disorders vary with  age and sex but there are few detailed analyses. METHODS: Specialist psychiatric  hospital separation data compiled by the Australian Institute of Health and Welfare in the National Hospital Morbidity Database from 1998/99-2004/5 were analysed for the principal psychiatric diagnoses of depressive disorders and neurotic, stress related and somatoform disorders. Separation rates were calculated by age, year and sex using population data linearly extrapolated from  Australian censuses. RESULTS: The average annual rate of specialised psychiatric  separations for all depressive disorders was 2.61 per 1000 for men, 4.77 for women. The highest separation rates for depression occurred in men aged 75-79 years. Severe depression without psychosis separations peaked in women in midlife. Psychotic depression separations peaked in late life. The average annual rate of separations for neurotic, stress related and somatoform disorder was 2.08 per 1000 for men, 1.96 for women. In women rates declined with age but in men rates peaked between ages 50 and 60 years due to PTSD. The average length of stay for depressive and anxiety disorders increased with age. LIMITATIONS: Accuracy of data collection by clinicians and coding by medical records staff is unknown. CONCLUSIONS: Planning for hospital services should take into account that separation rates for depressive and anxiety disorders vary with age, sex and type of disorder.

PMID: 18571242 [PubMed - as supplied by publi sher]

 

BMC Health Serv Res. 2008 Jun 17;8:132.

Study protocol: the Intensive Care Outcome Network ('ICON') study.

Griffiths JA, Morgan K, Barber VS, Young JD.

ICS Trials Group, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. drjgriffiths@yahoo.co.uk

BACKGROUND: Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined. METHODS/DESIGN: The ICON (Intensive Care Outcome Network) study is a multi-centre, longitudinal study of survivors of critical illness. Patients will be recruited prior to hospital discharge from 20-30 ICUs in the UK and will be assessed at 3, 6, and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 (SF-36) and the EuroQoL (EQ-5D); anxiety and depression as measured by the Hospital Anxiety and Depression Scale (HADS); and post traumatic stress disorder (PTSD) symptoms as measured by the PTSD Civilian Checklist (PCL-C). Postal questionnaires will be used. DISCUSSION: The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also inform economic modelling of the long-term burden of critical illness. TRIAL REGISTRATION: ISRCTN69112866.

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

PMID: 18559099 [PubMed - indexed for MEDLINE]

 

Time. 2008 Jun 16;171(24):38-42.

America's medicated Army.

Thompson M.

Publication Types:      News

PMID: 18605261 [PubMed - indexed for MEDLINE]

 

Am J Epidemiol. 2008 Jun 15;167(12):1446-52. Epub 2008 Apr 17.

Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive  symptoms and posttraumatic stress disorder.

Schneiderman AI, Braver ER, Kang HK.

War-Related Illness and Injury Study Center, Washington DC VA Medical Center, Washington, DC 20422, USA. aaron.schneiderman@va.gov

A cross-sectional study of military personnel following deployment to conflicts in Iraq or Afghanistan ascertained histories of combat theater injury mechanisms  and mild traumatic brain injury (TBI) and current prevalence of posttraumatic stress disorder (PTSD) and postconcussive symptoms. Associations among injuries,  PTSD, and postconcussive symptoms were explored. In February 2005, a postal survey was sent to Iraq/Afghanistan veterans who had left combat theaters by September 2004 and lived in Maryland; Washington, DC; northern Virginia; and eastern West Virginia. Immediate neurologic symptoms postinjury were used to identify mild TBI. Adjusted prevalence ratios and 95% confidence intervals were computed by using Poisson regression. About 12% of 2,235 respondents reported a history consistent with mild TBI, and 11% screened positive for PTSD. Mild TBI history was common among veterans injured by bullets/shrapnel, blasts, motor vehicle crashes, air/water transport, and falls. Factors associated with PTSD included reporting multiple injury mechanisms (prevalence ratio = 3.71 for three  or more mechanisms, 95% confidence interval: 2.23, 6.19) and combat mild TBI (prevalence ratio = 2.37, 95% confidence interval: 1.72, 3.28). The strongest factor associated with postconcussive symptoms was PTSD, even after overlapping symptoms were removed from the PTSD score (prevalence ratio = 3.79, 95% confidence interval: 2.57, 5.59).

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

PMID: 18424429 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2008 Jun 15;63(12):1147-54. Epub 2008 Mar 12.

Childhood parental loss and adult hypothalamic-pituitary-adrenal function.

Tyrka AR, Wier L, Price LH, Ross N, Anderson GM, Wilkinson CW, Carpenter LL.

Mood Disorders Research Program, Laboratory for Clinical Neuroscience, Butler Hospital, Providence, Rhode Island 02906, USA. Audrey_Tyrka@Brown.edu

BACKGROUND: Several decades of research link childhood parental loss with risk for major depression and other forms of psychopathology. A large body of preclinical work on maternal separation and some recent studies of humans with childhood parental loss have demonstrated alterations of hypothalamic-pituitary-adrenal (HPA) axis function that could predispose to the development of psychiatric disorders. METHODS: Eighty-eight healthy adults with no current Axis I psychiatric disorder participated in this study. Forty-four participants experienced parental loss during childhood, including 19 with a history of parental death and 25 with a history of prolonged parental separation. The loss group was compared with a matched group of individuals who reported no history of childhood parental separation or childhood maltreatment. Participants  completed diagnostic interviews and questionnaires and the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test. Repeated measures general linear models were used to test the effects of parental loss, parental care, gender, and age on the hormone responses to the Dex/CRH test. RESULTS: Parental loss was associated with increased cortisol responses to the test, particularly in men. The effect of loss was moderated by levels of parental care; participants with parental desertion and very low levels of care had attenuated cortisol responses. Adrenocorticotropic hormone responses to the Dex/CRH test did not differ significantly as a function of parental loss. CONCLUSIONS: These findings are consistent with the hypothesis that early parental loss induces enduring changes in neuroendocrine function.

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: 18339361 [PubMed - indexed for MEDLINE]

 

Am J Med Genet B Neuropsychiatr Genet. 2008 Jun 13. [Epub ahead of print]

Mood and anxiety disorders in females with the FMR1 premutation.

Roberts JE, Bailey DB Jr, Mankowski J, Ford A, Sideris J, Weisenfeld LA, Heath TM, Golden RN.

FPG Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Fragile X syndrome (FXS) is a model for studying the relative contributions of genetic and environmental factors to psychiatric disorders in mothers of children with disabilities. Here, we examine the frequency and predictors of mood and anxiety disorders in mothers with the FMR1 premutation. Ninety-three females with the FMR1 premutation were in the study and were compared to 2,159 women from the  National Comorbidity Survey Replication (NCS-R) dataset. Mood and anxiety disorders were assessed using the SCID-I. Our data reflect elevated lifetime major depressive disorder (MDD), lifetime panic disorder without agoraphobia and  current agoraphobia without panic disorder in the FMR1 premutation sample. Also,  we found a low frequency of lifetime social phobia, specific phobia, and post-traumatic stress disorders and current specific phobia in the FMR1 premutation sample. The profile of MDD in the FMR1 premutation sample was not episodic or comorbid with an anxiety disorder, as in the NCS-R dataset. Never having been married and smaller CGG repeat length were associated with increased  likelihood of MDD while increased children with FXS in the family and greater child problem behaviors were associated with increased likelihood of an anxiety disorder in the FMR 1 premutation group. Major depression in females with the FMR1 premutation may not be characterized as an episodically chronic recurrent disorder as it is in community samples and may have a genetic basis given the relationship with CGG repeat length and lack of association with all child and most demographic factors. (c) 2008 Wiley-Liss, Inc.

PMID: 18553360 [PubMed - as supplied by publi sher]

 

BMC Int Health Hum Rights. 2008 Jun 12;8:8.

Mental health of returnees: refugees in Germany prior to their state-sponsored repatriation.

von Lersner U, Wiens U, Elbert T, Neuner F.

Psychotrauma Research- and Outpatient Clinic for Refugees, University of Konstanz, Germany. ulrike.vonlersner@fu-berlin.de.

ABSTRACT: BACKGROUND: Many refugees live for years in exile. The combination of stress in the host country, together with long-term effects resulting from traumatic stress usually experienced in the home country may affect mental health. Little is known, to what extent these and other factors promote or stall  the willingness to return to the country of origin. Here, we investigate, as an example, refugees who will return to their country of origin after having lived in exile in Germany for some 11 years. OBJECTIVE: What is the mental health status of returnees before the actual return who have been living in exile for an extended period? We also asked, what are the current living conditions in Germany and what are the motives for and reasons against a voluntary return to the country of origin? METHODS: Forty-seven participants of programs for assisted voluntarreturn were interviewed about their present living situation, their view  regarding their home country and voluntary return. These findings were compared to a group of 53 refugees who had decided to remain in Germany (stayers). Participants were recruited by means of advertisements posted in refugee centres, language schools, at doctors' offices and in organisations involved in the management of voluntary return in Germany. The prevalence of psychiatric disorders among respondents was tested using the structured interview M.I.N.I. The Posttraumatic Stress Diagnostic Scale (PDS) was used to assess PTSD in more detail and EUROHIS was applied to measure the subjective quality of life of participants. RESULTS: We found a prevalence rate of 44% psychiatric disorders in the group of returnees and a rate of 78% in the group of stayers. We also recorded substantial correlations between the living situation in Germany, disposition to return and mental health. In almost two thirds of the participants the decision to return was not voluntary but strongly influenced by immigration authorities. The most important reason for participants to opt for a stay in Germany were their children, who have been born and raised in Germany. CONCLUSION: Psychological strains among the study participants were very high. Traumatic stress, experienced during war and refuge, has left the victims vulnerable and not well equipped to cope with post-migration stressors in exile.  It is noteworthy that the majority returned under pressure of the immigration authorities. The fear of an uncertain future after the return was substantial. These factors should be taken into account in programs designed to assist returnees, including those that offer support after return to the country of origin.

PMID: 18549469 [PubMed - in process]

 

Physiol Behav. 2008 Jun 9;94(3):341-8. Epub 2008 Feb 5.

Rats exposed to traumatic stress bury unfamiliar objects--a novel measure of hyper-vigilance in PTSD models?

Mikics E, Baranyi J, Haller J.

Department of Behavioral Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary.

Electric shocks lead to lasting behavioral deficits in rodents, and as such are often used to model post-traumatic stress disorder (PTSD) in the laboratory. Here we show that a single exposure of rats to 3 mA-strong shocks results in a marked  social avoidance that lasts at least 28 days; moreover, the response intensifies  over time. In an attempt to study the impact of cue reminders on the behavior of  shocked rats, we administered shocks in the presence of a highly conspicuous, 10  cm-large object. This object was introduced into the home cage of rats 28 days after shock exposure. Shocked rats manipulated the object considerably less than  controls. More importantly, however, the object was buried by shocked rats. This  behavior was virtually absent in controls. The response strongly depended on the  intensity of shocks, and was robust. Rats shocked with 3 mA currents spent 40% of time burying the object, which was often hardly visible at the end of the 5 min test. Subsequent experiments demonstrated that the response was not cue-specific  as unfamiliar objects were also buried. Rats are well known to bury dangerous objects; the shock-prod burying test of anxiety is based on this response. Behavioral similarities with this test and the differences from the marble-burying behavior of mice suggest that traumatized rats bury unfamiliar objects in defense, and the response can be interpreted as a sign of hyper-vigilance. We further suggest that object burying can be used as a sign of  hyper-vigilance in models of PTSD.

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

PMID: 18339410 [PubMed - indexed for MEDLINE]

 

Subst Abuse Treat Prev Policy. 2008 Jun 6;3:15.

Women's childhood and adult adverse experiences, mental health, and binge drinking: the California Women's Health Survey.

Timko C, Sutkowi A, Pavao J, Kimerling R.

Center for Health Care Evaluation, Department of Veterans Affairs (VA) Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA. ctimko@stanford.edu

BACKGROUND: This study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California. MATERIALS AND METHODS: Data were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older. RESULTS: The prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been  physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill,  or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood. CONCLUSION: Identifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood  home.

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

PMID: 18538028 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Jun 3. [Epub ahead of print]

Bidirectional Partner Violence Among Homeless Young Adults: Risk Factors and Outcomes.

Tyler KA, Melander LA, Noel H.

One of the most prevalent forms of violence in contemporary society is the victimization of intimate partners. Although it has been established that homeless young people experience high levels of victimization on the street, little is known about partner violence (PV) experiences among this group, especially bidirectional violence. As such, the purpose of this study is to examine the prevalence of PV and bidirectional violence and to investigate risk factors and outcomes of this form of violence using a sample of homeless young adults. Overall, 59% of the sample experienced bidirectional violence. Multivariate results reveal that sexual abuse and neglect are significant correlates of PV. In addition, being either a victim or perpetrator of PV is associated with more severe substance use and higher levels of posttraumatic stress disorder (PTSD). Finally, there is support for bidirectional violence among homeless young adults even after controlling for early histories of maltreatment.

PMID: 18523236 [PubMed - as supplied by publi sher]

 

Neuroscience. 2008 Jun 2;153(4):1126-34. Epub 2008 Mar 21.

p11 is up-regulated in the forebrain of stressed rats by glucocorticoid acting via two specific glucocorticoid response elements in the p11 promoter.

Zhang L, Li H, Su TP, Barker JL, Maric D, Fullerton CS, Webster MJ, Hough CJ, Li  XX; Traumatic Stress Brain Study Group, Ursano R.

Collaborators: Benedek D, Duman R, Friedman M, Holloway H, Kleinman J, Krystal J, Leskin G, Meyerhoff J, Osuch E.

Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. Lezhang@USUHS.mil

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. Despite the extensive study of the neurobiological correlates of this  disorder, the underlying mechanisms of PTSD are still poorly understood. Recently, a study demonstrated that dexamethasone (Dex), a synthetic glucocorticoid, can up-regulate p11, known as S100A10-protein which is down-regulated in patients with depression, (Yao et al., 1999; Huang et al., 2003) a common comorbid disorder in PTSD. These observations led to our hypothesis that traumatic stress may alter expression of p11 mediated through a glucocorticoid receptor. Here, we demonstrate that inescapable tail shock increased both prefrontal cortical p11 mRNA levels and plasma corticosterone levels in rats. We also found that Dex up-regulated p11 expression in SH-SY5Y cells through glucocorticoid response elements (GREs) within the p11 promoter. This response was attenuated by either RU486, a glucocorticoid receptor (GR) antagonist or mutating two of three glucocorticoid response elements (GRE2 and GRE3) in the p11 promoter. Finally, we showed that p11 mRNA levels were increased in postmortem prefrontal cortical tissue (area 46) of patients with PTSD. The data obtained from our work in a rat model of inescapable tail shock, a p11-transfected cell line and postmortem brain tissue from PTSD patients outline  a possible mechanism by which p11 is regulated by glucocorticoids elevated by traumatic stress.

PMID: 18440154 [PubMed - indexed for MEDLINE]

 

AAOHN J. 2008 Jun;56(6):243-50.

Caring for those who care: the role of the occupational health nurse in disasters.

Tomczyk D, Alvarez D, Borgman P, Cartier MJ, Caulum L, Galloway C, Groves C, Faust N, Meske D.

Hospital Emergency Preparedness, Wisconsin Division of Public Health, Madison, WI, USA.

Since the events of 9/11, health care facilities have devoted substantial resources to emergency preparedness, especially for a surge of patients in a large-scale incident. Hurricane Katrina reinforced the need for such surge planning. Due to the SARS experience in Toronto, health care professionals have had increased awareness of their "duty-to-care" responsibility. These caregivers  make the decision, even when they themselves may be at risk, to continue to care  for patients. However, little has been done about planning to care for these caregivers. Health care professionals can be deeply affected physically, emotionally, and spiritually when caring for patients in a large-scale incident.  Emergency preparedness professionals must consider the needs of health care providers because providers must care for a large number of patients with limited resources under stressful conditions. It is the obligation and responsibility of  each health care organization to care for these caregivers. However, when assigning responsibility for this task, it becomes evident this responsibility belongs to employee health nurses, "employee advocates," and organizational leaders.

PMID: 18604920 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2008 Jun;33(6):841-7. Epub 2008 Jan 11.

Development of the PTSD-alcohol expectancy questionnaire.

Norman SB, Inaba RK, Smith TL, Brown SA.

UCSD Department of Psychiatry, VA San Diego Healthcare Systems, San Diego, CA 92108, USA. snorman@ucsd.edu

Alcohol effect expectancies have important implications in our understanding drinking behavior and motivations for drinking. Several instruments have been developed to asses alcohol expectancies among various populations. Although co-occurrence of PTSD among those with alcohol use disorders is extremely common, there is no measure of PTSD-related alcohol expectancies. The Post-traumatic stress disorder-Alcohol Expectancy Questionnaire (P-AEQ) is a 27-item, self-report questionnaire that was developed to measure individuals' beliefs about the effects of alcohol with regard to symptoms of post-traumatic stress disorder. The P-AEQ was found to measure two primary dimensions, positive and negative alcohol effect expectancies. This instrument demonstrated internal consistency, reliability, and concurrent validity within the Alcohol Expectancies Questionnaire. In addition, the P-AEQ appears to be capable of differentiating AUD from non-AUD populations in a male veteran sample.

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

PMID: 18261858 [PubMed - indexed for MEDLINE]

 

Am J Epidemiol. 2008 Jun 1;167(11):1269-76. Epub 2008 Apr 23.

Comment in:     Am J Epidemiol. 2008 Jun 1;167(11):1277-80.    Am J Epidemiol. 2008 Nov 1;168(9):1093-4; author reply 1096-8.    Am J Epidemiol. 2008 Nov 1;168(9):1094-5; author reply 1096-8.    Am J Epidemiol. 2008 Nov 1;168(9):1095-6; author reply 1096-8.

Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect.

Larson GE, Highfill-McRoy RM, Booth-Kewley S.

Behavioral Science and Epidemiology Department, Naval Health Research Center, San Diego, CA 92106, USA.

Research studies have identified heightened psychiatric problems among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). However, these studies have not compared incidence rates of psychiatric disorders across robust cohorts, nor have they documented psychiatric problems prior to combat exposure. The authors' objectives in this study were to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF or OEF in 2001-2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups. After exclusion of persons who had been deployed to a combat zone with a preexisting psychiatric diagnosis, the cumulative rate of post-OIF/-OEF mental disorders was 6.4%. All psychiatric conditions except post-traumatic stress disorder occurred at a lower  rate in combat-deployed personnel than in personnel who were not deployed to a combat zone. The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit  personnel early in training creates a "healthy warrior effect," because only those persons who have proven their resilience during training remain eligible for combat.

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

PMID: 18436536 [PubMed - indexed for MEDLINE]

 

Am J Epidemiol. 2008 Jun 1;167(11):1277-80. Epub 2008 Apr 22.

Comment on:     Am J Epidemiol. 2008 Jun 1;167(11):1269-76.

Invited commentary: how healthy is the "healthy warrior"?

Toomey R.

Department of Psychology, Boston University, Boston, MA 02215, USA. rosemary_toomey@hms.harvard.edu

In this issue of the Journal, Larson et al. (Am J Epidemiol 2008;167:1269-1276) report incidence rates of 11.8% for any mental disorder and 1.6% for post-traumatic stress disorder among US Marines deployed during Operation Iraqi Freedom and Operation Enduring Freedom. Various methodological reasons can help explain why these rates are lower than those found in previous wars. One primary  reason is varying methods of diagnosis. Other reasons include differences in percentages of active-duty personnel, windows of observation, and methods of calculating rates. In addition, comorbidity for some mental disorders and specific risks for developing certain disorders complicate interpretation of rates. Nevertheless, Larson et al. document evidence for the "healthy warrior" effect-namely that deployed Marines have fewer mental disorders than nondeployed  Navy and Marine Corps personnel, with the exception of stress disorders. Suggestions are made for directions of future research into this effect.

Publication Types:      Comment

PMID: 18434295 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Jun;165(6):776.

Consistency of autobiographical memories in asylum seekers.

Eytan A, Laurencon M, Durieux-Paillard S, Ortiz N.

Publication Types:      Letter

PMID: 18519542 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Jun;165(6):775-6.

On-the-record screenings versus anonymous surveys in reporting PTSD.

McLay RN, Deal WE, Murphy JA, Center KB, Kolkow TT, Grieger TA.

Publication Types:      Letter

PMID: 18519540 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Jun;165(6):774-5.

Bizarre behavior in a patient treated with prazosin for PTSD.

Reardon CL, Factor RM.

Publication Types:      Case Reports     Letter

PMID: 18519538 [PubMed - indexed for MEDLINE]

 

Ann Epidemiol. 2008 Jun;18(6):447-57. Epub 2008 Feb 8.

Predictors of depressive symptoms among israeli jews and arabs during the Al aqsa intifada: a population-based cohort study.

Tracy M, Hobfoll SE, Canetti-Nisim D, Galea S.

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48104-2548, USA.

PURPOSE: We sought to assess the predictors of depressive symptoms in a population-based cohort exposed to ongoing and widespread terrorism. METHODS: Interviews of a representative sample of adults living in Israel, including both  Jews and Arabs, were conducted between August and September 2004, with follow-up  interviews taking place between February and April 2005. Censoring weights were estimated to account for differential loss to follow-up. Zero-inflated negative binomial models with bootstrapped confidence intervals were fit to assess predictors of severity of depressive symptoms, assessed using items from the Patient Health Questionnaire. RESULTS: A total of 1613 Israeli residents participated in the baseline interview (80.8% Jewish, 49.4% male, mean age 43 years); 840 residents also participated in the follow-up interview. In multivariable models, Israeli Arab ethnicity, lower household income, lower social support, experiencing economic loss from terrorism, experiencing higher levels of psychosocial resource loss, and meeting criteria for post-traumatic stress disorder were significantly associated with increased severity of depressive symptoms. CONCLUSIONS: Material deprivation is the primary modifiable  risk factor for depressive symptoms in the context of ongoing terrorism. Efforts  to minimize ongoing material and economic stressors may mitigate the mental health consequences of ongoing terrorism.

PMID: 18261923 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2008 Jun;65(6):659-67.

Treatment of acute stress disorder: a randomized controlled trial.

Bryant RA, Mastrodomenico J, Felmingham KL, Hopwood S, Kenny L, Kandris E, Cahill C, Creamer M.

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

CONTEXT: Recent trauma survivors with acute stress disorder (ASD) are likely to subsequently develop chronic posttraumatic stress disorder (PTSD). Cognitive behavioral therapy for ASD may prevent PTSD, but trauma survivors may not tolerate exposure-based therapy in the acute phase. There is a need to compare nonexposure therapy techniques with prolonged exposure for ASD. OBJECTIVE: To determine the efficacy of exposure therapy or trauma-focused cognitive restructuring in preventing chronic PTSD relative to a wait-list control group. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial of civilians who experienced trauma and who met the diagnostic criteria for ASD (N = 90) seen at an outpatient clinic between March 1, 2002, and June 30, 2006. INTERVENTION: Patients were randomly assigned to receive 5 weekly 90-minute sessions of either  imaginal and in vivo exposure (n = 30) or cognitive restructuring (n = 30), or assessment at baseline and after 6 weeks (wait-list group; n = 30). MAIN OUTCOME  MEASURES: Measures of PTSD at the 6-month follow-up visit by clinical interview and self-report assessments of PTSD, depression, anxiety, and trauma-related cognition. RESULTS: Intent-to-treat analyses indicated that at posttreatment, fewer patients in the exposure group had PTSD than those in the cognitive restructuring or wait-list groups (33% vs 63% vs 77%; P = .002). At follow-up, patients who underwent exposure therapy were more likely to not meet diagnostic criteria for PTSD than those who underwent cognitive restructuring (37% vs 63%; odds ratio, 2.10; 95% confidence interval, 1.12-3.94; P = .05) and to achieve full remission (47% vs 13%; odds ratio, 2.78; 95% confidence interval, 1.14-6.83; P = .005). On assessments of PTSD, depression, and anxiety, exposure resulted in  markedly larger effect sizes at posttreatment and follow-up than cognitive restructuring. CONCLUSIONS: Exposure-based therapy leads to greater reduction in  subsequent PTSD symptoms in patients with ASD when compared with cognitive restructuring. Exposure should be used in early intervention for people who are at high risk for developing PTSD.

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

PMID: 18519824 [PubMed - indexed for MEDLINE]

 

Arch Pediatr. 2008 Jun;15(5):626-8.

[Psychological aspects of ex child soldiers of Burundi]

[Article in French]

Mubiri-Pondard MA.

AP-HP, Service de Chirurgie Viscérale et Néonatale, Hôpital pour Enfants Armand Trousseau, Paris. marie-armelle.mubiri-pondard@trs.aphp.fr <marie-armelle.mubiri-pondard@trs.aphp.fr>

PMID: 18582694 [PubMed - indexed for MEDLINE]

 

Aust N Z J Psychiatry. 2008 Jun;42(6):547.

Follow up of post-traumatic stress disorder symptoms in Australian servicemen hospitalized in 1942-1952.

Garcia JI, Mullen R.

Publication Types:      Letter

PMID: 18465383 [PubMed - indexed for MEDLINE]

 

Aust N Z J Psychiatry. 2008 Jun;42(6):478-88.

Traumatic memories: bridging the gap between functional neuroimaging and psychotherapy.

Peres JF, McFarlane A, Nasello AG, Moores KA.

Neuroscience and Behavior, Institute of Psychology, University of São Paulo, São  Paulo, Brazil. julioperes@yahoo.com

OBJECTIVE: Neuroimaging studies have highlighted important issues related to structural and functional brain changes found in sufferers of psychological trauma that may influence their ability to synthesize, categorize, and integrate  traumatic memories. METHODS: Literature review and critical analysis and synthesis. RESULTS: Traumatic memories are diagnostic symptoms of post-traumatic  stress disorder (PTSD), and the dual representation theory posits separate memory systems subserving vivid re-experiencing (non-hippocampally dependent) versus declarative autobiographical memories of trauma (hippocampally dependent). But the psychopathological signs of trauma are not static over time, nor is the expression of traumatic memories. Multiple memory systems are activated simultaneously and in parallel on various occasions. Neural circuitry interaction is a crucial aspect in the development of a psychotherapeutic approach that may favour an integrative translation of the sensory fragments of the traumatic memory into a declarative memory system. CONCLUSION: The relationship between neuroimaging findings and psychological approaches is discussed for greater efficacy in the treatment of psychologically traumatized patients.

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

PMID: 18465374 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2008 Jun;46(6):766-75. Epub 2008 Feb 29.

The influence of data-driven processing on perceptions of memory quality and intrusive symptoms in children following traumatic events.

McKinnon AC, Nixon RD, Brewer N.

School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. anna.mckinnon@flinders.edu.au

Ehlers and Clark [(2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy, 38, 319-345] cognitive model of post-traumatic stress disorder (PTSD) has been relatively untested with children. Seventy-five children (7-16 years) were interviewed within 4 weeks of an injury that led to hospital treatment to examine whether peri-traumatic processing strategies (data-driven processing and fear) were associated with perceptions of memory quality and intrusive memories. Perceptions of memory quality mediated the relationship between data-driven processing and intrusive reactions but not avoidance, arousal or depressive reactions. Finally, the relationship between peri-event fear and intrusion reactions was mediated by perceptions of memory quality even after data-driven processing was controlled. The implications of these findings are discussed in the context of a cognitive developmental model of PTSD in children.

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

PMID: 18405880 [PubMed - indexed for MEDLINE]

 

Bipolar Disord. 2008 Jun;10(4):503-10.

Trauma exposure and posttraumatic stress disorder among primary care patients with bipolar spectrum disorder.

Neria Y, Olfson M, Gameroff MJ, Wickramaratne P, Pilowsky D, Verdeli H, Gross R,  Manetti-Cusa J, Marshall RD, Lantigua R, Shea S, Weissman MM.

Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA.

OBJECTIVE: To examine relationships between exposure to trauma, bipolar spectrum  disorder (BD) and posttraumatic stress disorder (PTSD) in a sample of primary care patients. METHODS: A systematic sample (n = 977) of adult primary care patients from an urban general medicine practice were interviewed with measures including the Mood Disorders Questionnaire, the PTSD Checklist-Civilian Version,  and the Medical Outcomes Study 12-Item Short Form Health Survey. RESULTS: Compared with patients who screened negative for BD (n = 881), those who screened positive (n = 96) were 2.6 times [95% confidence interval (CI): 1.6-4.2] as likely to report physical or sexual assault, and 2.9 times (95% CI: 1.6-5.1) as likely to screen positive for current PTSD. Among those screening positive for BD, comorbid PTSD was associated with significantly worse social functioning. These results controlled for selected background characteristics, current major depressive episode, and current alcohol/drug use disorder. CONCLUSION: In an urban general medicine setting, trauma exposure was related to BD, and the frequency of PTSD among patients with BD appears to be common and clinically significant. These results suggest an unmet need for mental health care in this specific population and are especially important in view of available treatments  for BD and PTSD.

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

PMID: 18452446 [PubMed - indexed for MEDLINE]

 

Br J Clin Psychol. 2008 Jun;47(Pt 2):245-9. Epub 2007 Nov 13.

Positive schizotypy and trait dissociation as vulnerability factors for post-traumatic distress.

Steel C, Mahmood M, Holmes EA.

Department of Psychology, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. c.steel@reading.ac.uk

OBJECTIVE: This study investigated whether trait positive schizotypy or trait dissociation was associated with increased levels of data-driven processing and symptoms of post-traumatic distress following a road traffic accident. METHODS: Forty-five survivors of road traffic accidents were recruited from a London Accident and Emergency service. Each completed measures of trait positive schizotypy, trait dissociation, data-driven processing, and post-traumatic stress. RESULTS: Trait positive schizotypy was associated with increased levels of data-driven processing and post-traumatic symptoms during a road traffic accident, whereas trait dissociation was not. CONCLUSIONS: Previous results which report a significant relationship between trait dissociation and post-traumatic symptoms may be an artefact of the relationship between trait positive schizotypy and trait dissociation.

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

PMID: 18001518 [PubMed - indexed for MEDLINE]

 

Brain Res Rev. 2008 Jun;58(1):71-84. Epub 2008 Feb 20.

Emotional memory function, personality structure and psychopathology: a neural system approach to the identification of vulnerability markers.

Haas BW, Canli T.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. bhaas@stanford.edu

It is well established that emotional events are ingrained stronger into memory relative to neutral events. Facilitated emotional memory is highly variable between individuals within the normal population and is particularly exacerbated  in those diagnosed with mood and anxiety disorders. In order to elucidate how variation of enhanced emotional memory within the normal population may manifest  into psychopathological states, we explored the convergence between studies investigating the neural systems engaged in emotional memory facilitation and studies investigating how these systems differ from person to person. Converging  evidence highlights the roles of three neural systems (1. Amygdala function and attention, 2. Neuroendocrine function, 3. Interactive effects with mood) that all govern emotional memory facilitation and are highly variable between individuals  as a function of personality. We applied this neural system approach to models of vulnerability of three forms of psychopathology that are particularly characterized by atypical emotional memory function (depression, generalized anxiety disorder and post-traumatic stress disorder). This application suggests that the incorporation of known vulnerability markers across psychological, neuroimaging and neuroendocrinological domains is cardinal to how susceptibility  is conceptualized and assessed in these disorders.

Publication Types:      Review

PMID: 18359090 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Jun;32(6):627-36. Epub 2008 Jun 26.

The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children.

Nilsson D, Wadsby M, Svedin CG.

BUP-Elefanten, Department of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden.

OBJECTIVE: To evaluate the psychometric properties of the Swedish version of the  Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. METHOD: A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. RESULTS: Good reliability such as internal consistency (Cronbach's alpha)  for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest  for the total scale r=.81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. CONCLUSION: The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences.

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

PMID: 18584867 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Jun;32(6):621-5. Epub 2008 Jun 26.

Multi-informant assessment of maltreated children: convergent and discriminant validity of the TSCC and TSCYC.

Lanktree CB, Gilbert AM, Briere J, Taylor N, Chen K, Maida CA, Saltzman WR.

Miller Children's Abuse and Violence Intervention Center, Miller Children's Hospital, 2865 Atlantic Ave. #110, Long Beach, CA 90806, USA.

OBJECTIVE: This study examined the convergent and discriminant validity of two trauma symptom measures, the Trauma Symptom Checklist for Children (TSCC) [Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC). Odessa, FL: Psychological Assessment Resources] and the Trauma Symptom Checklist for Young Children (TSCYC) [Briere, J. (2005). Trauma Symptom Checklist for Young Children  (TSCYC). Odessa, FL: Psychological Assessment Resources]. METHODS: Children's scores on the TSCC and their caretakers' ratings on the TSCYC were analyzed in a  study of 310 children presenting to one of two child abuse treatment centers. RESULTS: TSCC and TSCYC scales generally converged in their assessment of symptomatology in maltreated children. Equivalent scales measuring anxiety, depression, anger, dissociation, and sexual concerns were generally most correlated with one another. Similarly, the Posttraumatic Stress-Intrusion (PTS-I) scale of the TSCYC correlated highest with the Posttraumatic Stress (PTS) and Anxiety (ANX) scales of the TSCC, the TSCYC Posttraumatic Stress-Arousal (PTS-AR) scale was correlated with the TSCC ANX scale, and the TSCC PTS scale was most correlated with the TSCYC ANX, PTS-I, and Sexual Concerns (SC) scales. The TSCYC Posttraumatic Stress-Avoidance scale was unrelated to any TSCC scale. Discriminant function analysis revealed that the TSCC PTS scale was the best single predictor of sexual abuse-related PTSD status as identified by the TSCYC.  CONCLUSIONS: The TSCC and TSCYC display moderate convergent and discriminant validity with respect to one another, despite different information sources. Nevertheless, the relatively small association between relevant TSCC and TSCYC scales indicates that different symptom informants may have different perspectives on the child's symptomatology; an outcome that may be beneficial when both measures are administered simultaneously. PRACTICE IMPLICATIONS: These  results reinforce the notion that both child- and parent/caretaker report measures should be used in the evaluation of traumatized children, so that multiple sources of information can be considered simultaneously. In the current  context, administration of the TSCC to the child and the TSCYC to the caretaker,  when appropriate (i.e., in children 8-12 years of age) may yield more clinical information on the child's symptomatology than either measure would alone-perhaps especially in cases when one of the two respondents under- or over-reports the child's distress.

PMID: 18584866 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Jun;32(6):637-47. Epub 2008 Jun 25.

Effects of multiple maltreatment experiences among psychiatrically hospitalized youth.

Boxer P, Terranova AM.

Department of Psychology, Rutgers University, 101 Warren Street, Newark, NJ 07102, USA.

OBJECTIVE: Relying on indicators coded from information collected routinely during intake assessments at a secure inpatient psychiatric facility, this study  examined the extent to which different forms of maltreatment accounted for variations in youths' emotional and behavioral problems. METHODS: Clinical information was reviewed for a large (N=401) and diverse sample (mean age=13.9 years; 53% male; 54.6% racial/ethnic minority) of youth admitted to a publicly funded psychiatric hospital. Data were drawn from intake narratives, standardized psychopathology rating scales, and psychiatric diagnostic ratings. RESULTS: Findings provide some support for a hierarchical classification of multiple maltreatment experiences with sexual abuse identified as the specific form of maltreatment most reliably associated with poor adjustment. Support also was obtained for a cumulative classification approach, as the number of different types of maltreatment experiences was linked positively to elevated psychopathology ratings. CONCLUSIONS: Even in this high-risk, atypical sample, maltreatment experiences account for variation in levels of psychopathology. These results have implications for classifying multiple maltreatment and enhancing clinical care for atypical youth who have been maltreated. PRACTICE IMPLICATIONS: Clinicians working in youth psychiatric populations should implement maltreatment-specific psychotherapy approaches for maltreated youth, even as adjunctive treatments in a therapeutic milieu.

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

PMID: 18582936 [PubMed - indexed for MEDLINE]

 

Clin Psychol Rev. 2008 Jun;28(5):837-68. Epub 2007 Dec 23.

Posttraumatic stress disorder: an empirical evaluation of core assumptions.

Rosen GM, Lilienfeld SO.

University of Washington, Seattle, Washington, USA. grosen@u.washington.edu

The diagnosis of posttraumatic stress disorder (PTSD) rests on several core assumptions, particularly the premise that a distinct class of traumatic events is linked to a distinct clinical syndrome. This core assumption of specific etiology ostensibly distinguishes the PTSD diagnosis from virtually all other psychiatric disorders. Additional attempts to distinguish PTSD from extant conditions have included searches for distinctive markers (e.g., biological and laboratory findings) and hypothesized underlying mechanisms (e.g., fragmentation  of traumatic memory). We review the literature on PTSD's core assumptions and various attempts to validate the construct within a nomological network of distinctive correlates. We find that virtually all core assumptions and hypothesized mechanisms lack compelling or consistent empirical support. We consider the implications of these findings for conceptualizing PTSD in the forthcoming edition of the American Psychiatric Association's diagnostic manual.

Publication Types:      Review

PMID: 18329146 [PubMed - indexed for MEDLINE]

 

Clin Psychol Rev. 2008 Jun;28(5):746-58. Epub 2007 Nov 1.

The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct comparisons.

Benish SG, Imel ZE, Wampold BE.

Department of Counseling Psychology, University of Wisconsin - Madison, WI 53703, USA. sgbenish@wisc.edu

Psychotherapy has been found to be an effective treatment of post-traumatic stress disorder (PTSD), but meta-analyses have yielded inconsistent results on relative efficacy of psychotherapies in the treatment of PTSD. The present meta-analysis controlled for potential confounds in previous PTSD meta-analyses by including only bona fide psychotherapies, avoiding categorization of psychotherapy treatments, and using direct comparison studies only. The primary analysis revealed that effect sizes were homogenously distributed around zero for measures of PTSD symptomology, and for all measures of psychological functioning, indicating that there were no differences between psychotherapies. Additionally,  the upper bound of the true effect size between PTSD psychotherapies was quite small. The results suggest that despite strong evidence of psychotherapy efficaciousness vis-à-vis no treatment or common factor controls, bona fide psychotherapies produce equivalent benefits for patients with PTSD.

Publication Types:      Comparative Study     Meta-Analysis

PMID: 18055080 [PubMed - indexed for MEDLINE]

 

Cult Med Psychiatry. 2008 Jun;32(2):219-37.

Gulf war syndrome: a reaction to psychiatry's invasion of the military?

Kilshaw S.

Department of Anthropology, University College London, 14 Taviton Street, London, UK. s.kilshaw@ucl.ac.uk

Following the 1991 Gulf War, a number of soldiers who fought there began to complain of various symptoms and disorders, the collection of which came to be known as Gulf War syndrome (GWS). A debate has raged about the nature and cause of this illness, with many suggesting that it is a psychiatric condition. GWS continues to be a contested illness, yet there is no disputing that many Gulf veterans are ill. This article considers the way in which GWS sufferers understand their illness to be physical in nature and the way in which they negotiate and resist psychological theories of their illness. Based on 14 months  of ethnographic fieldwork in the United Kingdom, data for this article were collected mainly by in-depth, semistructured interviews with GWS sufferers, their family members, doctors, and scientists, as well as healthy Gulf veterans. A total of 93 informants were interviewed, including 67 UK Gulf veterans, most of whom were ill. The paper argues that despite the increasing presence of psychiatry in military discourse, GWS reveals the way that people are able to transform, negotiate and even negate its power and assumptions.

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

PMID: 18363083 [PubMed - indexed for MEDLINE]

 

Eur Child Adolesc Psychiatry. 2008 Jun;17(4):191-9.

Exposure to war trauma and PTSD among parents and children in the Gaza strip.

Thabet AA, Abu Tawahina A, El Sarraj E, Vostanis P.

Gaza Community Mental Health Programme, El Rasheed Street, P.O Box 1049, Gaza, Palestine, Israel.

OBJECTIVE: Exposure to war trauma has been independently associated with posttraumatic stress (PTSD) and other emotional disorders in children and adults. The aim of this study was to establish the relationship between ongoing war traumatic experiences, PTSD and anxiety symptoms in children, accounting for their parents' equivalent mental health responses. METHODS: The study was conducted in the Gaza Strip, in areas under ongoing shelling and other acts of military violence. The sample included 100 families, with 200 parents and 197 children aged 9-18 years. Parents and children completed measures of experience of traumatic events (Gaza Traumatic Checklist), PTSD (Children's Revised Impact of Events Scale, PTSD Checklist for parents), and anxiety (Revised Children's Manifest Anxiety Scale, and Taylor Manifest Anxiety Scale for parents). RESULTS:  Both children and parents reported a high number of experienced traumatic events, and high rates of PTSD and anxiety scores above previously established cut-offs.  Among children, trauma exposure was significantly associated with total and subscales PTSD scores, and with anxiety scores. In contrast, trauma exposure was  significantly associated with PTSD intrusion symptoms in parents. Both war trauma and parents' emotional responses were significantly associated with children's PTSD and anxiety symptoms. CONCLUSIONS: Exposure to war trauma impacts on both parents' and children's mental health, whose emotional responses are inter-related. Both universal and targeted interventions should preferably involve families. These could be provided by non-governmental organizations in the first instance.

PMID: 18365135 [PubMed - indexed for MEDLINE]

 

Fam Process. 2008 Jun;47(2):261-75.

The contribution of loneliness and posttraumatic stress disorder to marital adjustment following war captivity: a longitudinal study.

Solomon Z, Dekel R.

Tel-Aviv University, Adler Center, POB 39040, Tel Aviv 61390, Israel. Solomon@post.tau.ac.il

This prospective study examined the relative contribution of loneliness and posttraumatic stress disorder (PTSD) to marital adjustment among Israeli veterans of the 1973 Yom Kippur war. Specifically, we examined the mediating role of loneliness as measured in 1991 in the association between PTSD as measured in 1991 and marital adjustment as measured in 2003. Our sample consisted of 225 participants divided into 2 groups: ex-prisoners of war (ex-POWs) (N = 122) and a comparison group comprised of veterans who fought in the same war but who had not experienced captivity (N = 103). The findings demonstrate that ex-POWs display lower levels of marital adjustment and higher levels of PTSD than controls. Loneliness was found to mediate the relationship between PTSD as measured in 1991 and marital adjustment as measured in 2003 for both ex-POWs and controls. Further, for ex-POWs, loneliness contributes to marital adjustment above and beyond the contribution of PTSD as measured in 2003. The theoretical implications of loneliness for the marital relationships of traumatized ex-POWs are discussed.

PMID: 18605125 [PubMed - indexed for MEDLINE]

 

Fam Process. 2008 Jun;47(2):173-95.

Treating family relational trauma: a recursive process using a decision dialogue.

Sheinberg M, True F.

Training and Clinical Services, Ackerman Institute for the Family, 149 E. 78 St., New York, NY 10075, USA. msheinberg@ackerman.org

This article describes a therapeutic process that combines individual and family  sessions to maximize therapeutic opportunities to bring forward, understand, validate, and empower children's experience as equal participants in family therapy. The aim is to strengthen relational bonds within the family. Drawing from earlier work with families where incest had occurred, the authors present a  recursive process that utilizes a "decision dialogue" to link individual and family sessions. Clinical examples are provided.

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

PMID: 18605120 [PubMed - indexed for MEDLINE]

 

Int J Prison Health. 2008 Jun;4(2):104-19.

Could recidivism in prisoners be linked to traumatic grief? A review of the evidence.

Leach RM, Burgess T, Holmwood C.

Faculty of Health Sciences, University of Adelaide, Australia. spiritual.healer@bigpond.com

Traumatic grief arises as a result of interpersonal trauma experienced as a betrayal of attachment. The distinct set of symptoms associated with it were first recognized in the 1990s. Losses associated with traumatic grief can be either death or non-death related. A variety of studies have demonstrated that many prisoners have suffered from losses and trauma throughout their lives, and in many instances they have never received any support or interventions to address resultant problems. This paper examines whether there could be a relationship between many of the maladaptive behaviours demonstrated by the prisoners (including substance use), mental illness and traumatic grief. Of particular importance is the exploration of whether the high rates of recidivism  seen in many developed countries (and which in Australia have been reported as high as 77%) may be related to traumatic grief. This paper explores new concepts  that may be relevant to the development of strategies to reduce recidivism.

Publication Types:      Review

PMID: 18464064 [PubMed - indexed for MEDLINE]

 

Int Rev Psychiatry. 2008 Jun;20(3):317-28.

The mental health of children affected by armed conflict: protective processes and pathways to resilience.

Betancourt TS, Khan KT.

Harvard School of Public Health, Cambridge, MA 02115, USA. Theresa_Betancourt@Harvard.edu

This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain 'invulnerable' children. In contrast, this paper argues that a number of  protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection  in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology.

Publication Types:      Review

PMID: 18569183 [PubMed - indexed for MEDLINE]

 

Int Rev Psychiatry. 2008 Jun;20(3):291-303.

Responding to the needs of children in crisis.

Jones L.

International Medical Corps, and Developmental Psychiatry Section, Cambridge University, Cambridge, UK. ljones@imcworldwide.org

This paper explores the issues confronting service providers setting up child and family mental health programmes in conflict, post conflict and disaster areas. Drawing on clinical experience and research in humanitarian settings, it calls for greater attention to the child's perspective, their individuality and the cultural, social and political context in which they live. It argues that those concerned with the psychopathology of children in crises should widen their frame of reference beyond narrowly defined traumatic reactions to include other mental  health and psychosocial issues, including the current problems of daily life and  the needs of children with pre-existing psychiatric disorders. It recommends culturally valid means of assessment, the creation of age-appropriate services and training for primary healthcare workers. Children's mental health needs in crises are varied, complex and intimately connected with their needs for security, food, shelter, education and family connection. This requires holistic, rights-based approaches that can access resources to address basic needs, advocate for security and protection, and recognize and address the needs of the  more vulnerable children. This is the approach recommended by the Inter Agency Standing Committee Guidelines for Mental health and Psychosocial Support in Emergency Settings.

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

PMID: 18569181 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Jun;22(5):809-23. Epub 2007 Aug 30.

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, USA.

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.

Publication Types:      Comparative Study

PMID: 17913453 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Jun;22(5):793-800. Epub 2007 Aug 22.

The cortisol awakening response as a function of PTSD severity and abuse chronicity in sheltered battered women.

Johnson DM, Delahanty DL, Pinna K.

Summa-Kent State Center for the Treatment and Study of Traumatic Stress, Summa Health System, Akron, OH 44310, USA. johnsod@summa-health.org

Although intimate partner violence (IPV) is a significant social problem associated with severe psychiatric problems, most notably PTSD, only a handful of studies has examined PTSD and associated physiological factors in battered women. Further, no research to date has investigated impact of abuse chronicity on HPA functioning. The present study examined the impact of PTSD severity and abuse chronicity on the cortisol awakening response in a sample of 52 sheltered battered women. Results suggest that IPV-related PTSD and abuse chronicity have opposite effects on waking salivary cortisol curves in battered women. PTSD severity was associated with significantly greater cortisol output the first hour after awakening, while more chronic abuse was associated with lower total cortisol output in the first hour after awakening. Implications of findings and suggestions for future research are discussed.

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

PMID: 17890049 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Jun;22(5):801-8. Epub 2007 Aug 22.

Effects of eye movement versus therapist instructions on the processing of distressing memories.

Lee CW, Drummond PD.

School of Psychology, Murdoch University, Perth, Australia. chris.lee@murdoch.edu.au

The effectiveness of components of eye movement desensitization and reprocessing  (EMDR) was tested by randomly assigning 48 participants to either an eye movement or an eye stationary condition and to one of two types of therapist instructions  (reliving or distancing). Participants were university students (mean age 23) who were asked to recall a personal distressing memory with measures of distress and  vividness taken before and after treatment, and at follow-up. There was no significant effect of therapist's instruction on the outcome measures. There was  a significant reduction in distress for eye movement at post-treatment and at follow-up but overall no significant reduction in vividness. Post hoc analysis revealed a significant reduction in vividness only for the eye movement and distancing instruction condition. The results were consistent with other evidence that the mechanism of change in EMDR is not the same as traditional exposure.

Publication Types:      Comparative Study     Randomized Controlled Trial

PMID: 17890048 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2008 Jun;69(6):959-65.

Pharmacotherapy of PTSD in the U.S. Department of Veterans Affairs: diagnostic- and symptom-guided drug selection.

Mohamed S, Rosenheck RA.

New England Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs Connecticut Health Care System, West Haven, Conn 06516, USA. Somaia.Mohamed@yale.edu

BACKGROUND: Although increasing numbers of war veterans are seeking treatment for posttraumatic stress disorder (PTSD) at the U.S. Department of Veterans Affairs (VA), information on the role of psychotropic pharmacotherapy in their treatment  has not been available. METHOD: Records of psychotropic prescriptions for all VA  patients diagnosed with ICD-9 PTSD (N = 274,297) in fiscal year 2004 (October 1,  2003, to September 30, 2004) were examined. Descriptive statistics and multivariable logistic regression were used to identify veteran characteristics and measures of service use that were associated with receipt of any psychotropic medication and, among users of such medications, with use of each of 3 medication classes: antidepressants, anxiolytics/sedative-hypnotics, and antipsychotics. RESULTS: Most veterans diagnosed with PTSD received psychotropic medication (80%), and among these, 89% were prescribed antidepressants, 61% anxiolytics/sedative-hypnotics, and 34% antipsychotics. Greater likelihood of medication use was associated with greater mental health service use and comorbid psychiatric disorders. Among comorbidities, medication-appropriate comorbid diagnoses were the most robust predictors of use of each of the 3 medication subclasses, i.e., depressive disorders were associated with antidepressant use, anxiety disorders with anxiolytic/sedative-hypnotic use, and psychotic disorders  with antipsychotic use. Use of anxiolytics/sedative-hypnotics and antipsychotics  in the absence of a clearly indicated diagnosis was substantial. CONCLUSIONS: Diverse psychotropic medication classes are extensively used in the treatment of  PTSD in the VA. While disease-specific use for both PTSD and comorbid disorders is common, substantial use seems to be unrelated to diagnosis and thus is likely  to be targeted at specific symptoms (e.g., insomnia, anxiety, nightmares, and flashbacks) rather than diagnosed illnesses. A new type of efficacy research may  be needed to determine symptom responses to psychotropic medications as well as disorder responses, perhaps across diagnoses.

PMID: 18588361 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2008 Jun;69(6):923-9.

A multisite study of the capacity of acute stress disorder diagnosis to predict posttraumatic stress disorder.

Bryant RA, Creamer M, O'Donnell ML, Silove D, McFarlane AC.

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

OBJECTIVE: Previous studies investigating the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) have reported mixed findings and have been flawed by small sample sizes and single sites. This study  addresses these limitations by conducting a large-scale and multisite study to evaluate the extent to which ASD predicts subsequent PTSD. METHOD: Between April  2004 and April 2005, patients admitted consecutively to 4 major trauma hospitals  across Australia (N = 597) were randomly selected and assessed for ASD (DSM-IV criteria) during hospital admission (within 1 month of trauma exposure) and were  subsequently reassessed for PTSD 3 months after the initial assessment (N = 507). RESULTS: Thirty-three patients (6%) met criteria for ASD, and 49 patients (10%) met criteria for PTSD at the 3-month follow-up assessment. Fifteen patients (45%) diagnosed with ASD and 34 patients (7%) not diagnosed with ASD subsequently met criteria for PTSD. The positive predictive power of PTSD criteria in the acute phase (0.60) was a better predictor of chronic PTSD than the positive predictive  power of ASD (0.46). CONCLUSIONS: The majority of people who develop PTSD do not  initially meet criteria for ASD. These data challenge the proposition that the ASD diagnosis is an adequate tool to predict chronic PTSD.

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

PMID: 18422396 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2008 Jun;23(6):741-7. Epub 2008 Apr 15.

Effects of military trauma exposure on women veterans' use and perceptions of Veterans Health Administration care.

Kelly MM, Vogt DS, Scheiderer EM, Ouimette P, Daley J, Wolfe J.

Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare  System, Boston, MA, USA. mkelly@butler.org

BACKGROUND: Few studies have addressed how military trauma exposure, particularly sexual assault and combat exposure, affects women veterans' use and perceptions of Veterans Health Administration (VHA) care. OBJECTIVE: The aim of the present study was to evaluate the effects of military sexual assault and combat exposure  on women veterans' use and perceptions of different aspects of VHA care. DESIGN:  Cross-sectional telephone survey of a national sample of women veterans. PARTICIPANTS: Women from the VA's National Registry of Women Veterans. MEASUREMENTS: Sociodemographic characteristics, VHA care utilization, perceptions of care. RESULTS: Women veterans with histories of military sexual assault reported more use of VHA services, but less satisfaction, poorer perceptions of VHA facilities and staff, and more problems with VHA services compared to women veterans without histories of sexual assault. Combat exposure was related to more problems with VHA staff, although few other differences were observed for women with and without histories of combat exposure. CONCLUSIONS: Findings provide information on areas that can be targeted with respect to caring for women veterans exposed to military sexual trauma and combat exposure, including improving interactions with VHA staff and the ease of using VHA services.

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

PMID: 18414956 [PubMed - indexed for MEDLINE]

 

J Holist Nurs. 2008 Jun;26(2):117-8.

Comment on:     J Holist Nurs. 2008 Jun;26(2):109-16.

Commentary on "a spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasability study".

Wind Wardell D.

University of Texas at Houston, Houston, TX 77030, USA. diane.wardell@uth.tmc.edu

Publication Types:      Comment

PMID: 18539878 [PubMed - indexed for MEDLINE]

 

J Holist Nurs. 2008 Jun;26(2):109-16. Epub 2008 Mar 20.

Comment in:     J Holist Nurs. 2008 Jun;26(2):117-8.

A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study.

Bormann JE, Thorp S, Wetherell JL, Golshan S.

VA San Diego Healthcare System and San Diego State University, San Diego, CA 92161, USA. jill.bormann@va.gov

PURPOSE: To assess the feasibility, effect sizes, and satisfaction of mantram repetition -- the spiritual practice of repeating a sacred word/phrase throughout the day -- for managing symptoms of posttraumatic stress disorder (PTSD) in veterans. DESIGN: A two group (intervention vs. control) by two time (pre- and postintervention) experimental design was used. METHODS: Veterans were randomly assigned to intervention (n = 14) or delayed-treatment control (n = 15). Measures were PTSD symptoms, psychological distress, quality of life, and patient satisfaction. Effect sizes were calculated using Cohen's d. FINDINGS: Thirty-three male veterans were enrolled, and 29 (88%) completed the study. Large effect sizes were found for reducing PTSD symptom severity (d = -.72), psychological distress (d = -.73) and increasing quality of life (d = -.70). CONCLUSIONS: A spiritual program was found to be feasible for veterans with PTSD. They reported moderate to high satisfaction. Effect sizes show promise for symptom improvement but more research is needed.

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

PMID: 18356284 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Jun;23(6):853-68. Epub 2008 Feb 21.

Beyond fear: the role of peritraumatic responses in posttraumatic stress and depressive symptoms among female crime victims.

Rizvi SL, Kaysen D, Gutner CA, Griffin MG, Resick PA.

National Center for Posttraumatic Stress Disorder and Boston University School of Medicine. RizviS@newschool.edu

This study examines peritraumatic (and posttrauma) responses in a sample of female crime victims who had been sexually or physically assaulted within the previous 2 months. Women were interviewed about their emotional and behavioral responses during the trauma and assessed for posttraumatic stress disorder and depression symptomatology. Results indicate that women experience a wide range of behavioral and emotional responses during a traumatic event and that these responses have implications for posttrauma adjustment. Women who experienced behaviors typical of a freeze response are more likely to have a greater degree of symptomatology after the assault. Peritraumatic emotions, other than fear, such as sadness, humiliation, and anger, also appear to be related to posttrauma  depression symptoms. These findings highlight the necessity of exploring the full range of possible reactions during a trauma.

PMID: 18292400 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Jun;196(6):504-7.

The relationship between PTSD arousal symptoms and depression among mothers exposed to the World Trade Center attacks.

Rubacka JM, Schmeidler J, Nomura Y, Luthra R, Rajendran K, Abramovitz R, Chemtob  CM.

Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.

Posttraumatic stress disorder (PTSD) is associated with greater risk of developing comorbid depression. However, little is known about the relationship between specific PTSD symptom clusters and comorbid depression. Approximately 4 years after the World Trade Center (WTC) attacks, we examined the association between PTSD symptom clusters and depression severity among 64 mothers directly exposed to the WTC attacks. Severity scores were computed for each PTSD symptom cluster by summing symptom frequency. Partial correlations with depression severity were calculated separately for PTSD symptom clusters, controlling for demographic variables, time elapsed since the attacks, WTC attack exposure, meeting PTSD criterion A, and the other cluster scores. Higher arousal symptom cluster scores were significantly correlated with persistent depression, but the  re-experiencing and avoidance symptom clusters were not. Subsequent analyses isolating shared symptoms of PTSD and depression from those unique to PTSD suggest a complex interrelationship among symptoms of arousal, numbing, and depression.

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

PMID: 18552630 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Jun;196(6):437-45.

Mental disorder and threats made by noninstitutionalized people with weapons in the national comorbidity survey replication.

Casiano H, Belik SL, Cox BJ, Waldman JC, Sareen J.

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. hygiea_casiano@hotmail.com

Controversy exists as to whether mental disorders are associated with a higher risk of violent behavior. Data from the nationally-representative National Comorbidity Survey Replication was examined. Multiple logistic regression was used to determine whether mood, anxiety, impulse control, and substance use disorders were associated with a higher rate of potentially violent behavior as assessed by threatening others with a gun or other weapon. After adjusting for sociodemographic factors, an association was found between mood, anxiety, impulse control, and substance use disorders and the rate of threatening others. A significant association was found between threats made against others with a gun  and both substance use disorders (adjusted odds ratio [AOR] 2.27; 95% confidence  interval [CI] 1.62-3.20) and impulse control disorders (AOR 2.67; 95% CI 1.95-3.66). Threats made against others with any other type of weapon were significantly associated with any anxiety (AOR 1.76; 95% CI 1.34-2.31), substance (AOR 2.63; 95% CI 1.87-3.71), or impulse control disorder (AOR 2.49; 95% CI 1.96-3.18). Of the disorders studied, social phobia, specific phobia, and impulse control disorders seemed to have their onset before the act of threatening others with weapons. This finding was also true for those who had attempted suicide. Further research is needed to determine whether treatment of mental disorders decreases the risk of violence in this population.

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

PMID: 18552620 [PubMed - indexed for MEDLINE]

 

J Neurochem. 2008 Jun;105(5):1642-55. Epub 2008 Jan 25.

Transient suppression of progenitor cell proliferation through NMDA receptors in  hippocampal dentate gyrus of mice with traumatic stress experience.

Tamaki K, Yamada K, Nakamichi N, Taniura H, Yoneda Y.

Laboratories of Molecular Pharmacology, Kanazawa University Graduate School of Natural Science and Technology, Kakuma-machi, Kanazawa, Ishikawa, Japan.

Post-traumatic stress disorder is a long-lasting psychiatric disease after the traumatic experience of severe fatal stress with the consequence of hippocampal atrophy. Freezing behaviors were more than quintupled on the fear-conditioning test in mice previously subjected to water immersion restrain stress (WIRS) with  metronome tones when determined 1-28 days after WIRS, while these mice exhibited  the increased immobility time on the forced swimming test with the increased spontaneous locomotion. Prior experience of WIRS led to a transient decrease in subsequent 5-bromo-2'-deoxyuridine (BrdU) incorporation into proliferating cells  in the hippocampal dentate gyrus. These behavioral and neurochemical alterations  were significantly prevented by the daily injection of the tricyclic antidepressant imipramine and the selective serotonin reuptake inhibitor fluvoxamine, respectively. Moreover, WIRS significantly decreased the number of cells holding BrdU without affecting the differentiation ratio to astroglial and  neuronal lineages 28 days later. Prior administration of an NMDA receptor antagonist significantly prevented the aforementioned changes by WIRS. These results suggest that NMDA receptors may play a role in mechanisms underlying the  crisis of a variety of psychiatric symptoms relevant to post-traumatic stress disorder through transient suppression of neural progenitor cell proliferation in the murine hippocampal dentate gyrus.

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

PMID: 18221371 [PubMed - indexed for MEDLINE]

 

J Occup Environ Med. 2008 Jun;50(6):689-95.

Mental health outcomes in police personnel after Hurricane Katrina.

West C, Bernard B, Mueller C, Kitt M, Driscoll R, Tak S.

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Cincinnati, Ohio 45226, USA. cawest@cdc.gov

OBJECTIVE: We examined symptoms of depression and posttraumatic stress disorder (PTSD) among New Orleans Police Department (NOPD) personnel who provided law enforcement and relief services to affected communities following Hurricane Katrina. METHODS: We conducted a cross-sectional survey of mental health outcomes related to personal and work-related exposures of police personnel 8 weeks after  the Hurricane. RESULTS: Of the 912 police personnel who completed the questionnaire, 227 (26%) reported symptoms consistent with depression and 170 (19%) reported symptoms consistent with PTSD. Risk factors associated with PTSD include recovery of bodies, crowd control, assault, and injury to a family member. Depressive symptoms were associated with rare family contact, uninhabitable home, isolation from the NOPD, assault, and injury to a family member. CONCLUSIONS: Police personnel reported symptoms of PTSD and depression associated with work-related and personal factors following Hurricane Katrina.

PMID: 18545096 [PubMed - in process]

 

J Psychiatr Res. 2008 Jun;42(7):515-20. Epub 2008 Feb 29.

Presence and acquired origin of reduced recall for fear extinction in PTSD: results of a twin study.

Milad MR, Orr SP, Lasko NB, Chang Y, Rauch SL, Pitman RK.

Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, United States. milad@nmr.mgh.harvard.edu

Recall of fear extinction, which is thought to aid in recovery from a psychologically traumatic event, is hypothesized to be deficient in post-traumatic stress disorder (PTSD), but this has not yet been demonstrated in  the laboratory, nor has its origin been investigated. To address these two issues, 14 pairs of monozygotic twins discordant for combat exposure, in 7 of which the combat-exposed twin had PTSD, underwent a two-day fear conditioning and extinction procedure. On Day 1, subjects viewed colored light conditioned stimuli, some of which were paired with mild electric shock, followed by extinction of the conditioned responses. On Day 2, recall of Day 1 extinction learning (i.e., extinction retention) was assessed. Skin conductance response (SCR) was the dependent measure. There were no group differences during acquisition or extinction learning. However, a significant PTSD Diagnosis (in the exposed twin) x combat Exposure interaction emerged during extinction recall, with the PTSD combat veterans having larger SCRs than their own co-twins, and than the non-PTSD combat veterans and their co-twins. These results indicate that retention of extinction of conditioned fear is deficient in PTSD. Furthermore, they support the conclusion that this deficit is acquired as a result of combat trauma leading to PTSD, rather than being a predisposing factor to developing PTSD upon the stress of combat.

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

PMID: 18313695 [PubMed - indexed for MEDLINE]

 

J Psychosoc Nurs Ment Health Serv. 2008 Jun;46(6):41-51.

Comment in:     J Psychosoc Nurs Ment Health Serv. 2008 Oct;46(10):12; author reply 12, 53.

Health disparities in military veterans with PTSD: influential sociocultural factors.

Nayback AM.

U.S. Army, TX, USA. ann_nayback@yahoo.com

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness  and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.

Publication Types:      Review

PMID: 18595458 [PubMed - indexed for MEDLINE]

 

J R Army Med Corps. 2008 Jun;154(2):136-9.

The mental health of veterans.

Murphy D, Iversen A, Greenberg N.

King's Centre for Military Health Research, King's College London.

For the majority service in the Armed Forces is beneficial and, in the main, military veterans have successful lives. However, a minority have a bleaker outlook as a result of on-going ill health and social exclusion. Whilst the media focuses on Post Traumatic Stress Disorder, in reality the most frequent mental health problems for veterans are alcohol problems, depression and anxiety disorders. These difficulties are difficult to manage as veterans, particularly those who are unwell, demonstrate a reticence to seek help for mental health problems. Another issue is that many veterans are now reserve personnel who have  been found to be at greater risk of developing mental health problems than their  regular counterparts. Steps to improve the knowledge and expertise of primary care services about veteran's mental health issues and increasing the availability of treatment options are important and are underway.

PMID: 19043996 [PubMed - in process]

 

J Trauma Stress. 2008 Jun;21(3):333-9.

Trauma exposure and the drug endangered child.

Sprang G, Staton-Tindall M, Clark J.

Center for the Study of Violence Against Children, University of Kentucky, Lexington, KY 40509, USA. sprang@uky.edu

This study examines the differences in trauma exposure and the response to those  events between drug endangered children (DEC) and non-drug endangered children involved in the child welfare system. This data represents the experiences of 1,127 children randomly selected from the state's child protective service database and represents 20% of all open cases during 2005-2006. Archival data were analyzed to determine the presence of exposure using DSM-IV-TR posttraumatic stress disorder (PTSD) Criterion A1, and whether or not the child's response to exposure met PTSD Criterion A2. Results reveal high rates of trauma exposure in the DEC group and indicate that trauma exposure and trauma response did significantly vary across groups. Implications for the assessment and treatment of child welfare-involved children are drawn.

Publication Types:      Comparative Study

PMID: 18553419 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):326-32.

Assessing the psychometric properties of the World Assumptions Scale.

Kaler ME, Frazier PA, Anders SL, Tashiro T, Tomich P, Tennen H, Park C.

Department of Psychology, University of Minnesota, Twin Cities Campus, Minneapolis, MN 55455, USA.

The notion that traumatic events shatter survivors' fundamental assumptions about the world has been accepted as a truism in the trauma literature, although tests  of this hypothesis provide a somewhat mixed picture. Because this research has relied heavily on the World Assumptions Scale (WAS), it is unclear whether these  inconsistent results are due to problems with assumptive world theory, improper tests of the theory, or problems with the WAS. Data were gathered from 742 undergraduate students at four universities to assess the psychometric properties of the WAS. Findings suggest several shortcomings of the WAS, including temporal  instability, and mixed evidence regarding construct validity. Implications for trauma research are discussed.

Publication Types:      Multicenter Study

PMID: 18553418 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):301-8.

A2 diagnostic criterion for combat-related posttraumatic stress disorder.

Adler AB, Wright KM, Bliese PD, Eckford R, Hoge CW.

US Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Heidelberg, Germany. amy.adler@us.army.mil

Individuals trained to respond to a potentially traumatic event may not experience the posttraumatic stress disorder (PTSD) A2 diagnostic criterion of fear, helplessness, or horror and yet may still report significant PTSD symptoms. The present study included interviews with 202 soldiers returning from a year in  Iraq. Although reporting an A2 response was associated with higher PTSD Checklist scores, there were no significant differences in the percentage of subjects who met cutoff criteria for PTSD. The most common alternative A2 responses were related to military training and anger. The A2 criterion for PTSD should be expanded so as not to underestimate the number of individuals trained for high-risk occupations who might benefit from treatment.

PMID: 18553417 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):290-300.

Estimating population prevalence of posttraumatic stress disorder: an example using the PTSD checklist.

Terhakopian A, Sinaii N, Engel CC, Schnurr PP, Hoge CW.

Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.

The PTSD Checklist (PCL) is among the most widely used self-report instruments for assessing PTSD. To determine PCL's performance on a population level, the authors combined data from published studies that compared the PCL with structured diagnostic interviews. Weighted average sensitivities and specificities were calculated for cutoff categories most often reported in the literature. Weighted average sensitivity decreased from .85 to .39 and specificity increased from .73 to .97 for cutoffs ranging from 30 to 60. The PCL's ability to accurately estimate PTSD prevalence varied as a function of cutoff and true PTSD prevalence. In populations with a true PTSD prevalence of 15% or less, cutoff values below 44 will substantially overestimate PTSD prevalence. Uncalibrated use of the PCL for prevalence estimation may lead to large errors.

Publication Types:      Comparative Study     Review

PMID: 18553416 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):274-81.

Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection.

Kaniasty K, Norris FH.

Department of Psychology, Indiana University of Pennsylvania, Indiana, PA 15705,  USA. kaniasty@iup.edu

The authors examined social causation and social selection explanations for the association between perceptions of social support and psychological distress. Data came from a sample of 557 victims of natural disaster in Mexico. Structural  equation modeling analyses indicated that social causation (more social support leading to less posttraumatic stress disorder [PTSD]) explained the support-to-distress relationship in the earlier postdisaster phase, 6 to 12 months after the impact. Both causal mechanisms emerged as significant paths in the midpoint of the study (12 and 18 months). Only social selection (more PTSD leading to less social support) accounted for the support-to-distress relationship at 18 to 24 months after the event. Interpersonal and social dynamics of disasters may explain why these two contrasting causal mechanisms emerged over time.

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

PMID: 18553415 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):264-73.

Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks.

DiGrande L, Perrin MA, Thorpe LE, Thalji L, Murphy J, Wu D, Farfel M, Brackbill RM.

Division of Epidemiology, New York City Department of Health and Mental Hygiene,  New York, NY 10013, USA. ldigrand@health.nyc.gov

Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD.

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

PMID: 18553414 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):352-5.

A confirmatory factor analysis of the acute stress disorder interview.

Brooks R, Silove D, Bryant R, O'Donnell M, Creamer M, McFarlane A.

School of Psychiatry, University of New South Wales, Australia.

Acute stress disorder (ASD) was introduced in 1994 to describe posttraumatic stress reactions that occur in the initial month after trauma exposure. Although  it comprises the distinct symptom clusters of dissociation, reexperiencing, avoidance, and arousal, there have been no confirmatory factor analyses of the construct. In this study, 587 individuals admitted to five major hospitals after  traumatic injury were administered the Acute Stress Disorder Interview. Forty-four participants met criteria for ASD. Confirmatory factor analysis based  on the four symptom clusters described the Acute Stress Disorder Interview responses. These data provide the first confirmatory factor analysis of the ASD symptoms, and are discussed in terms of the 4-factor models repeatedly found in samples of chronic posttraumatic stress disorder.

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

PMID: 18553413 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):340-3.

Pilot study on prolonged exposure of Japanese patients with posttraumatic stress  disorder due to mixed traumatic events.

Asukai N, Saito A, Tsuruta N, Ogami R, Kishimoto J.

Tokyo Institute of Psychiatry, Tokyo Medical & Dental University, Tokyo, Japan. asukai@prit.go.jp

This pilot study investigated the feasibility of Prolonged Exposure (PE) treatment for Japanese patients with posttraumatic stress disorder (PTSD) due to  mixed traumatic events. Among 12 participants in this study, 9 women and 1 man completed between 9 and 15 weekly individual PE sessions; 2 female participants dropped out in early sessions. Among completers, the authors identified a significant reduction of symptom severity scores from pretreatment to posttreatment in terms of PTSD and depression on therapist-rated and self-rated measurements. Symptom levels remained low in 3- and 6-month follow-up assessments. Our findings suggest that PE is feasible and can be accepted for PTSD patients not only in Western countries, but also for those in Japan.

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

PMID: 18553411 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):318-25.

The contribution of stressful life events throughout the life cycle to combat-induced psychopathology.

Solomon Z, Zur-Noah S, Horesh D, Zerach G, Keinan G.

The Adler Research Center for Child Welfare and Protection, Bob Shapel School of  Social Work, Tel Aviv University, Tel Aviv, Israel. Solomon@post.tau.ac.il

This study examines the contribution of prewar life events, war exposure, and postwar life events to combat-induced psychopathology among 425 Israeli War veterans from the Lebanon War. Data was collected at two time points (1983 and 2002). The sample included veterans with and without combat stress reaction (CSR). Battle intensity and subjective experience of risk in war were associated  with CSR. Negative childhood life events, CSR, PTSD in 1983 and postwar negative  life events were associated with PTSD in 2002. Furthermore, a path analysis revealed that CSR mediated the relation between battle intensity and PTSD in 2002. Our findings suggest that stressful life events throughout the life cycle contribute significantly to veterans' posttraumatic symptomatology, above and beyond combat exposure.

Publication Types:      Comparative Study

PMID: 18553410 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):309-17.

Factorial invariance of posttraumatic stress disorder symptoms across three veteran samples.

McDonald SD, Beckham JC, Morey R, Marx C, Tupler LA, Calhoun PS.

VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC 27705, USA. mcdonald@biac.duke.edu

Research generally supports a 4-factor structure of posttraumatic stress disorder (PTSD) symptoms. However, few studies have established factor invariance by comparing multiple groups. This study examined PTSD symptom structure using the Davidson Trauma Scale (DTS) across three veteran samples: treatment-seeking Vietnam-era veterans, treatment-seeking post-Vietnam-era veterans, and Operation  Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veteran research participants. Confirmatory factor analyses of DTS items demonstrated that a 4-factor structural model of the DTS (reexperiencing, avoidance, numbing, and hyperarousal) was superior to five alternate models, including the conventional 3-factor model proposed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994). Results supported factor invariance across the three veteran cohorts, suggesting that cross-group comparisons are interpretable. Implications and applications for DSM-IV nosology  and the validity of symptom measures are discussed.

Publication Types:      Comparative Study

PMID: 18553409 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):282-9.

Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories.

Cloitre M, Stovall-McClough C, Zorbas P, Charuvastra A.

NYU Child Study Center, Department of Psychiatry, New York University Medical College, New York, NY 10016, USA. marylene.cloitre@nyumc.org

Despite the consistent documentation of an association between compromised attachment and clinical disorders, there are few empirical studies exploring factors that may mediate this relationship. This study evaluated the potential roles of emotion regulation and social support expectations in linking adult attachment classification and psychiatric impairment in 109 women with a history  of childhood abuse and a variety of diagnosed psychiatric disorders. Path analysis confirmed that insecure attachment was associated with psychiatric impairment through the pathways of poor emotion regulation capacities and diminished expectations of support. Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play.

Publication Types:      Comparative Study

PMID: 18553408 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Jun;21(3):253-63.

A group randomized trial of critical incident stress debriefing provided to U.S.  peacekeepers.

Adler AB, Litz BT, Castro CA, Suvak M, Thomas JL, Burrell L, McGurk D, Wright KM, Bliese PD.

US Army Medical Research Unit-Europe, Heidelberg, Germany. amy.adler@us.army.mil

In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more  alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress.

Publication Types:      Randomized Controlled Trial

PMID: 18553407 [PubMed - indexed for MEDLINE]

 

J Womens Health (Larchmt). 2008 Jun;17(5):793-804.

Women, war, and violence: surviving the experience.

Usta J, Farver JA, Zein L.

American University of Beirut, Beirut, Lebanon. ju@aub.edu.lb

OBJECTIVES: To investigate how Lebanese women were affected by the July 2006 conflict that erupted between the Hezbollah and the State of Israel, with a specific focus on their personal violence exposure and how they coped with these  circumstances. METHODS: Participants were 310 women at Ministry of Social Affairs Centers (MOSA) located in six geographic areas with varying exposure to the conflict. A questionnaire was administered in interview format to collect information about the participants' demographic characteristics, experiences of the conflict, perceived psychological functioning, exposure to violence associated with the conflict, exposure to domestic violence during and after the  conflict, and their coping strategies. RESULTS: Of the women, 89% had to leave their homes during the conflict because of fear or worry about safety. Of the 310 participants, 39% reported at least one encounter with violence perpetrated by soldiers, 27% reported at least one incident of domestic abuse during the conflict, and 13% reported at least one incident after the conflict perpetrated by their husbands or other family members. Women's self-reported negative mental  health scores were positively correlated with the violence associated with the conflict and with domestic violence during and after the conflict. Women who reported that they did not know how to cope or had just tried to forget about their experiences reported more frequent domestic violence exposure during the conflict and had higher negative mental health outcomes associated with the conflict than did those who reported using active strategies. CONCLUSIONS: During armed conflict, domestic violence is also likely to increase. Therefore, when investigating the psychological impact of war on women, both forms of violence exposure should be considered. The use of active coping strategies may help in reducing psychological distress.

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

PMID: 18537482 [PubMed - indexed for MEDLINE]

 

Mil Med. 2008 Jun;173(6):576-82.

Challenging the conclusion that lower preinduction cognitive ability increases risk for combat-related post-traumatic stress disorder in 2,375 combat-exposed, Vietnam War veterans.

Thompson WW, Gottesman II.

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

OBJECTIVE: Among U.S. Vietnam War veterans, we assessed whether preinduction cognitive abilities were associated with the risk of developing combat-related post-traumatic stress disorder (PTSD). METHODS: The sample included 2,375 single-term, enlisted, male, Army, Vietnam War veterans who reported exposure to  combat during the war. There were two measures of cognitive abilities obtained before military induction, the Armed Forces Qualification Test and the General Technical Examination. Associations of ability with current and lifetime diagnoses of Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised, combat-related PTSD were assessed. An index was used to grade the severity of combat exposure. RESULTS: Among low-combat exposure veterans, higher  preinduction cognitive abilities decreased the risk for lifetime, Diagnostic and  Statistical Manual of Mental Disorders, Third Edition Revised, combat-related PTSD. For veterans with higher levels of combat exposure, higher scores for preinduction cognitive abilities had no effect on reducing the risk for lifetime  diagnosis of combat-related PTSD. For a current diagnosis of combat-related PTSD, approximately 20 years after the stressful life events, preinduction cognitive abilities had no effect on the rates of combat-related PTSD. CONCLUSIONS: We found significant interactions between preinduction cognitive abilities and severity of combat exposure for the lifetime diagnosis of combat-related PTSD among Army Vietnam War veterans. High levels of combat exposure are likely to exhaust intellectual resources available for coping with stressful life events. Lower scores for cognitive abilities are not uniformly disadvantageous, and this  should be considered by military manpower policymakers.

PMID: 18595422 [PubMed - indexed for MEDLINE]

 

Mil Med. 2008 Jun;173(6):570-5.

Long-term effects of military service on mental health among veterans of the Vietnam War era.

Brooks MS, Laditka SB, Laditka JN.

Army-Baylor Graduate Program in Health and Business Administration, Army Medical  Department Center and School, Fort Sam Houston, TX 78234, USA.

Comparing outcomes of veterans who served in Vietnam and those who served elsewhere, we examined treatment of post-traumatic stress disorder, treatment of  other mental health conditions, psychiatric treatment location, and six mental health well-being measures. The analytic sample consisted of nationally representative data from the 2001 National Survey of Veterans. Analyses included  multivariate logistic regression that controlled for sociodemographic characteristics. Of Vietnam War-era veterans in the National Survey of Veterans (N = 7,914), 3,937 served in Vietnam and 3,977 served elsewhere. These veterans were stratified into < 60 years of age (N = 6,141) and > or = 60 years of age (N  = 1,766). Veterans who served in Vietnam had notably poorer mental health than did those who served elsewhere. There were striking mental health differences between younger and older veterans; younger veterans had substantially worse measures of mental health. These results suggest greater resource needs among younger Vietnam War veterans. Clinicians and the Department of Veterans Affairs should focus on mental health services for younger veterans.

PMID: 18595421 [PubMed - indexed for MEDLINE]

 

Mil Med. 2008 Jun;173(6):v-viii.

Standardized model is needed to study the neurological effects of primary blast wave exposure.

Bell MK.

Publication Types:      Editorial

PMID: 18595410 [PubMed - indexed for MEDLINE]

 

Neuropsychiatr Dis Treat. 2008 Jun;4(3):635-46.

Disruption of bradycardia associated with discriminative conditioning in combat veterans with PTSD.

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

Shirley L. Buchanan Neuroscience Laboratory, Dorn VA Medical Center Columbia, SC, USA.

The effects of combat-related posttraumatic stress disorder (PTSD) on heart rate  (HR) responding associated with a discriminative delay eyeblink (EB) conditioning paradigm are reported. Combat PTSD+, Combat PTSD-, and Noncombat PTSD- veterans were assessed with psychometric self-report measures, and baseline heart rate variability (HRV) was measured before receiving a 72-trial session of discriminative EB classical conditioning. Two types (red or green light) of conditioned stimuli (CS) were used: one (CS+) predicted a tone, followed immediately by an aversive stimulus (corneal airpuff); the other (CS-) predicted  a tone alone, not followed by the airpuff. The light signal was presented for 5 seconds, during which HR was measured. On all psychometric measures, the PTSD+ subgroup was significantly different from the PTSD- subgroups (Combat + Noncombat), and the PTSD- subgroups did not significantly differ from each other. A linear deceleration in HR to CS+ and CS- signals was found in the combined PTSD- subgroup and on CS- trials in the PTSD+ subgroup, but was not present on CS+ trials in the PTSD+ subgroup. Results are interpreted with respect to a behavioral stages model of conditioned bradycardia and in terms of neural substrates which are both critical to HR conditioning and known to be abnormal in PTSD.

PMID: 18830395 [PubMed - in process]

 

Pol Merkur Lekarski. 2008 Jun;24(144):572-6.

[Psychiatric disorders of the contemporary battlefield]

[Article in Polish]

Korzeniewski K.

Wojskowy Instytut Medyczny MON, Zakład Medycyny Morskiej i Tropikalnej w Gdyni. kktropmed@wp.pl

This article presents the factors exerted an influence on psychiatric health status of participants of military missions and psychiatric disorders forming on  the contemporary battlefield. The main stressors are threats being a result of duty in warfare, also hard climatic conditions, long-lasting separation from family, foreign language of local population, other customs, religion, caused alienation of mission personnel. Significant factors seem also dependences on duty and unofficial relationships prevailing in military environment. The consequence of survived psychiatric trauma being a result of short-lived incident or prolonged event are often acute stress disorder (ASD) or posttraumatic stress  disorder (PTSD).

Publication Types:      English Abstract     Review

PMID: 18702347 [PubMed - indexed for MEDLINE]

 

Psychiatr Danub. 2008 Jun;20(2):208-16.

Survey of domestic violence among young adolescents in Slovenia.

Sprah L.

Sociomedical Institute Scientific Research Centre of the Slovenian Academy of Sciences and Arts, Novi trg 2, 1000 Ljubljana, Slovenia. lilijana.sprah@guest.arnes.si

OBJECTIVE: It has been estimated that domestic violence is wide spread in Slovenia, but the lack of empirical data of domestic violence prevalence and its  consequences, aggravate the precise knowledge on the extension of the phenomenon. The aim of the study was to assess the extensiveness and characteristics of domestic violence in the group of Slovenian adolescents. SUBJECTS: 1297 young adolescents (age 13-15 years) from 65 Slovenian primary schools participated in the study. METHODS: A questionnaire for domestic violence experience and help seeking screening, McMaster Family Functioning Scale, Buss/Perry Aggression Questionnaire and Trauma Symptom Checklist for Children (TSCC) have been applied. RESULTS: 18.7% of participants experienced violence in their own family (38.3% males and 61.7% females). Different patterns of verbal violence, irritability and indirect violence predominated. In the most cases of domestic violence the adolescent's parents were involved as perpetrators and their close relatives (brothers, sisters). Victims displayed a significant profile that could be linked with their violence experience: dysfunctional family environmental, aggressiveness, anxiety, depression, anger and posttraumatic stress symptoms. CONCLUSIONS: Presented study confirmed that the phenomenon of domestic violence and abused adolescents is quite widespread in Slovenia and that in the future more attention on research and policy making level should be given to this phenomenon. Particularly the perceived gap between attitudes towards support and  the actually given help could be the orientation for developing a better prevention strategies and screening procedures for domestic violence. A proper intervention and protection of the adolescent victims could effectively prevent the outburst of depression, suicide, behavioural problems and, spreading the aggressive behaviour patterns to the future generations.

PMID: 18587291 [PubMed - indexed for MEDLINE]

 

Psychiatr Q. 2008 Jun;79(2):139-50. Epub 2008 May 20.

Comorbid anxiety in bipolar disorder alters treatment and prognosis.

El-Mallakh RS, Hollifield M.

Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, MedCenter One, 501 E Broadway, Louisville, KY 40202, USA. rselma01@louisville.edu

Mood disorders in general, and bipolar disorder in particular, are unique among the psychiatric conditions in that they are associated with extraordinarily high  rates of comorbidity with a multitude of psychiatric and medical conditions. Among all the potential comorbidities, co-occurring anxiety disorders stand out due to their very high prevalence. Outcome in bipolar illness is worse in the presence of a comorbid anxiety disorder. The coexistence of an anxiety disorder presents a particularly difficult challenge in the treatment of bipolar illness since antidepressants, the mainstay of pharmacologic treatments for anxiety, may  adversely alter the course of manic-depression. Identification of anxiety disorders in bipolar patients is important. The treatment plan needs to balance the potential benefit and harm of antidepressant administration.

Publication Types:      Comparative Study     Review

PMID: 18491230 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2008 Jun;59(6):635-40.

Evaluation of universal screening for military-related sexual trauma.

Kimerling R, Street AE, Gima K, Smith MW.

National Center for PTSD, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, CA 94131, USA. rachel.kimerling@va.gov

OBJECTIVES: In response to growing concerns about sexual violence as an underrecognized traumatic consequence of military service, Veterans Health Administration policy requires universal screening for sexual trauma sustained during military service. This prospective study, the first to evaluate national efforts to screen for military sexual trauma, investigated whether sexual trauma  screening is associated with increased utilization of mental health services. METHODS: This study examined data for all male (N=540,381) and female (N=33,259)  veterans who had valid responses to screens for military sexual trauma in 2005. The use of mental health services during the three months after screening was examined for persons who screened positive for military sexual trauma and for those who screened negative. Findings were stratified by use of mental health services in the six months before the screening. RESULTS: Compared with negative  screens, positive screens were associated with significantly increased rates of postscreen mental health treatment. A more than twofold increase was observed for patients without previous use of mental health treatment (women: relative risk [RR]=2.52, 95% confidence interval [CI]= 2.38-2.66; men: RR=2.47, 95% CI=2.34-2.61). In this group, the number of positive screens needed for one additional patient to access treatment was 5.5 for women and 7.2 for men. CONCLUSIONS: Our findings suggest that detection via screening is associated with increased rates of mental health treatment. An effective screening program that promotes detection of sexual trauma and access to mental health care can help to  reduce the burden of psychiatric illness for those who have experienced military  sexual trauma.

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

PMID: 18511583 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2008 Jun;59(6):627-34.

Trauma and PTSD among adolescents with severe emotional disorders involved in multiple service systems.

Mueser KT, Taub J.

Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire. kim.t.mueser@dartmouth.edu

OBJECTIVE: This study examined the prevalence and correlates of posttraumatic stress disorder (PTSD) among adolescents with severe emotional disorders who were involved in multiple service systems. METHODS: Sixty-nine adolescents, ages 11-17, and their primary caregivers participated in a system-of-care project in three regions of New Hampshire and were interviewed to determine adolescent trauma exposure, prevalence of PTSD, treatment history, family background, behavioral and emotional problems, functioning, caregiver strain, and strengths and resilience. RESULTS: The rate of current PTSD was 28%, which was underdiagnosed in adolescents' medical records. PTSD was related to gender (42% for girls and 19% for boys; p=.03), history of sexual abuse (61% among youths with sexual abuse and 15% among youths without), chart diagnosis of depression (47% among youths with depression diagnoses and 16% among youths without), and treatment with multiple psychotropic medications (53% among youths prescribed two or more medications and 26% among those prescribed no medication or one medication). Adolescents with PTSD also were more likely to have run away, engaged in self-injurious and delinquent behavior, reported higher anxiety and depression, and functioned worse at school and home than those without PTSD. CONCLUSIONS: PTSD is a common but underdiagnosed disorder among adolescents with  severe emotional and behavioral disorders who are involved in multiple service systems. Routine screening for trauma exposure and PTSD should be conducted with  all adolescents receiving mental health services so that treatment can be provided to those with PTSD.

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

PMID: 18511582 [PubMed - indexed for MEDLINE]

 

Psychoanal Rev. 2008 Jun;95(3):387-416.

Traumatic memories and the need to punish: the boycott of Israeli academics.

Silver CB.

464 Riverside Drive, New York, NY 10027, USA. csilver@brooklyn.cuny.edu

PMID: 18554104 [PubMed - indexed for MEDLINE]

 

Psychol Assess. 2008 Jun;20(2):131-8.

Change in posttraumatic stress disorder symptoms: do clinicians and patients agree?

Monson CM, Gradus JL, Young-Xu Y, Schnurr PP, Price JL, Schumm JA.

Women's Health Sciences Division, National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. Candice.Monson@va.gov

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the  PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed.

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

PMID: 18557690 [PubMed - indexed for MEDLINE]

 

Psychol Rep. 2008 Jun;102(3):779-90.

Effects of trauma and religiosity on self-esteem.

Reiland S, Lauterbach D.

Eastern Michigan University, USA.

Self-esteem is often lower among persons who have experienced trauma, but religiosity may ameliorate these psychological effects. The purpose of this paper was to examine the relationships among religiosity, self-esteem, and childhood exposure to trauma, utilizing data from the National Comorbidity Survey, a large  (N = 8,098) nationally representative population survey in the 48 contiguous states of the USA that assessed religious practices, self-esteem, and exposure to trauma. Exposure to trauma in childhood was assessed through self-report of presence or absence of childhood physical abuse, sexual abuse, or neglect. Religiosity was assessed as the sum of responses to 4 self-report items (religious service attendance, use of religion for comfort and guidance, and importance of religion). Self-esteem was assessed on 9 self-report items adapted  from the Rosenberg Self-Esteem Scale. Analysis of variance compared scores for persons who reported exposure to childhood abuse and differed in the value they placed on various religious practices on self-esteem. Persons who reported physical abuse, sexual abuse, or neglect in childhood had significantly lower mean self-esteem than those who did not report these events. There was also a main effect for religiosity in a comparison of persons who reported childhood sexual abuse with those who reported none. The High Religiosity group had higher  mean self-esteem than the Medium and Low Religiosity groups. There was a significant interaction as those who reported childhood sexual abuse had lower mean self-esteem than peers who reported none in the Low and Medium Religiosity groups. Mean self-esteem for those who reported childhood sexual abuse was comparable to that of those who reported none in the High Religiosity group.

PMID: 18763449 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2008 Jun;70(5):531-8.

Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care.

Whetten K, Reif S, Whetten R, Murphy-McMillan LK.

Center for Health Policy, Law, and Management, Department of Public Policy, Duke  University, Durham NC 27708, USA. K.whetten@duke.edu

Individuals living with HIV often have complicated histories, including negative  experiences such as traumatic events, mental illness, and stigma. As the medical  community in the United States adapts to managing HIV as a chronic disease, understanding factors such as these negative experiences that may be associated with poorer adherence to treatment regimens, greater HIV risk behavior, and lower patient quality of life becomes critical to HIV care and prevention. In less wealthy nations, these issues are also critical for addressing quality of life as well as medication adherence in the areas where antiretroviral therapies are being made available. This article presents a review of the literature regarding  the following psychosocial factors as they relate to HIV/AIDS in the US and globally: traumatic events; mental illness, including depression, anxiety, and posttraumatic stress disorder; lack of trust in the healthcare system and government; and experiences of stigma among individuals with HIV disease. These factors have been found to be prevalent among individuals with HIV/AIDS, regardless of gender or race/ethnicity. Traumatic events, mental illness, distrust, and stigma have also been linked with poorer adherence to medication regimens and HIV risk behavior.

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

PMID: 18541904 [PubMed - indexed for MEDLINE]

 

Psychother Psychosom Med Psychol. 2008 Jun;58(6):257-63. Epub 2007 Oct 23.

[Psychological complaints, interpersonal problems, quality of life and sense of coherence in former German warchildren]

[Article in German]

Kuwert P, Spitzer C, Dudeck M, Vogel M, Freyberger HJ, Ermann M.

Klinik und Poliklinik für Psychiatrie und Psychotherapie der Ernst-Moritz-Arndt-Universität Greifswald am HANSE-Klinikum Stralsund. kuwert@uni-greifswald.de

Recently there is a growing psychotraumatological interest in late life effects in former German warchildren. The following article focusses on kind and amount of trauma and psychopathology (Symptom Check List 90-R; SCL-90-R) in elderly people, who have grown up during World War II. By means of psychometric self-reports we assessed their current interpersonal problems (Inventory of Interpersonal Problems; IIP), the quality of life (SF-36 Health Survey) and their sense of coherence (Antonovsky's Sense of coherence-Scale; SOC). Compared to norms from the general population and from "healthy controls", respectively, former German warchildren showed a higher psychopathological distress. They showed an interpersonal pattern of lower expressive/dominant in favour of enlarged passive and caring behaviour. The psychosocial dimension of quality of life was reduced, in contrast to the somatic scales. The former warchildren showed an increased sense of coherence, especially in the dimension of "meaningfulness". We discuss our findings in the light of the current scientifical knowledge and highlight possible future prospects to develop the warchildhood debate from the clinical and scientifical point of view.

Publication Types:      English Abstract

PMID: 17957652 [PubMed - indexed for MEDLINE]

 

Sex Abuse. 2008 Jun;20(2):139-60.

Childhood maltreatment and cluster B personality pathology in female serious offenders.

Loper AB, Mahmoodzadegan N, Warren JI.

University of Virginia, Charlottesville, VA 22904, USA. abl2x@virginia.edu

The authors examined early maltreatment among serious female offenders at a maximum-security correctional facility, contrasting the maltreatment histories of inmates with and without Cluster B personality pathology. Women were interviewed  regarding the frequency of 13 indicators of psychological or physical abuse perpetrated by maternal or paternal caregivers and the frequency of 10 types of sexual abuse perpetrated by persons at least 5 years older. Reports were based on inmates' recollected worst years of maltreatment before age 16. Women in both diagnostic groups reported substantial early maltreatment. Cluster B inmates reported higher levels and a greater variety of maternal and paternal physical and psychological abuse but were not distinguished from non-Cluster B inmates on  levels of childhood sexual abuse. Inmates reported more physical and psychological abuse from maternal than paternal caregivers. The results document  the high levels of childhood maltreatment of female prisoners and the relevance of this history to personality pathology.

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

PMID: 18490479 [PubMed - indexed for MEDLINE]

 

Sleep Med Rev. 2008 Jun;12(3):165-7.

Sleep and post-traumatic stress disorder: a roadmap for clinicians and researchers.

Mellman TA.

Publication Types:      Editorial     Introductory Journal Article

PMID: 18486033 [PubMed - indexed for MEDLINE]

 

Sleep Med Rev. 2008 Jun;12(3):169-84.

Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature?

Spoormaker VI, Montgomery P.

Centre for Evidence-Based Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom. spoormaker@sleephealth.eu

Sleep disturbances are often viewed as a secondary symptom of post-traumatic stress disorder (PTSD), thought to resolve once PTSD has been treated. Specific screening, diagnosis and treatment of sleep disturbances is therefore not commonly conducted in trauma centres. However, recent evidence shows that this view and consequent practices are as much unhelpful as incorrect. Several sleep disorders-nightmares, insomnia, sleep apnoea and periodic limb movements-are highly prevalent in PTSD, and several studies found disturbed sleep to be a risk  factor for the subsequent development of PTSD. Moreover, sleep disturbances are a frequent residual complaint after successful PTSD treatment: a finding that applies both to psychological and pharmacological treatment. In contrast, treatment focusing on sleep does alleviate both sleep disturbances and PTSD symptom severity. A growing body of evidence shows that disturbed sleep is more than a secondary symptom of PTSD-it seems to be a core feature. Sleep-focused treatment can be incorporated into any standard PTSD treatment, and PTSD research needs to start including validated sleep measurements in longitudinal epidemiologic and treatment outcome studies. Further clinical and research implications are discussed, and possible mechanisms for the role of disturbed (REM) sleep in PTSD are described.

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

PMID: 18424196 [PubMed - indexed for MEDLINE]

 

Sleep Med Rev. 2008 Jun;12(3):197-210. Epub 2008 Jan 25.

Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity.

Meerlo P, Sgoifo A, Suchecki D.

Department of Molecular Neurobiology, Center for Behavior and Neurosciences, University of Groningen, P.O. Box 14, 9750 AA Haren, The Netherlands. p.meerlo@rug.nl

Frequently disrupted and restricted sleep is a common problem for many people in  our modern around-the-clock society. In this context, it is an important question how sleep loss affects the stress systems in our bodies since these systems enable us to deal with everyday challenges. Altered activity and reactivity of these systems following insufficient sleep might have serious repercussions for health and well-being. Studies on both humans and rodents have shown that sleep deprivation and sleep restriction are conditions often associated with mild, temporary increases in the activity of the major neuroendocrine stress systems, i.e., the autonomic sympatho-adrenal system and the hypothalamic-pituitary-adrenal axis. Sleep deprivation may not only have a direct activating effect by itself but, in the long run, it may also affect the reactivity of these systems to other stressors and challenges. Although the first signs of alterations in the way people deal with challenges under conditions of restricted sleep appear to be on the level of emotional perception, chronic sleep restriction may ultimately change the fundamental properties of neuroendocrine stress systems as well. Understandably, few controlled studies in humans have been devoted to this topic. Yet, experimental studies in rodents show that chronic sleep restriction may gradually alter neuroendocrine stress responses as  well as the central mechanisms involved in the regulation of these responses. Importantly, the available data from studies in laboratory animals suggest that sleep restriction may gradually change certain brain systems and neuroendocrine systems in a manner that is similar to what is seen in stress-related disorders such as depression (e.g., reduced serotonin receptor sensitivity and altered regulation of the hypothalamic-pituitary-adrenal axis). Such data support the view that insufficient sleep, by acting on stress systems, may sensitize individuals to stress-related disorders. Indeed, epidemiological studies suggest  that sleep complaints and sleep restriction may be important risk factors for a variety of diseases that are often linked to stress, including cardiovascular diseases and mood disorders.

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

PMID: 18222099 [PubMed - indexed for MEDLINE]

 

Sleep Med Rev. 2008 Jun;12(3):185-95. Epub 2007 Nov 9.

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. germaina@upmc.edu

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.

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

PMID: 17997114 [PubMed - indexed for MEDLINE]

 

Transcult Psychiatry. 2008 Jun;45(2):287-317.

The 'multiplex model' of somatic symptoms: application to tinnitus among traumatized Cambodian refugees.

Hinton DE, Hinton SD, Loeum RJ, Pich V, Pollack MH.

Harvard Medical School, MA, USA. devon_hinton@hms.harvard.edu

Somatic symptoms are a common clinical presentation of distress among ethnic populations in the USA, particularly traumatized refugees. In this article, we apply a 'multiplex model' of bodily experience to explain how a somatic symptom is evoked, amplified, and generates distress, particularly distress related to post-traumatic stress disorder. We illustrate the multiplex model's applicability to acute episodes of tinnitus (i.e., a buzzing-like sound in the ear) among Cambodian refugees, a common symptom in that group. The article demonstrates the  importance of carefully examining somatic symptoms and associated meanings in distressed ethnic populations, especially traumatized refugees, and aims to contribute to a medical anthropology of somatic symptoms.

PMID: 18562496 [PubMed - indexed for MEDLINE]

 

Transcult Psychiatry. 2008 Jun;45(2):163-97.

Coming to our senses: appreciating the sensorial in medical anthropology.

Nichter M.

University of Arizona, Tucson, AZ 85721, USA. Mnichter@u.arizona.edu

This article supports the call for the sensorially engaged anthropological study  of healing modalities, popular health culture, dietary practices, drug foods and  pharmaceuticals, and idioms of distress. Six concepts are of central importance to sensorial anthropology: embodiment, the mindful body, mimesis, local biology,  somatic idioms of distress, and 'the work of culture'. Fieldwork in South and Southeast Asia and North America illustrates how cultural interpretations associate bodily sensations with passions (strong emotions) and anxiety states, and bodily communication about social relations. Lay interpretations of bodily sensations inform and are informed by local understanding of ethnophysiology, health, illness, and the way medicines act in the body. Bodily states are manipulated by the ingestion of substances ranging from drug foods (e.g., sources of caffeine, nicotine, dietary supplements) to pharmaceuticals that stimulate or  suppress sensations concordant with cultural values, work demands, and health concerns. Social relations are articulated at the site of the body through somatic modes of attention that index bodily ways of knowing learned through socialization, bodily memories, and the ability to relate to how another is likely to be feeling in a particular context. Sensorial anthropology can contribute to the study of transformative healing and trajectories of healthcare  seeking and patterns of referral in pluralistic healthcare arenas.

PMID: 18562492 [PubMed - indexed for MEDLINE]

 

Violence Against Women. 2008 Jun;14(6):634-54.

Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse.

Mechanic MB, Weaver TL, Resick PA.

California State University, Fullerton, CA, USA.

Battered women are exposed to multiple forms of intimate partner abuse. This article explores the independent contributions of physical violence, sexual coercion, psychological abuse, and stalking on symptoms of posttraumatic stress disorder (PTSD) and depression among a sample of 413 severely battered, help-seeking women. The authors test the unique effects of psychological abuse and stalking on mental health outcomes, after controlling for physical violence,  injuries, and sexual coercion. Mean scores for the sample fall into the moderate  to severe range for PTSD and within the moderate category for depression scores.  Hierarchical regressions test the unique effects of stalking and psychological abuse, after controlling for physical violence, injuries, and sexual coercion. Psychological abuse and stalking contribute uniquely to the prediction of PTSD and depression symptoms, even after controlling for the effects of physical violence, injuries, and sexual coercion. Results highlight the importance of examining multiple dimensions of intimate partner abuse.

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

PMID: 18535306 [PubMed - indexed for MEDLINE]

 

Eur J Pharmacol. 2008 May 31;586(1-3):205-11. Epub 2008 Mar 13.

Stress and re-stress increases conditioned taste aversion learning in rats: possible frontal cortical and hippocampal muscarinic receptor involvement.

Brand L, Groenewald I, Stein DJ, Wegener G, Harvey BH.

Unit for Drug Research and Development, School of Pharmacy (Pharmacology), North-West University (Potchefstroom Campus), Potchefstroom, 2520, South Africa.

Symptoms of posttraumatic stress disorder are often precipitated by sensory cues  in the form of visual, auditory, olfactory and gustatory "flashbacks" resulting in enhanced fear-memory consolidation and the characteristic symptoms of re-experiencing, avoidance and hyper-arousal. Single prolonged stress with and without re-stress have been used to explore the neurobiology of this disorder, particularly with respect to contextual conditioning and spatial memory impairment. However, less work has been done regarding associative sensory-related memories linked to aversive events. Although growing evidence supports a role for cholinergic pathways in stress, this has not been studied in  the above animal models. We studied the effects of single prolonged stress with and without re-stress on conditioned taste aversion learning in rats, together with differential analysis of frontal cortical and hippocampal [3H]-quinuclidinyl benzylate ([3H]-QNB) muscarinic receptor binding. Single prolonged stress with and without re-stress both enhanced associative sensory aversion learning 7 days  after stressor-taste pairing, although re-stress did not strengthen this response. Increased cortical and hippocampal muscarinic receptor density (Bmax) was found 7 days after single prolonged stress with re-stress, although receptor  affinity remained unaltered. Frontal cortical and hippocampal muscarinic receptor changes may thus underlie conditioned taste aversion learning in rats exposed to  stress and re-stress. These data suggest that it may be useful to study the role  of cholinergic pathways in mediating associative memory in psychiatric disorders  such as posttraumatic stress disorder.

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

PMID: 18439577 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 May 30;159(1-2):226-36. Epub 2008 Apr 18.

Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: a multi-site study.

Zinzow HM, Grubaugh AL, Frueh BC, Magruder KM.

Department of Psychology, University of Georgia, GA, United States.

This study examined the nature and prevalence of sexual assault (SA), as well as  its relationship to psychiatric sequelae and service use, among the veteran population. We performed a secondary data analysis of a cross-sectional dataset consisting of 643 male and 173 female veterans seen in four Veterans Affairs (VA) primary care clinics. Original data were obtained through semi-structured clinic  assessments, structured telephone interviews, and medical chart reviews. Analyses included descriptive statistics, chi-square, analysis of variance (ANOVA), and logistic regression. The lifetime prevalence of SA was 38% among women and 6% among men. Of veterans reporting a history of SA, most experienced child sexual abuse and sexual revictimization. SA victims also had a more extensive trauma history and demonstrated greater psychological impairment in comparison to veterans reporting other types of trauma. However, only 25% of male SA survivors  and 38% of female SA survivors used mental health services in the past year. These findings suggest that VA primary care clinics may benefit from expanding the current mandated screen for military sexual trauma to include lifetime experiences and trauma-related symptoms, thereby connecting more veterans with needed mental health services.

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

PMID: 18423615 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 May 30;159(1-2):140-6. Epub 2008 Apr 21.

Posttraumatic stress disorder, cognitive function and quality of life in patients with schizophrenia.

Fan X, Henderson DC, Nguyen DD, Cather C, Freudenreich O, Evins AE, Borba CP, Goff DC.

Schizophrenia Program, Department of Psychiatry, Massachusetts General Hospital,  Harvard Medical School, Boston, MA 02114, USA. xfan@partners.org

The purpose of the present study was to assess posttraumatic stress disorder (PTSD), cognitive function, and quality of life in patients with schizophrenia who had a self-reported history of trauma exposure. Outpatients diagnosed with schizophrenia or schizoaffective disorder were referred to the study. Each patient was assessed with the Positive and Negative Syndrome Scale (PANSS), the Harvard Trauma Questionnaire (HTQ), a cognitive assessment battery, Heinrich's Quality of Life Scale (QLS), and the Behavior and Symptom Identification Scale (BASIS). Eighty-seven subjects who reported experiencing at least one traumatic event were included in the study. Fifteen of 87 (17%) met the DSM-IV criteria for PTSD. The PTSD group had significantly worse overall cognitive performance than the non-PTSD group, especially in the domains of attention, working memory and executive function. In addition, the PTSD group showed significantly worse self-rated quality of life as measured by the BASIS total score. The development  of PTSD is associated with poor cognitive function and subjectively, but not objectively, rated low quality of life in patients with schizophrenia. Evaluating PTSD in patients with schizophrenia could have important implications from both clinical and research perspectives.

Publication Types:      Comparative Study

PMID: 18423611 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 May 30;159(1-2):196-206. Epub 2008 Apr 18.

Differentiating cortical patterns of cognitive dysfunction in schizophrenia and posttraumatic stress disorder.

Galletly CA, McFarlane AC, Clark R.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Elanor Harrald Building, Frome Rd, Adelaide 5000, South Australia, Australia. cherrie.galletly@adelaide.edu.au

Comparative studies are needed to determine whether the cognitive impairments found in various psychiatric disorders are specific to those disorders, or are a  more universal consequence of mental illness. This study compares the patterns of cognitive dysfunction in two conditions characterized by working memory dysfunction, schizophrenia and posttraumatic stress disorder (PTSD). Three matched groups (Schizophrenia, PTSD, Control) of 16 subjects had event related potentials recorded, using a 27 electrode array, while they performed a working memory auditory target detection task. Both disorders were associated with impaired task performance, with greater impairment in schizophrenia. Reduction in N1 amplitude was found only in schizophrenia, and an increase in target N2 amplitude and latency was found only in PTSD. Both patient groups showed a reduction in the amplitude of the non-target and target P3, but the groups were distinguished by a reduction in non-target parietal P3 amplitude in the schizophrenia group and a reduction in target P3 amplitude over the left posterior parietal region in the PTSD Group. This study demonstrates that there are specific patterns of cognitive dysfunction associated with schizophrenia and  with PTSD.

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

PMID: 18423610 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 May 30;159(1-2):101-8. Epub 2008 Mar 11.

Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: outcome is stable in 35-month follow-up.

Högberg G, Pagani M, Sundin O, Soares J, Aberg-Wistedt A, Tärnell B, Hällström T.

Department of Clinical Neuroscience, Section for Psychiatry, Huddinge, Karolinska Institutet, Stockholm, Sweden. goran.hogberg@gmail.com

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may follow major psychological trauma. The disorder is longstanding, even chronic, and there is a need for effective treatment. The most effective short-term treatments are cognitive behavioural therapy and eye movement desensitization and reprocessing (EMDR). Twenty subjects with chronic PTSD following occupational health hazards from "person under train" accidents or assault at work were treated with five sessions of EMDR. They were assessed with psychometric scales and diagnostic interviews before treatment, directly after treatment, at 8 months, and at 35 months after the end of Therapy. The primary outcome variable was full diagnosis  of PTSD according to the DSM-IV diagnostic criteria. Results from interview-based and self-evaluation psychometric scales were used as secondary outcome variables. Immediately following treatment, the patients were divided up into two groups, initial remitters (12 of 20) and non-remitters (8 of 20). There were no drop-outs during therapy, but three patients withdrew during follow-up. The initial result  was maintained at the 35-month follow-up. The secondary outcome variables also showed a significant immediate change towards normality that was stable during the long-term follow-up. After 3 years of follow-up, 83% of the initial remitters had full working capacity.

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

PMID: 18336919 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 May 30;159(1-2):31-6. Epub 2008 Mar 12.

Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief.

Simon NM, Shear MK, Fagiolini A, Frank E, Zalta A, Thompson EH, Reynolds CF 3rd,  Silowash R.

Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114, USA. nsimon@partners.org

Complicated grief (CG) is a debilitating syndrome that can be reliably identified, but there is a paucity of research examining treatment of CG. A targeted psychotherapy for complicated grief (CGT) was recently shown to be efficacious [Shear, K., Frank, E., Houck, P.R., Reynolds, C.F., 3rd, 2005. Treatment of complicated grief: a randomized controlled trial. Journal of the American Medical Association 293, 2601-2608]. We provide a detailed examination of the association of naturalistic pharmacotherapy use with treatment response and study completion in the psychotherapy study. Patients on an antidepressant medication were more likely to complete a full course of CGT (91% vs. 58% completed), while antidepressant use had no effect on completion rates for the comparator, interpersonal psychotherapy (70% vs. 77%). Our naturalistic data underscore the need for prospective, randomized controlled studies of CG pharmacotherapy and psychotherapy alone and in combination.

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

PMID: 18336918 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 May 30;159(1-2):77-85. Epub 2008 Mar 7.

Aggression and psychopathology in detained adolescent females.

Hamerlynck SM, Doreleijers TA, Vermeiren R, Jansen LM, Cohen-Kettenis PT.

VU University Medical Center, Department of Child and Adolescent Psychiatry, c/o  De Bascule, P.O. Box 303, 1115 ZG Duivendrecht, The Netherlands. s.hamerlynck@debascule.com

The aim of the study was to investigate a group of detained females with regard to aggression and psychopathology and to examine the relationship between the two conditions. For this purpose, a representative sample of 216 detained adolescent  females aged 12-18 (mean 15.5) was studied with a standard set of self-report instruments, while a subgroup of 73 parents was interviewed by telephone on the participants' externalizing psychopathology. Based on aggression items derived from the Conduct Disorder section of the Kiddie-SADS, the following three aggression subgroups were identified: (1) non-aggressive (NA; 41%), (2) mildly aggressive (MA; 39%), and (3) severely aggressive (SA; 20%). In addition to high  levels of psychopathology for the group as a whole, differences were found between aggression groups, with the NA group demonstrating the lowest levels, the MA group intermediate levels, and the SA group the highest levels. These differences were most pronounced for externalizing psychopathology, and were also found for post-traumatic stress symptomatology (PTSS) and suicidality. The clinical implications of these findings should be investigated in the future, but may well relate to issues of diagnostic identification and administration of adequate and targeted treatment, especially with regard to PTSS and suicidality.  Since the current study was cross-sectional, the predictive effect of the investigated relationships should be the focus of further study.

Publication Types:      Comparative Study

PMID: 18314201 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatry Ment Health. 2008 May 29;2(1):12.

Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first gulf war.

Al-Turkait FA, Ohaeri JU.

Department of Psychiatry, Psychological Medicine Hospital, Gamal Abdul Naser Road, P,O, Box 4081, Safat, 13041, Kuwait. judeohaeri@hotmail.com.

ABSTRACT: OBJECTIVES: Following the end of the Gulf War that resulted in the liberation of Kuwait, there are no reports on the impact of veterans' traumatic exposure and posttraumatic stress disorder (PTSD) on their children. We compared  the severity of anxiety, depression, deviant behavior and poor family adjustment  among the children of a stratified random sample of four groups of Kuwaiti military men, viz: the retired; an active -in-the-army group (AIA) (involved in duties at the rear); an in-battle group (IB) (involved in combat); and a prisoners -of- war (POWs) group. Also, we assessed the association of father's PTSD/combat status and mother's characteristics with child psychosocial outcomes. METHOD: Subjects were interviewed at home, 6 years after the war, using: the Child Behavior Index to assess anxiety, depression, and adaptive behavior; Rutter Scale A2 for deviant behavior; and Family Adjustment Device for adjustment at home. Both parents were assessed for PTSD. RESULTS: The 489 offspring (250 m, 239 f; mean age 13.8 yrs) belonged to 166 father-mother pairs. Children of POWs tended to have higher anxiety, depression, and abnormal behavior scores. Those whose fathers had PTSD had significantly higher depression scores. However, children of fathers with both PTSD and POW status (N = 43) did not have significantly different outcome scores than the other father PTSD/combat status groups. Mother's PTSD, anxiety, depression and social status were significantly associated with all the child outcome variables. Parental age, child's age and child's level of education were significant covariates. Although children with both parents having PTSD had significantly higher anxiety/depression scores, the  mother's anxiety was the most frequent and important predictor of child outcome variables. The frequency of abnormal test scores was: 14% for anxiety/depression, and 17% for deviant behavior. CONCLUSION: Our findings support the impression that child emotional experiences in vulnerable family situations transcend culture and are associated with the particular behavior of significant adults in  the child's life. The primacy of the mother's influence has implications for interventions to improve the psychological functioning of children in such families. Mental health education for these families has the potential to help those in difficulty.

PMID: 18510770 [PubMed - in process]

 

Child Adolesc Psychiatry Ment Health. 2008 May 20;2(1):9.

Posttraumatic stress disorder (PTSD) in children after paediatric intensive care  treatment compared to children who survived a major fire disaster.

Bronner MB, Knoester H, Bos AP, Last BF, Grootenhuis MA.

Psychosocial Department, Emma Children's Hospital Academic Medical Center, University of Amsterdam, The Netherlands. m.b.bronner@amc.nl.

ABSTRACT: BACKGROUND: The goals were to determine the presence of posttraumatic stress disorder (PTSD) in children after paediatric intensive care treatment, to  identify risk factors for PTSD, and to compare this data with data from a major fire disaster in the Netherlands. METHODS: Children completed the Dutch Children's Responses to Trauma Inventory at three and nine months after discharge from the paediatric intensive care unit (PICU). Comparison data were available from 355 children survivors who completed the same questionnaire 10 months after  a major fire disaster. RESULTS: Thirty-six children aged eight to 17 years completed questionnaires at three month follow-up, nine month follow-up, or both. More than one third (34.5%) of the children had subclinical PTSD, while 13.8% were likely to meet criteria for PTSD. Maternal PTSD was the strongest predictor  for child PTSD. There were no significant differences in (subclinical) PTSD symptoms either over time or compared to symptoms of survivors from the fire disaster. CONCLUSION: This study shows that a considerable number of children have persistent PTSD after PICU treatment. Prevention of PTSD is important to minimize the profound adverse effects that PTSD can have on children's well-being and future development.

PMID: 18489798 [PubMed - in process]

 

BMC Psychiatry. 2008 May 19;8:38.

Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda.

Roberts B, Ocaka KF, Browne J, Oyok T, Sondorp E.

Conflict and Health Programme, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. bayard.roberts@lshtm.ac.uk

BACKGROUND: The 20 year war in northern Uganda between the Lord's Resistance Army and the Ugandan government has resulted in the displacement of up to 2 million people within Uganda. The purpose of the study was to measure rates of post-traumatic stress disorder (PTSD) and depression amongst these internally displaced persons (IDPs), and investigate associated demographic and trauma exposure risk factors. METHODS: A cross-sectional multi-staged, random cluster survey with 1210 adult IDPs was conducted in November 2006 in Gulu and Amuru districts of northern Uganda. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression were measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association of demographic and trauma exposure variables on the outcomes of PTSD and depression. RESULTS: Over half (54%) of the respondents met symptom criteria for PTSD, and over two thirds (67%) of respondents met symptom criteria for depression. Over half (58%) of respondents had experienced 8 or more of the 16 trauma events covered in the questionnaire. Factors strongly linked with PTSD and depression included gender, marital status, distance of displacement, experiencing ill health without medical care, experiencing rape or sexual abuse, experiencing lack of food or water, and experiencing higher rates of trauma exposure. CONCLUSION: This study provides evidence of exposure to traumatic events and deprivation of essential goods and services suffered by IDPs, and the resultant effect this has  upon their mental health. Protection and social and psychological assistance are  urgently required to help IDPs in northern Uganda re-build their lives.

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

PMID: 18489768 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 May 16. [Epub ahead of print]

Substance Use and PTSD Symptoms Impact the Likelihood of Rape and Revictimization in College Women.

Messman-Moore TL, Ward RM, Brown AL.

The present study utilized a mixed retrospective and prospective design with an 8-month follow-up period to test a model of revictimization that included multiple childhood (i.e., child sexual, physical, and emotional abuse) and situational variables (i.e., substance use, sexual behavior) for predicting rape  among 276 college women. It was of particular interest to determine whether traumatic responses (e.g., posttraumatic symptomatology or risky behavior) increased vulnerability for revictimization. During the 8-month follow-up period, 9% of participants were raped; 88% of assaults involved substance use by the victim. Posttraumatic stress disorder (PTSD) symptomatology predicted rape, substance use, and sexual behavior. Substance use, but not sexual behavior, mediated the relation between PTSD symptomatology and rape during the follow-up period. Sexual behavior indirectly impacted risk for rape via substance use. Results suggest that college women with PTSD symptomatology may be at greater risk for rape if they use substances to reduce distress.

PMID: 18487522 [PubMed - as supplied by publi sher]

 

Am J Med Genet C Semin Med Genet. 2008 May 15;148(2):127-32.

Genetics of post-traumatic stress disorder: informing clinical conceptualizations and promoting future research.

Nugent NR, Amstadter AB, Koenen KC.

Brown Medical School and Bradley/ Hasbro Children's Research Center, USA.

The purpose of this article is to provide an overview of genetic research involving post-traumatic stress disorder (PTSD). First, we summarize evidence for genetic influences on PTSD from family investigations. Second, we discuss the distinct contributions to our understanding of the genetics of PTSD permitted by  twin studies. Finally, we summarize findings from molecular genetic studies, which have the potential to inform our understanding of underlying biological mechanisms for the development of PTSD. Copyright 2008 Wiley-Liss, Inc.

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

PMID: 18412098 [PubMed - indexed for MEDLINE]

 

N Engl J Med. 2008 May 15;358(20):2178; author reply 2179.

Comment on:     N Engl J Med. 2008 Jan 31;358(5):453-63.

Mild traumatic brain injury in U.S. soldiers returning from Iraq.

Stonesifer LD.

Publication Types:      Comment     Letter

PMID: 18491418 [PubMed - indexed for MEDLINE]

 

Eur J Pharmacol. 2008 May 13;585(2-3):453-7. Epub 2008 Mar 18.

Pharmacological manipulation of memory reconsolidation: towards a novel treatment of pathogenic memories.

Diergaarde L, Schoffelmeer AN, De Vries TJ.

Department of Anatomy and Neurosciences, Center for Neurogenomics and Cognitive Research, VU Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. l.diergaarde@vumc.nl

Well-consolidated memories, when retrieved, may return to a transiently fragile state, and need to be consolidated again in order to be maintained. This process  has been referred to as memory reconsolidation and presumably serves to modify or strengthen memory traces. In recent years, our understanding of the neurobiological mechanisms underlying this phenomenon has increased rapidly. Here, we will briefly review some of the pharmacological evidence, stressing a crucial role for the brain's major neurotransmitter systems, such as glutamate and noradrenaline, in memory reconsolidation. Pharmacological intervention of reconsolidation processes may have clinical relevance, especially for the treatment of psychiatric disorders that are characterized by pathological memories, including post-traumatic stress disorder and addictive behaviour.

Publication Types:      Review

PMID: 18410917 [PubMed - indexed for MEDLINE]

 

Eur J Pharmacol. 2008 May 6;585(1):64-75. Epub 2008 Feb 26.

The As and Ds of stress: metabolic, morphological and behavioral consequences.

Reagan LP, Grillo CA, Piroli GG.

Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, USA. lpreagan@med.sc.edu

Unlike responses to acute stressful events that are protective and adaptive in nature, chronic stress elicits neurochemical, neuroanatomical and cellular changes that may have deleterious consequences upon higher brain functioning. For example, while exposure to acute stress facilitates memory formation and consolidation, chronic stress or chronic exposure to stress levels of glucocorticoids impairs cognitive performance. Chronic stress or glucocorticoid exposure, as well as impairments in hypothalamic-pituitary-adrenal (HPA) axis function are proposed to participate in the etiology and progression of neurological disorders such as depressive illness, anxiety disorders and post-traumatic stress disorder (PTSD). HPA axis dysfunction, impaired stress responses and elevated basal levels of glucocorticoids are also hallmark features of experimental models of type 1 and type 2 diabetes, as well as diabetic subjects in poor glycemic control. Such results suggest that stress and glucocorticoids contribute to the neurological complications observed in diabetes patients. Interestingly, many of the hyperglycemia mediated changes in the brain  are similar to those observed in depressive illness patients and in experimental  models of chronic stress. Such results suggest that common mechanisms may be involved in the development of the neurological complications associated with Anxiety, Depressive illness and Diabetes: the As and Ds of stress. The aim of the current review will be to discuss the mechanisms through which limbic structures  such as the hippocampus and amygdala respond and adapt to the deleterious consequences of chronic stress and hyperglycemia.

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

PMID: 18387603 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 May 5. [Epub ahead of print]

Unemployment Among Women: Examining the Relationship of Physical and Psychological Intimate Partner Violence and Posttraumatic Stress Disorder.

Kimerling R, Alvarez J, Pavao J, Mack KP, Smith MW, Baumrind N.

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and women's workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms.  When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] =1.60; 95% confidence interval [CI] =1.22, 2.09) and psychological violence (AOR =1.78; 95% CI =1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.

PMID: 18458353 [PubMed - as supplied by publi sher]

 

J Interpers Violence. 2008 May 5. [Epub ahead of print]

Resource Loss and Naturalistic Reduction of PTSD Among Inner-City Women.

Walter KH, Hobfoll SE.

Halting the process of psychosocial and material resource loss has been theorized as being associated with the reduction of Posttraumatic Stress Disorder (PTSD). We examined how the limiting of resource loss was related to alleviation of PTSD  symptoms among 102 inner-city women who originally met diagnostic criteria for PTSD after experiencing interpersonal traumatic events such as child abuse, rape  and sexual assault. Participants whose PTSD symptoms improved and became non-diagnositic for PTSD were compared to those who remained diagnositic. The two groups were not significantly different at pretest. However, at the 6-month time  point, those who became non-diagnositic for PTSD reported less resources loss in  3 of 4 domains. This pattern suggests that as PTSD symptoms decrease, women?s material and psychosocial resource loss dimishes, which in turn, may aid their recovery process.

PMID: 18458352 [PubMed - as supplied by publi sher]

 

BMC Psychiatry. 2008 May 2;8:33.

Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka.

Catani C, Jacob N, Schauer E, Kohila M, Neuner F.

Department of Psychology, University of Konstanz and Center for Psychiatry Reichenau, D-78457 Konstanz, Germany. Claudia.Catani@uni-konstanz.de

BACKGROUND: The consequences of war violence and natural disasters on the mental  health of children as well as on family dynamics remain poorly understood. Aim of the present investigation was to establish the prevalence and predictors of traumatic stress related to war, family violence and the recent Tsunami experience in children living in a region affected by a long-lasting violent conflict. In addition, the study looked at whether higher levels of war violence  would be related to higher levels of violence within the family and whether this  would result in higher rates of psychological problems in the affected children.  METHODS: 296 Tamil school children in Sri Lanka's North-Eastern provinces were randomly selected for the survey. Diagnostic interviews were carried out by extensively trained local Master level counselors. PTSD symptoms were established by means of a validated Tamil version of the UCLA PTSD Index. Additionally, participants completed a detailed checklist of event types related to organized and family violence. RESULTS: 82.4% of the children had experienced at least one  war-related event. 95.6% reported at least one aversive experience out of the family violence spectrum. The consequences are reflected in a 30.4% PTSD and a 19.6% Major Depression prevalence. Linear regression analyses showed that fathers' alcohol intake and previous exposure to war were significantly linked to the amount of maltreatment reported by the child. A clear dose-effect relationship between exposure to various stressful experiences and PTSD was found in the examined children. CONCLUSION: Data argue for a relationship between war violence and violent behavior inflicted on children in their families. Both of these factors, together with the experience of the recent Tsunami, resulted as significant predictors of PTSD in children, thus highlighting the detrimental effect that the experience of cumulative stress can have on children's mental health.

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

PMID: 18454851 [PubMed - indexed for MEDLINE]

 

Acta Psychiatr Scand. 2008 May;117(5):369-80. Epub 2008 Mar 10.

The mental health impact of terrorism in Israel: a repeat cross-sectional study of Arabs and Jews.

Gelkopf M, Solomon Z, Berger R, Bleich A.

Department of Community Mental Health, Faculty of Social Health Sciences, University of Haifa, Haifa, Israel. emgelkopf@013.net.il

OBJECTIVE: Since September 2000 Israeli society has been subjected to numerous deadly terror attacks. Few studies have studied the comparative mental health vulnerability of minorities and majorities to continuous terror attacks. METHOD:  Two telephone surveys (N = 512 and 501) on two distinct representative samples of the Israeli population after 19 months and after 44 months of terror. The Arab minority and Jewish majority were compared on measures of exposure to terrorism,  posttraumatic stress symptomatology, feeling depressed, coping, sense of safety,  future orientation, and previous traumatic experiences. RESULTS: After 19 months  of terrorist attacks Arab Israelis and Jewish Israelis reacted roughly similarly  to the situation, however after 44 months of terror, posttraumatic symptom disorder in the Arab population increased three-fold, posttraumatic symptomatology doubled and resiliency almost disappeared. CONCLUSION: We suggest  that certain conditions inherent to political conflict situations may potentially put minorities at risk and may only be observable as terrorism-related stressors  become chronic.

PMID: 18331581 [PubMed - indexed for MEDLINE]

 

Acta Psychiatr Scand. 2008 May;117(5):390-3. Epub 2008 Mar 10.

Oligodipsia and dissociative experiences in borderline personality disorder.

Hoeschel K, Guba K, Kleindienst N, Limberger MF, Schmahl C, Bohus M.

Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.

OBJECTIVE: To test the frequency of attenuated fluid intake behavior (oligodipsia) in patients with borderline personality disorder (BPD) and to test  if there is an inverse correlation between oligodipsia and the intensity of current dissociative experience in a pilot study. METHOD: Analyses were based on  a sample of 15 BPD patients and 15 healthy controls. Fluid intake per diem and intensity of dissociative experience were measured by standardized self-reports daily for 7 days. RESULTS: The BPD patients ingested a significantly lower fluid  volume per diem when compared with healthy controls (P < 0.001). We found a strong correlation between intensity of co-occurring dissociative experience and  fluid intake or urine osmolality (r = 0.762 and 0.665), independently of sleep quality and general BPD symptom severity. CONCLUSION: The results indicate that oligodipsia may constitute a serious problem at least for a subgroup of BPD patients, and may be correlated with some of the most problematic symptoms of BPD.

PMID: 18331578 [PubMed - indexed for MEDLINE]

 

Adm Policy Ment Health. 2008 May;35(3):147-58. Epub 2007 Nov 13.

Targeting trauma-related interventions and improving outcomes for women with co-occurring disorders.

Cusack KJ, Morrissey JP, Ellis AR.

Cecil G. Sheps Center for Health Services Research, University of North Carolina  at Chapel Hill, Chapel Hill, NC 27599-7590, USA. kcusack@schsr.unc.edu

National attention to the effects of interpersonal trauma has led mental health systems to adopt policies on trauma-related services; however, there is a lack of clarity regarding targeting of these services. Data from the Women, Co-occurring  Disorders and Violence Study (WCDVS) were reanalyzed by grouping women on their baseline PTSD and substance abuse presentation and assessing the differential response to an integrated mental health/substance abuse intervention. Treatment effects were largest for subgroups characterized by high levels of PTSD, whereas  the effects for those in the low symptom group were near zero. These findings underscore the need for clinicians to conduct careful assessments of trauma-related symptoms and to target the most intensive trauma-related interventions to individuals with PTSD symptoms.

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

PMID: 17999175 [PubMed - indexed for MEDLINE]

 

Aggress Behav. 2008 May-Jun;34(3):231-44.

Does war beget child aggression? Military violence, gender, age and aggressive behavior in two Palestinian samples.

Qouta S, Punamäki RL, Miller T, El-Sarraj E.

Gaza Community Mental Health Program, Gaza, Palestine.

We examined, first, the relations between children's exposure to military violence and their aggressive behavior and the role of age and gender in that relation in two Palestinian samples. Second, we tested parenting practices as a moderator of the relation between exposure to military violence and aggressive behavior, and third, whether exposure to military violence of different nature (direct victimization versus witnessing) has specific associations with different forms of aggression (reactive, proactive and aggression-enjoyment). Study I was conducted in a relatively calm military-political atmosphere in Palestine-Gaza, and included 640 children, aged 6-16 years whose parents (N=622) and teachers (N=457) provided reports. Older children (> or =12 years) provided self-reports (N=211). Study II included 225 Palestinian children aged 10-14-year, who participated during a high-violence period of the Al Aqsa Intifada characterized  by air raids, killing and destruction. Results showed that witnessing severe military violence was associated with children's aggressive and antisocial behavior (parent-reported) in study I, and with proactive, reactive and aggression-enjoyment (child-reported) in the study II. As hypothesized, good and  supporting parenting practices could moderate the link between exposure to military violence and aggressive behavior. Aggr. Copyright 2007 Wiley-Liss, Inc.

Publication Types:      Comparative Study

PMID: 17985361 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2008 May;98(5):775; author reply 775-6. Epub 2008 Apr 1.

Erratum in:     Am J Public Health. 2008 Jul;98(7):1158.

Comment on:     Am J Public Health. 2007 Dec;97(12):2143-5.

VA disability policies and posttraumatic morbidity.

Rosen GM, Spitzer RL.

Publication Types:      Comment     Letter

PMID: 18381981 [PubMed - indexed for MEDLINE]

 

Am J Respir Crit Care Med. 2008 May 1;177(9):976-82. Epub 2008 Jan 31.

Children's factual and delusional memories of intensive care.

Colville G, Kerry S, Pierce C.

Pediatric Psychology Service, St. George's Hospital, London, United Kingdom. gcolvill@sgul.ac.uk

RATIONALE: Delusional memories are significantly associated with post-traumatic stress in adult patients after intensive care. OBJECTIVES: In this study, we attempted to establish whether this relationship was found in children. We also examined the association between factual memory and distress. METHODS: One hundred two consecutive children, aged between 7 and 17 years, were interviewed about their pediatric intensive care unit (PICU) experience 3 months after discharge from a PICU. Principal measures were the ICU Memory Tool (a checklist of intensive care memories) and an abbreviated version of the Impact of Event Scale (a screen for post-traumatic stress disorder). MEASUREMENTS AND MAIN RESULTS: In total, 64 of 102 (63%) children reported at least one factual memory  of their admission and 33 of 102 (32%) reported delusional memories, including disturbing hallucinations. Traumatic brain injury was negatively associated with  factual memory (odds ratio, 0.23; 95% confidence interval [CI], 0.09-0.58; P = 0.002). Longer duration of opiates/benzodiazepines was associated with delusional memory (odds ratio, 4.98; 95% CI, 1.3-20.0; P = 0.023). Post-traumatic stress scores were higher in children reporting delusional memories (adjusted difference, 3.0; 95% CI, 0.06-5.9; P = 0.045) when illness severity and emergency status were controlled for. Factual memory was not significantly associated with  post-traumatic stress. CONCLUSIONS: This study indicates that delusional memories are reported by almost one-third of children and are associated both with the duration of opiates/benzodiazepines and risk of post-traumatic stress. More research is needed on the presence of delusional memories and associated risk factors in children receiving intensive care treatment.

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

PMID: 18244955 [PubMed - indexed for MEDLINE]

 

Am Psychol. 2008 May-Jun;63(4):282-3; discussion 283-5.

Comment on:     Am Psychol. 2007 May-Jun;62(4):304-16.

Does virtual trauma cause posttraumatic stress disorder?

McNally RJ, Breslau N.

Department of Psychology, Harvard University, Cambridge, MA 02138, USA. rjm@wjh.harvard.edu

Publication Types:      Comment

PMID: 18473622 [PubMed - indexed for MEDLINE]

 

Anaesthesia. 2008 May;63(5):474-81.

Intra-operative awareness in children and post-traumatic stress disorder.

Lopez U, Habre W, Van der Linden M, Iselin-Chaves IA.

Division of Anaesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Geneva, Switzerland. ursula.lopez@hcuge.ch

Adults who experience intra-operative awareness can develop disturbing long-lasting after-effects, such as daytime anxiety, sleep disturbances, nightmares, flashbacks and, in the worst case, a post-traumatic stress disorder (PTSD). It is unknown whether intra-operative awareness has a similar psychological impact in children. We designed the present study in order to evaluate the incidence of psychological symptoms in children who had either confirmed or possible intra-operative awareness. Attempts were made to locate 11  children who had been identified in a previous study, approximately 1 year following their experience. A PTSD questionnaire was administered to the children and their parents in order to detect any long-term or short-term psychological symptoms (the 1-month postoperative data were evaluated retrospectively). Factors believed to be associated with PTSD, such as intra-operative perceptions, the children's temperament and cognitive strategies, and the parents' coping strategies, were also analysed. Seven children were successfully located and interviewed and no short or long-term psychological symptoms were identified. None of them offered negative appraisals of the traumatic event and none had displayed dysfunctional behaviour or cognitive strategies. Thus, none of them had developed a PTSD syndrome. In contrast with what has been reported in adults, these children claimed not to have experienced major pain, terror or helplessness during their surgery. Despite the small sample size, the results of the present study suggest that children suffer less psychological sequelae than adults following intra-operative awareness. This may be due to the fact that the children reported less frightening intra-operative sensations as compared with the adults, and had less understanding of the anaesthesia procedure, and this may have influenced their appraisal of their awareness and protected them from the full impact of this potentially traumatic experience.

PMID: 18412644 [PubMed - indexed for MEDLINE]

 

Anasthesiol Intensivmed Notfallmed Schmerzther. 2008 May;43(5):384-91; quiz  392.

[EEG-Monitoring to avoid awareness during anaesthesia - benefit or luxury?]

[Article in German]

Linstedt U, Wulf H.

Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie am Diakonissenkrankenhaus Flensburg. linstedtul@diako.de

The intraoperative perception of pain, anxiety and helplessness is a serious complication of anaesthesia, the frequency is now 0,1-0,2 %. Post-operative memories can cause posttraumatic stress disorder (PTSD), but this will require a  consolidation of conscious awareness in the long-term memory. Memory formation is promoted by high emotional contents and a longer duration of awareness. There are defined risk factors for awareness, including patient factors, surgery and anaesthesia technique. In patients with high risk of awareness EEG monitoring can decrease the incidence. Because of lack of evidence, its use in every anaesthesia cases is an option but not a must.

Publication Types:      English Abstract

PMID: 18464217 [PubMed - indexed for MEDLINE]

 

Arch Pediatr Adolesc Med. 2008 May;162(5):447-52.

Identifying, treating, and referring traumatized children: the role of pediatric  providers.

Cohen JA, Kelleher KJ, Mannarino AP.

Department of Psychiatry, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania 15212, USA. jcohen1@wpahs.org

OBJECTIVES: To describe practical ways for pediatric providers to screen children for exposure to potentially traumatic events and trauma symptoms, provide brief office-based pediatric interventions for trauma-exposed children, engage families in mental health care referrals, and recognize elements of evidence-based practices for traumatized children. MAIN EXPOSURE: Many children exposed to potentially traumatic events develop severe and long-lasting negative somatic and psychological problems. Pediatric providers are often ideally situated to detect  children with these symptoms, provide office-based interventions, and make referrals to optimal community treatment providers. MAIN OUTCOME MEASURES: Several comprehensive literature reviews of evidence-based treatments for traumatized children conducted by other organizations were evaluated and summarized for their relevance to primary care pediatricians. RESULTS: Optimal pediatric screening and office-based interventions for traumatized children are described. Evidence-based practices for traumatized children are summarized and their common treatment elements extracted. Suggestions for engaging families in mental health care referrals are included. CONCLUSIONS: Pediatric providers can identify and provide office-based interventions for traumatized children as well  as play a critical role in referring children for optimal mental health treatments.

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

PMID: 18458191 [PubMed - indexed for MEDLINE]

 

Arch Pediatr Adolesc Med. 2008 May;162(5):403-10.

Comment in:     Arch Pediatr Adolesc Med. 2008 May;162(5):487-8.

Antecedents and sequelae of sudden parental death in offspring and surviving caregivers.

Melhem NM, Walker M, Moritz G, Brent DA.

Western Psychiatric Institute and Clinic and the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

OBJECTIVES: To examine the psychiatric antecedents that put parents at risk for early death, and the psychological sequelae of bereavement in offspring and caregivers. DESIGN: A population-based study. SETTING: Bereaved families were recruited through the coroner's records and by advertisement. Control families were recruited by random-digit dialing and advertisement. PARTICIPANTS: Families  with biological offspring from 7 to 25 years of age in which 1 parent died of suicide, accident, or sudden natural death were included (n = 140). Controls (n = 99) had 2 living parents and their biological offspring and had no death of a first-degree relative within the past 2 years. MAIN OUTCOME MEASURES: Lifetime psychiatric history for deceased parents (probands) and new-onset psychiatric disorders, self-reported symptoms, and functional status in offspring and surviving caregivers. RESULTS: Bipolar disorder, substance abuse, and personality disorders are more common in probands who died of suicide or accident than in control parents. Bereaved offspring and their caregivers were at increased risk for depression and posttraumatic stress disorder. Bereaved offspring had a 3-fold (95% confidence interval, 1.3-7.0) increased risk of depression, even after controlling for antecedent and concomitant risk factors. Offspring bereaved by suicide showed similar outcomes compared with those bereaved by other types of death. CONCLUSIONS: Bereavement conveys an increased risk of depression and posttraumatic stress disorder above and beyond other vulnerability factors. Better integration of medical and psychiatric care may prevent premature parental death, but once it occurs, physicians should be alert to the increased risk for depression and posttraumatic stress disorder in bereaved offspring and their caregivers.

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

PMID: 18458185 [PubMed - indexed for MEDLINE]

 

Bosn J Basic Med Sci. 2008 May;8(2):135-40.

Stress, memory and Bosnian war veterans.

Sarac-Hadzihalilović A, Kulenović A, Kucukalić A.

Department for Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

The aim of this study was to analyze cognitive dysfunction in PTSD. The testing included 79 Bosnian Army veterans, who participated in Bosnian war from 1992 to 1995. Out of 79 tested war veterans, 45 of developed PTSD while 34 did not. The veterans without PTSD where included in the control group. All the war veterans were of the same education level (secondary education) and between 30 and 50 years of age. Rivermead Behavioral Memory Test - RBMT was applied to all the subjects. The test was originally developed for the purpose of everyday memory problems identification. Clear goal of the 10 RBMT subtests is simulation of everyday life situations. PTSD group achieved significantly lower results than the control group. Results of the total score showed highly significant difference between PTSD and control group. Value of the t-test is t=10,056 with significance level of p<0,001. The same conclusion stands for any RBMT subtest. Numerous psychological studies on PTSD patients show more prominent psychological deficit in war veterans. Our study clearly confirms that finding.

PMID: 18498263 [PubMed - indexed for MEDLINE]

 

Br J Health Psychol. 2008 May;13(Pt 2):327-42. Epub 2007 Apr 5.

Post-disaster physical symptoms of firefighters and police officers: role of types of exposure and post-traumatic stress symptoms.

Slottje P, Witteveen AB, Twisk JW, Smidt N, Huizink AC, van Mechelen W, Smid T.

EMGO Institute, Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands.

OBJECTIVES: To examine the relationships between exposure to the air disaster in  Amsterdam and multiple physical symptoms among firefighters and police officers,  and to explore the role of post-traumatic stress symptoms (PTSS) herein. DESIGN:  Historic cohort study. METHODS: On average 8.5 years post-disaster, exposed professional firefighters (N=334) and police officers (N=834) and their nonexposed colleagues (N=194 and N=634, respectively) completed questionnaires on disaster exposure and current symptoms. Logistic regression with adjustment for background characteristics was used to compare exposed and nonexposed workers. PTSS were added to these models, as was the interaction between exposure and PTSS, to explore potential mediating and modifying effects, respectively. RESULTS: Exposed workers reported multiple physical symptoms significantly more often. Multiple physical symptoms seemed to have particularly affected the exposed firefighters who rescued people, and the exposed police officers who supported injured victims and workers, who were involved in the identification of or search for victims and human remains, who witnessed the immediate disaster scene or had a close one affected by the disaster. These exposure effects were essentially independent of PTSS, and no significant interactions between exposure and PTSS were found. CONCLUSIONS: In conclusion, the excess in post-disaster multiple physical symptoms in exposed workers could not be attributed to PTSS.

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: 17535500 [PubMed - indexed for MEDLINE]

 

Br J Psychiatry. 2008 May;192(5):394; author reply 395.

Comment on:     Br J Psychiatry. 2008 Jan;192(1):3-4.

Post-traumatic stress disorder's future.

Cantor C.

Publication Types:      Comment     Letter

PMID: 18450671 [PubMed - indexed for MEDLINE]

 

Br J Psychiatry. 2008 May;192(5):392-3.

Predictive validity of acute stress disorder in children and adolescents.

Dalgleish T, Meiser-Stedman R, Kassam-Adams N, Ehlers A, Winston F, Smith P, Bryant B, Mayou RA, Yule W.

Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. tim.dalgleish@mrc-cbu.cam.ac.uk

Adult research suggests that the dissociation criterion of acute stress disorder  has limited validity in predicting post-traumatic stress disorder (PTSD). We addressed this issue in child and adolescent survivors (n=367) of road accidents. Dissociation accounted for no significant unique variance in later PTSD, over and above other acute stress disorder criteria. Furthermore, thresholds of either three or more re-experiencing symptoms, or six or more re-experiencing/hyperarousal symptoms, were as effective at predicting PTSD as the full acute stress disorder diagnosis.

Publication Types:      Multicenter Study

PMID: 18450669 [PubMed - indexed for MEDLINE]

 

Br J Psychiatry. 2008 May;192(5):376-83.

Post-traumatic stress disorder in serious accidental injury: 3-year follow-up study.

Hepp U, Moergeli H, Buchi S, Bruchhaus-Steinert H, Kraemer B, Sensky T, Schnyder  U.

Psychiatrische Dienste Aargau AG, Baden, Switzerland. Urs.Hepp@pdag.ch

BACKGROUND: Long-term data on post-traumatic stress disorder (PTSD) following accidents are scarce. AIMS: To assess and predict PTSD in people 3 years after severe accidental injury. METHOD: Severely injured patients were recruited consecutively from the intensive care unit (n=121) and assessed within 1 month of the trauma. Follow-up interviews were conducted 6 months, 12 months and 36 months later; 90 patients participated in all four interviews. Symptoms were assessed using the Clinician-Administered PTSD Scale. RESULTS: Post-traumatic stress disorder was diagnosed in 6% of patients 2 weeks after the accident, in 2% after  1 year and in 4% after 3 years. Robust predictors of later PTSD symptom level were intrusive symptoms shortly after the accident and biographical risk factors. There were individual changes over time between the categories PTSD, sub-threshold PTSD and no PTSD. Whereas PTSD symptom severity was low or decreased for most of the patients, some of them showed an increase or a delayed  onset. Patients with persisting PTSD symptoms at 6 months and patients with delayed onset of symptoms are at risk of long-term PTSD. CONCLUSIONS: The prevalence of PTSD was low over the whole period of 3 years.

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

PMID: 18450664 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 May;32(5):561-6.

Mediational significance of PTSD in the relationship of sexual trauma and eating  disorders.

Holzer SR, Uppala S, Wonderlich SA, Crosby RD, Simonich H.

Department of Social Work, University of Minnesota-Duluth, Duluth, MN, USA.

OBJECTIVE: To examine the mediational significance of posttraumatic stress disorder (PTSD) and the development of eating disorder symptomatology following sexually traumatic experiences. METHOD: Seventy-one victims of sexual trauma and  25 control subjects completed interviews and questionnaires assessing eating disorder psychopathology and posttraumatic stress disorder symptomatology. Mediational analyses were conducted examining the relationships among trauma, posttraumatic stress, and eating disorder symptoms. Mediational significance was  assessed by the drop in the overall correlation between trauma and eating disorder symptoms when PTSD symptoms were included in the regression model. RESULTS: There is a significant association between a history of trauma and eating disorder symptoms. Also, there was a significant association between a history of trauma and posttraumatic stress disorder symptoms. Importantly, the relationship between trauma and eating disorder symptoms was significantly reduced when posttraumatic stress disorder symptoms were included in the regression analyses, indicating mediational significance of the posttraumatic stress construct. These findings were most pronounced for the physiological arousal and avoidance components of posttraumatic stress disorder. DISCUSSION: The present findings support the idea that individuals who develop eating disorders after sexual trauma are likely to have experienced posttraumatic stress disorder symptomatology. These findings have significant implications for causal  models of eating disorder onset in trauma victims. Furthermore, clinical interventions for traumatized eating disordered individuals may benefit from a focus on posttraumatic stress symptomatology.

PMID: 18511117 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 May;32(5):589-601.

The effects of community violence on children in Cape Town, South Africa.

Shields N, Nadasen K, Pierce L.

Department of Sociology, University of Missouri-St. Louis, One University Boulevard, St. Louis, MO 63121, USA.

OBJECTIVE: The primary objective of the study was to investigate the relationship between exposure to community violence (neighborhood, school, police, and gang violence) and psychological distress in a sample of children living in the Cape Town, South Africa area. Another objective was to identify variables that moderate and mediate the relationship between exposure to community violence and  psychological distress. METHODS: Face-to-face interviews were conducted with 185  children between the age of 8 and 13 from five Cape Town Township schools. Structured scales were used to measure exposure to several forms of community violence, family functioning, social support, perceptions of safety, and "unknown" locus of control. RESULTS: Exposure to all forms of violence was extremely high and resulted in substantial psychological distress. Perceived safety functioned as a mediating variable for all forms of violence. Unknown locus of control, social support, family organization, and family control moderated the effects of exposure to certain kinds of violence. Surprisingly, exposure to murder was not related to psychological distress, suggesting a possible "numbing" effect of extreme forms of violence. Hearing about violence from others had almost the same effect as actually witnessing it. Older children  had witnessed more violence and were experiencing more distress, suggesting an "exposure accumulation" effect. CONCLUSIONS: The findings suggest the importance  of a child's ability to feel safe in reducing the distress that occurs as a result to exposure to violence. Parents and schools can help children cope, but there appear to be limits. Early intervention, before maladaptive coping mechanisms have developed, also appears to be important.

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

PMID: 18511114 [PubMed - indexed for MEDLINE]

 

Clin Neuropsychol. 2008 May;22(3):565-82. Epub 2007 Jun 18.

Validity testing in dually diagnosed post-traumatic stress disorder and mild closed head injury.

Greiffenstein MF, Baker WJ.

Psychological Systems, Inc., Royal Oak, MI 48073, USA. mfgreiff@comcast.net

Prospects for the coexistence of post-traumatic stress syndrome (PTSS) and mild traumatic brain injury (mTBI) rely exclusively on subjective evidence, increasing the risk of response bias in a compensatable social context. Using a priori specificities derived from genuine brain disorder groups, we examined validity failure rates in three domains (symptom, cognitive, motor) in 799 persons reporting persistent subjective disability long after mild neurological injury. Validity tests included the Test of Memory Malingering, MMPI-2 Fake Bad Scale, and Infrequency (F) scales, reliable digit span, and Halstead-Reitan finger tapping. Analyses showed invalidity signs in large excess of actuarial expectations, with rising invalidity risk conditional on post-traumatic complexity; the highest failure rates were produced by the 95 persons reporting both neurogenic amnesia and re-experiencing symptoms. We propose an "over-endorsement continuum" hypothesis: The more complex the post-traumatic presentation after mild neurological injury, the stronger the association with response bias. Late-appearing dual diagnosis is a litigation phenomenon so intertwined with secondary gain as to be a byproduct of it.

PMID: 17853127 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2008 May;13(5):385-92.

Diagnosing PTSD: does it help us heal?

DeGaetano N, Shapira RY.

The Mount Sinai School of Medicine, New York, NY, USA.

Publication Types:      Case Reports     Clinical Conference

PMID: 18496476 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2008 May;13(5):361-2.

Trauma, multiple sclerosis, delayed sleep phase disorder, subjective experiences, and duration of illness in GAD.

Hollander E.

Publication Types:      Editorial     Introductory Journal Article

PMID: 18496473 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 May-Jun;49(3):313-8. Epub 2007 Dec 21.

Reliability and validity of the Korean version of the Davidson Trauma Scale.

Seo HJ, Chung SK, Lim HK, Chee IS, Lee KU, Paik KC, Kim D, Lee SY, Ryu SH, Kim JB, Kim TS, Kim W, Chong J, Chae JH; Disaster Psychiatry Committee, Korean Academy of Anxiety Disorders.

Department of Psychiatry, St. Mary's Hospital, The Catholic University of Korea,  College of Medicine, Seoul, South Korea.

The Davidson Trauma Scale (DTS) is a validated, 17-item, brief global assessment  scale for posttraumatic stress disorder (PTSD). The purposes of this study were to develop a Korean version of the DTS (DTS-K) while maintaining its basic structure and to evaluate its reliability and validity for the Korean population. Participants of this study included 93 patients with PTSD (PTSD group), 73 patients with nonpsychotic mood or other anxiety disorders (psychiatric control group), and 88 healthy controls (normal control group). Subjects completed psychometric assessments, including the DTS-K and the Korean version of the Clinician-Administered PTSD Scale and the State Trait Anxiety Inventory. The DTS-K showed good internal consistency (Cronbach alpha = .97) and test-retest reliability (r = .93). The DTS-K showed a significantly positive correlation with Clinician-Administered PTSD Scale (r = .94). The highest diagnostic efficiency of DTS-K was at a total score of 47, with sensitivity and specificity of 0.87 and 0.84, respectively. Our findings suggest that the DTS-K is composed of good psychometric properties and is a valid and reliable tool for assessing the frequency and severity of PTSD symptoms regardless of ethnicity.

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

PMID: 18396192 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 May-Jun;49(3):297-304. Epub 2008 Jan 10.

Posttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol  dependence, and major depression in male twins.

Scherrer JF, Xian H, Lyons MJ, Goldberg J, Eisen SA, True WR, Tsuang M, Bucholz KK, Koenen KC.

St Louis Veterans Affairs Medical Center, Research Service, St Louis, MO 63106, USA. scherrej@msnotes.wustl.edu

Combat exposure is associated with increased risk of psychiatric and substance use disorders in veterans. However, it is not known whether combat exposure independently increases risk for these disorders or whether this association is accounted for by genetic vulnerability common to posttraumatic stress disorder (PTSD). This article tests competing explanations for the association of combat exposure and PTSD with nicotine dependence (ND), alcohol dependence (AD), and major depression (MD). Data were obtained from 6099 members of the Vietnam Era Twin Registry, a national registry of male-male twin pairs who served in the military during the Vietnam era. Twin models were fit to estimate the genetic and environmental variance common and specific to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, lifetime diagnoses of PTSD, combat trauma, and 3 comorbid conditions: ND, AD, and MD. Variance specific to ND, AD, and MD was due to genetic factors (48%, 36%, and 12%, respectively) and unique environmental factors (36%, 42%, and 58%, respectively). After accounting for variance common to PTSD, no residual genetic and environmental variance overlapped between combat and ND, combat and AD, and combat and MD. Combat exposure is not independently associated with lifetime ND, AD, and MD. The association of combat exposure with these 3 disorders is due to genetic and unique environmental contributions in common with PTSD. These findings suggest comorbid PTSD may represent a genetically mediated vulnerability to psychopathology after trauma.

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.     Twin Study

PMID: 18396190 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2008 May;21(3):242-6.

Substance use, post-traumatic stress disorder and violence.

Johnson SD.

University of Missouri-St Louis, School of Social Work, St Louis, Missouri 63121, USA. Sharon_Johnson@umsl.edu

PURPOSE OF REVIEW: The present review focuses on the co-occurrence of substance use disorder and post-traumatic stress disorder, with special attention to measurement and the role of violence as a contributor to the comorbidity. RECENT  FINDINGS: Symptoms of post-traumatic stress disorder in the presence or absence of a post-traumatic stress disorder diagnosis are comorbid with several substance use dependencies and with a range of severity of substance use. SUMMARY: Lack of  consistency in terms of substance use classification and measurement of post-traumatic stress disorder across studies continues to hinder comparisons of  rates of comorbid substance use disorder and post-traumatic stress disorder. More attention to the role of violence as a contributor to the comorbidity and its impact on treatment outcomes is warranted.

Publication Types:      Review

PMID: 18382221 [PubMed - indexed for MEDLINE]

 

Epidemiology. 2008 May;19(3):505-12.

Prior assault and posttraumatic stress disorder after combat deployment.

Smith TC, Wingard DL, Ryan MA, Kritz-Silverstein D, Slymen DJ, Sallis JF; Millennium Cohort Study Team.

Collaborators: Amoroso PJ, Boyko EJ, Gackstetter GD, Gray GC, Hooper TI, Riddle JR, Smith B, Wells TS, Seggerman SL, Boyd GD, Farnell L, Gumbs G, Jacobson I, Leard C, Leleu T, Reed R, Spiegel S, Welch K, Whitmer J, Stoia M, Friedl KE.

Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, CA 92186-5122, USA. tyler.c.smith@med.navy.mil

BACKGROUND: Factors that make people vulnerable to or resilient against posttraumatic stress disorder (PTSD) following overwhelming stress are not well understood. The objective of this study was to prospectively examine the relation between prior assault and new-onset PTSD symptoms in a large US military cohort deployed in the wars in Iraq and Afghanistan. METHODS: Data on exposures and health outcomes were collected in the Millennium Cohort study at enrollment (July 2001 to June 2003) and follow-up (June 2004 to February 2006) from over 55,000 participants. Of these, 5324 were deployed in Iraq and Afghanistan, reported combat exposures, and were free of PTSD at baseline (881 women and 4443 men). We  used multivariable logistic regression analysis to model the odds of new-onset PTSD in relation to prior assault. RESULTS: New-onset PTSD symptoms or diagnosis  among deployers reporting combat exposures occurred in 22% of women who reported  prior assault and 10% not reporting prior assault. Among men reporting prior assault, rates were 12% and 6%, respectively. Adjusting for baseline factors, the odds of new-onset PTSD symptoms was more than 2-fold higher in both women and men who reported assault prior to deployment. CONCLUSIONS: Prior assault appears to confer increased vulnerability for, rather than resilience against, PTSD symptoms among military professionals deployed to recent combat operations.

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

PMID: 18414091 [PubMed - indexed for MEDLINE]

 

Eur J Pain. 2008 May;12(4):455-63. Epub 2007 Sep 27.

Acute stress response and recovery after whiplash injuries. A one-year prospective study.

Kongsted A, Bendix T, Qerama E, Kasch H, Bach FW, Korsholm L, Jensen TS.

The Back Research Center Part of Clinical Locomotion Science, Backcenter Funen, University of Southern Denmark, Funen Hospital Ringe, Lindevej 5, DK-5750 Ringe,  Denmark. Alice.Kongsted@shf.regionsyddanmark.dk

Chronic whiplash-associated disorder (WAD) represents a major medical and psycho-social problem. The typical symptomatology presented in WAD is to some extent similar to symptoms of post traumatic stress disorder. In this study we examined if the acute stress reaction following a whiplash injury predicted long-term sequelae. Participants with acute whiplash-associated symptoms after a  motor vehicle accident were recruited from emergency units and general practitioners. The predictor variable was the sum score of the impact of event scale (IES) completed within 10 days after the accident. The main outcome-measures were neck pain and headache, neck disability, general health, and working ability one year after the accident. A total of 737 participants were included and completed the IES, and 668 (91%) participated in the 1-year follow-up. A baseline IES-score denoting a moderate to severe stress response was obtained by 13% of the participants. This was associated with increased risk of considerable persistent pain (OR=3.3; 1.8-5.9), neck disability (OR=3.2; 1.7-6.0), reduced working ability (OR=2.8; 1.6-4.9), and lowered self-reported general health one year after the accident. These associations were modified by baseline neck pain intensity. It was not possible to distinguish between participants who recovered and those who did not by means of the IES (AUC=0.6). In conclusion, the association between the acute stress reaction and persistent WAD suggests that post traumatic stress reaction may be important to consider in  the early management of whiplash injury. However, the emotional response did not  predict chronicity in individuals.

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

PMID: 17900949 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2008 May-Jun;30(3):200-7.

Offering a medical examination following disaster exposure does not result in long-lasting reassurance about health complaints.

Verschuur MJ, Spinhoven P, Rosendaal FR.

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

OBJECTIVE: This study tested the hypothesis that large-scale provision of individual medical examination will reduce persistent anxiety about health and subjective health complaints after involvement in an aviation disaster with alleged exposure to hazardous chemicals. METHOD: Three measurements were performed: during the medical examination, 6 weeks later during consultation with the physician and 12 weeks after the first examination. Rescue workers (n=1736) and residents (n=339) involved in the disaster participated. Standardized questionnaires on health complaints and concerns were administered. RESULTS: Both groups reported increased health anxiety and somatic sensitivity after 12 weeks.  Residents reported more posttraumatic stress symptoms, whereas rescue workers seemed to have gained a better quality of life and were somewhat reassured. Participants who attended the consultation with the physician showed increased reassurance scores after 6 weeks, but their worries had increased again on follow-up. However, nonattendees reported more health anxiety on follow-up. More  participants judged participation to have had a positive impact, instead of a negative impact, on their health. CONCLUSION: Our study does not indicate that a  large-scale medical examination offered after involvement in a disaster has long-lasting reassuring effects and suggests that such examination may have counterproductive effects by sensitizing participants to health complaints.

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

PMID: 18433652 [PubMed - indexed for MEDLINE]

 

Hum Brain Mapp. 2008 May;29(5):517-23.

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. r.bryant@unsw.edu.au

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, 2008. (c) 2007 Wiley-Liss, Inc. (Copyright) 2006 Wiley-Liss, Inc.

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

PMID: 17525984 [PubMed - indexed for MEDLINE]

 

Int J Neuropsychopharmacol. 2008 May;11(3):419-24. Epub 2008 Jan 11.

beta2 Nicotinic acetylcholine receptor availability in post-traumatic stress disorder.

Czermak C, Staley JK, Kasserman S, Bois F, Young T, Henry S, Tamagnan GD, Seibyl  JP, Krystal JH, Neumeister A.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06516, USA.

Availability of nicotinic acetylcholine receptors containing beta2 subunits (beta2-nAChRs) was studied in unmedicated, symptomatic patients with post-traumatic stress disorder (PTSD) and healthy control subjects, all current non-smokers. A subgroup of participants had a history of smoking. Availability of beta2-nAChRs in the mesiotemporal cortex, prefrontal cortex, thalamus and striatum was determined using the radiotracer [123I]5-IA-85380 ([123I]5-IA) and single-photon emission computed tomography (SPECT). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Never-smoking PTSD patients compared to never-smoking healthy controls showed significantly higher [123I]5-IA binding in the mesiotemporal cortex (ANOVA: F=6.21, d.f.=1, 11, p=0.030). Among all PTSD patients, there was a significant correlation between the re-experiencing symptom cluster and thalamic [123I]5-IA binding (R2=0.66, p=0.019, Bonferroni corrected). These findings not only suggest an involvement of beta2-nAChRs in the pathophysiology of PTSD but also raise the possibility that this receptor may be a novel molecular target for drug development.

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

PMID: 18190729 [PubMed - indexed for MEDLINE]

 

Int J Neuropsychopharmacol. 2008 May;11(3):365-72. Epub 2007 Oct 31.

Stress hormones and post-traumatic stress disorder in civilian trauma victims: a  longitudinal study. Part I: HPA axis responses.

Shalev AY, Videlock EJ, Peleg T, Segman R, Pitman RK, Yehuda R.

Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel. ashalev@cc.huji.ac.il

The aim of the study was to evaluate the association between post-traumatic disorder (PTSD) and hypothalamic-pituitary-adrenal (HPA) axis responses to the triggering trauma. A companion paper evaluates the adrenergic response and interactions between the two. We measured plasma and saliva cortisol, hourly urinary excretion of cortisol, plasma levels of adrenocorticotropin (ACTH), and the leukocyte glucocorticoid receptor (GR) density of 155 non-injured survivors of traumatic events (91 males and 64 females; 125 road traffic accidents, 19 terrorist attacks, 11 others). Measurements were taken during survivors' admissions to an emergency room (ER) of a general hospital, and in the mornings,  10 d, 1 month, and 5 months later. Symptoms of peri-traumatic dissociation, PTSD, and depression were assessed on each follow-up session. The clinician-administered PTSD scale (CAPS) conferred a diagnosis of PTSD at 5 months. Survivors with (n=31) and without (n=124) PTSD at 5 months had similar levels of hormones at all times. Plasma cortisol levels decreased with time in both groups. Female subjects had lower ACTH levels than males. PTSD in females was associated with higher levels of ACTH. In unselected cohorts of trauma survivors, PTSD is not preceded by a detectable abnormality of peripheral HPA axis hormones.

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

PMID: 17971262 [PubMed - indexed for MEDLINE]

 

Int J Neuropsychopharmacol. 2008 May;11(3):373-80. Epub 2007 Oct 31.

Stress hormones and post-traumatic stress disorder in civilian trauma victims: a  longitudinal study. Part II: the adrenergic response.

Videlock EJ, Peleg T, Segman R, Yehuda R, Pitman RK, Shalev AY.

Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel.

The aim of the study was to prospectively evaluate the association between the occurrence of post-traumatic stress disorder (PTSD) and the adrenergic response to the traumatic event, and additionally, to explore the link between PTSD and the initial norepinephrine:cortisol ratio. Plasma levels and urinary excretion of norepinephrine (NE) were measured in 155 survivors of traumatic events during their admission to a general hospital emergency room (ER) and at 10 d, 1 month and 5 months later. Symptoms of peri-traumatic dissociation, PTSD and depression  were assessed in each follow-up session. The Clinician-Administered PTSD Scale (CAPS) conferred a diagnosis of PTSD at 5 months. Trauma survivors with (n=31) and without (n=124) PTSD had similar levels of plasma NE, urinary NE excretion, and NE:cortisol ratio in the ER. Plasma NE levels were lower in subjects with PTSD at 10 d, 1 month, and 5 months. There was a weak but significant positive correlation between plasma levels of NE in the ER and concurrent heart rate, and  a negative correlation between NE in the ER and dissociation symptoms. Peripheral levels of NE, shortly after traumatic events, are poor risk indicators of subsequent PTSD among civilian trauma victims. Simplified biological models may not properly capture the complex aetiology of PTSD.

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

PMID: 17971259 [PubMed - indexed for MEDLINE]

 

Int J Neuropsychopharmacol. 2008 May;11(3):331-49. Epub 2007 Jul 27.

Post-traumatic stress behavioural responses in inbred mouse strains: can genetic  predisposition explain phenotypic vulnerability?

Cohen H, Geva AB, Matar MA, Zohar J, Kaplan Z.

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. hagitc@bgu.ac.il

Clinical studies of twin pairs and families of post-traumatic stress disorder (PTSD) patients raise questions as to possible genetic predisposition to PTSD. Studies using isogenic animal populations exposed to a stress paradigm could elucidate the relative contributions of genotype and environment to endophenotypic expression. The prevalence of individuals displaying severely compromised behavioural responses to predator scent stress (PSS) was assessed in  six inbred strains of mice in an animal model of PTSD that classifies individuals into groups according to the degree of their behavioural response. The choice of  strains was based on the frequent use of these mice in transgenic research. The prevalence of extreme behavioural response in the elevated plus maze and the acoustic startle response paradigms, performed in sequence, was assessed at baseline and 7 d after PSS exposure between and within strains, and compared to differences in circulating corticosterone levels. Narrow-sense trait heritability was determined by comparing the between-strain variance to the total variance. Although strain-specific differences in anxiety-like behaviours were demonstrated, the results revealed a significant degree of individual variability in response patterns within each of the inbred strains, yielding a baseline heritability factor for anxiety-like behaviours of 30%, but only 10% for response to stress exposure. Baseline anxiety-like behaviours were found not to be predictive of post-exposure behavioural responses. The response of the individual to stress is multifactorial and environmental factors play a predominant role in  characterizing the individual response to stress exposure, although there are significant genetic underpinnings.

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

PMID: 17655807 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2008 May;117(2):479-84.

Posttraumatic stress disorder in a patient with no left amygdala.

Smith SD, Abou-Khalil B, Zald DH.

Department of Psychology, University of Winnipeg, Winnipeg, Manitoba, Canada. s.smith@uwinnipeg.ca

Existing biological models of posttraumatic stress disorder (PTSD) posit that the amygdala plays a critical role in the development and expression of this disorder. However, increasing data indicate that the amygdalae are not functionally identical, raising the possibility that the 2 amygdalae may make differential contributions to the expression of PTSD. The authors present a unique patient who developed PTSD following a traffic accident that occurred 2 years after she had undergone removal of her left amygdala to treat pharmacologically intractable epilepsy. The authors propose that the right amygdala is preferentially involved in several processes related to the expression of PTSD symptoms, such that the disorder can occur even in the absence of the left amygdala.

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

PMID: 18489226 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2008 May;117(2):460-6.

The developmental mental-disorder histories of adults with posttraumatic stress disorder: a prospective longitudinal birth cohort study.

Koenen KC, Moffitt TE, Caspi A, Gregory A, Harrington H, Poulton R.

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

Clinical and epidemiologic studies have established that posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, such studies have largely relied on adults' retrospective reports to ascertain comorbidity. The authors examined the developmental mental health histories of adults with PTSD using data on mental disorders assessed across the first 3 decades of life among members of the longitudinal Dunedin Multidisciplinary Health and Development Study; 100% of those diagnosed with past-year PTSD and 93.5% of those with lifetime PTSD at age 26 had met criteria for another mental disorder between ages 11 and 21. Most other mental disorders had first onsets by  age 15. Of new cases of PTSD arising between ages 26 and 32, 96% had a prior mental disorder and 77% had been diagnosed by age 15. These data suggest PTSD almost always develops in the context of other mental disorders. Research on the  etiology of PTSD may benefit from taking lifetime developmental patterns of comorbidity into consideration. Juvenile mental-disorder histories may help indicate which individuals are most likely to develop PTSD in populations at high risk of trauma exposure.

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

PMID: 18489223 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2008 May;117(2):444-53.

Autobiographical memory specificity after manipulating retrieval cues in adults reporting childhood sexual abuse.

Hauer BJ, Wessel I, Geraerts E, Merckelbach H, Dalgleish T.

Department of Clinical Psychological Science, Maastricht University, Maastricht,  the Netherlands. bjahauer@gmail.com

Traumatized samples have relative difficulty in generating specific autobiographical memories on a cue word task, compared to nonexposed controls. Simultaneously, trauma is associated with highly specific intrusive trauma memories in day-to-day life. Possibly, day-to-day intrusions and memories generated to cue words rely on different retrieval processes, with the former dependent on close associations between retrieval cues and specific memory representations (direct retrieval), and the latter on iterative retrieval cycles  through a hierarchical memory system (generative retrieval). This study investigated this distinction using two versions of the cue word task, designed to promote generative and direct retrieval, respectively, in participants with or without a history of child sexual abuse (CSA). The data demonstrated that CSA participants were less specific than nonabused controls to generative retrieval cues, but this difference disappeared with direct retrieval cues. This interaction was stronger in CSA participants with relatively greater posttraumatic stress and remained significant when participants with past or current major depressive disorder were excluded and also when only those participants with corroborated CSA were included.

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

PMID: 18489221 [PubMed - indexed for MEDLINE]

 

J Adolesc Health. 2008 May;42(5):466-72. Epub 2008 Mar 4.

Outcome of cognitive behavioral therapy in adolescents after natural disaster.

Shooshtary MH, Panaghi L, Moghadam JA.

Iran University of Medical Sciences, Tehran Institute of Psychiatry (Mental Health Research Center), Tehran, Iran. hakimshooshtary@tehranpi.org

PURPOSE: The authors evaluated the effectiveness of cognitive behavioral therapy  (CBT) among adolescents exposed to the 2004 earthquake in Bam, Iran. METHODS: Four months after the earthquake, 135 adolescents as a case group and 33 adolescents as a comparison group were evaluated with the Impact of Event Scale Revised (IES-R). Two therapists were trained in CBT in 3-day classes according to a manual provided by mental health services. After conducting CBT in the case group, both groups were evaluated again with IES-R. RESULTS: The severity of posttraumatic stress symptoms significantly decreased among the subjects given CBT in the case group. The improvement in posttraumatic stress symptoms was attributable to improvement in each of three-symptom categories (intrusion, avoidance, and arousal) and in the total score of posttraumatic stress disorder (p < .05). CONCLUSIONS: The findings demonstrate the efficacy of CBT in alleviating posttraumatic stress symptoms among adolescents after a catastrophic  disaster.

Publication Types:      Comparative Study     Evaluation Studies

PMID: 18407041 [PubMed - indexed for MEDLINE]

 

J Adv Nurs. 2008 May;62(3):276-92.

Short- and long-term impact of critical illness on relatives: literature review.

Paul F, Rattray J.

School of Nursing and Midwifery, University of Dundee, Tayside Campus, Ninewells  Hospital, Dundee, UK. f.paul@dundee.ac.uk

AIM: This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives. BACKGROUND: Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after  intensive care. DATA SOURCES: The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials. SEARCH METHODS: Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions',  'satisfaction', 'psychological outcomes' and 'coping'. RESULTS: Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives. CONCLUSION: Despite widespread use of the Critical Care Family Needs Inventory, factors such  as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the  illness.

Publication Types:      Review

PMID: 18426451 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 May;22(4):622-34. Epub 2007 Jun 3.

Physiological correlates of eye movement desensitization and reprocessing.

Elofsson UO, von Schèele B, Theorell T, Söndergaard HP.

National Institute for Psychosocial Factors and Health (IPM) & Karolinska Institutet, Stockholm, Sweden. ulf.elofsson@pbmstressmedicine.com

Eye movement desensitization and reprocessing (EMDR) is an established treatment  for post-traumatic stress disorder (PTSD). However, its working mechanism remains unclear. This study explored physiological correlates of eye movements during EMDR in relation to current hypotheses; distraction, conditioning, orienting response activation, and REM-like mechanisms. During EMDR therapy, fingertip temperature, heart rate, skin conductance, expiratory carbon dioxide level, and blood pulse oximeter oxygen saturation, were measured in male subjects with PTSD. The ratio between the low and high frequency components of the heart rate power spectrum (LF/HF) were computed as measures of autonomic balance. Respiratory rate was calculated from the carbon dioxide trace. Stimulation shifted the autonomic balance as indicated by decreases in heart rate, skin conductance and LF/HF-ratio, and an increased finger temperature. The breathing frequency and end-tidal carbon dioxide increased; oxygen saturation decreased during eye movements. In conclusion, eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM-sleep.

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

PMID: 17604948 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2008 May;69(5):693-700.

Trauma and posttraumatic stress disorder in the elderly: findings from a German community study.

Spitzer C, Barnow S, Völzke H, John U, Freyberger HJ, Grabe HJ.

Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt-University, Greifswald/Stralsund, Germany. c.spitzer@uke.uni-hamburg.de

OBJECTIVE: The present study assessed the risk of trauma exposure and subsequent  posttraumatic stress disorder (PTSD) in an elderly community sample. Furthermore, gender differences and psychiatric comorbidity were analyzed. METHOD: 3170 adults living in a German community were assessed by the PTSD module of the Structured Clinical Interview for DSM-IV and the Composite International Diagnostic-Screener. They were assigned to 3 age groups: young (44 years and younger; N = 997), middle-aged (45-64 years; N = 1322), and elderly (65 years and older; N = 851). Data for the present study were collected between December 2002  and December 2006. RESULTS: At least 1 trauma was reported by 54.6%, and the odds for trauma exposure were almost 4-fold in the elderly compared to the younger age groups (OR = 3.74; 95% CI = 3.13 to 4.47). Among those traumatized, the lifetime  and 1-month prevalence rates of PTSD in the elderly were 3.1% and 1.5%, respectively, and did not differ from the rates of the young and middle-aged adults. Elderly men had a significantly increased risk for trauma exposure in general than elderly women (p = .012), but there were no gender differences in PTSD prevalence rates. Elderly PTSD-positive participants had significantly higher odds for any psychiatric syndrome than those without PTSD (OR = 9.10; 95%  CI = 2.64 to 31.28) with depression and anxiety being the most frequent conditions. CONCLUSION: Our findings suggest that PTSD is certainly not rare in the elderly and that a lifetime diagnosis of PTSD is associated with symptoms of  depression and anxiety. Assessment of trauma and PTSD should be integrated into routine examinations of the elderly to improve management and treatment provisions.

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

PMID: 18452344 [PubMed - indexed for MEDLINE]

 

J Clin Psychiatry. 2008 May;69(5):854-9.

Psychological adjustment of adolescents 18 months after the terrorist attack in Beslan, Russia: a cross-sectional study.

Moscardino U, Scrimin S, Capello F, Altoè G, Axia G.

Department of Developmental and Social Psychology, University of Padua, Italy. ughetta.moscardino@unipd.it

OBJECTIVE: Children exposed to terrorism are at high risk for developing emotional and behavioral problems, but only a few studies have examined adolescents' long-term psychological adjustment after a terrorist attack. We aimed to assess psychological distress, problem behaviors, and coping in adolescents who survived the terrorist attack on School No. 1 in Beslan, Russia.  METHOD: Seventy-one youths aged 14 to 17 years held as hostages by terrorists completed self-reported measures of psychological symptoms, emotional and behavioral difficulties, and coping behaviors 18 months after the traumatic event. They were compared with 100 adolescents who were not directly exposed to the attack. Data were collected during a 1-month period in May 2006. RESULTS: No  significant differences were found between the 2 groups in overall levels of psychological symptoms as well as in emotional and behavioral problems. Girls in  both groups reported significantly more psychological distress (p = .0001) and total difficulties (p = .0001) than boys. In the directly exposed group, avoidant coping was related to worse psychological functioning for girls (r = 0.54, p < .001) and boys (r = 0.50, p < .01), whereas in the indirectly exposed group this  strategy was associated with psychological distress (r = 0.43, p < .01) and total difficulties (r = 0.40, p < .01) for girls only. CONCLUSIONS: More than 1 year after a terrorist attack, adolescents may experience psychological distress regardless of being directly or indirectly exposed. Professionals working with adolescents affected by terrorism should be sensitive to developmental level and  gender, consider the cultural context, and foster coping skills that may be differentially effective for girls and boys.

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

PMID: 18373385 [PubMed - indexed for MEDLINE]

 

J Epidemiol Community Health. 2008 May;62(5):455-60.

Predictors of symptoms of post-traumatic stress disorder after the AZF chemical factory explosion on 21 September 2001, in Toulouse, France.

Rivière S, Schwoebel V, Lapierre-Duval K, Guinard A, Gardette V, Lang T; Scientific and Operational Committees.

Collaborators: Lang T, Cassadou S, Cayla F, Choisnard G, Combier M, Ducassé JL, Fabre M, Fraysse B, Deguine O, Raynaud JP, Schmitt L, Soulat JM, Goldberg M, Gourier-Frery C, Imbernon E, Malfait P, Helynck B, Thélot B, Schwoebel V, Diène E, Dasté S, Guinard A, Lapierre-Duval K, Hemery C, Ricoux C, Bauvin E, Garrigue E, Rivière S.

Institut de Veille Sanitaire, Département Santé Travail, Faculté de Médecine, Toulouse, France. stephanie.riviere@cict.fr

OBJECTIVE: To analyse in the general population the prevalence and predictors of  symptomatology consistent with post-traumatic stress disorder (S-PTSD) 18 months  after an industrial explosion. DESIGN: Cross-sectional survey. PARTICIPANTS AND OUTCOME MEASURES: A random sample of 1191 city inhabitants, including an oversample of the immediate area (<3 km). S-PTSD was measured by the self-administered Impact of Event Scale-Revised. The relation between S-PTSD and  individual vulnerability factors, immediate exposure and post-trauma factors was  analysed by gender. RESULTS: S-PTSD was more prevalent in the immediate area than in the peripheral area (women 19% vs 8%; men 8% vs 2%, p<0.01). In the immediate  area, S-PTSD was independently associated with birth outside France (men: OR(a) = 13.9, 95% CI 3.7 to 52.8; women: OR(a) = 2.1, 95% CI 1.0 to 4.2), age more than 40 years (men: OR(a) = 4.3, 95% CI 1.01 to 18.2; women: OR(a) = 2.3, 95% CI 1.1 to 4.5), previous psychotropic treatment (men: OR(a) = 11.5, 95% CI 2.4 to 53.6), proximity to the explosion (less educated men only) (OR(a) = 9.3, 95% CI 1.9 to 44.7), rescue efforts (men: OR(a) = 5.2, 95% CI 1.5 to 18.2), temporarily uninhabitable home (men: OR(a) = 5.8, 95% CI 1.9 to 18.1), personal injury (women: OR(a) = 3.7, 95% CI 1.7 to 8.4), financial difficulties (men: OR(a) = 17.4, 95% CI 4.2 to 72.1; women: OR(a) = 3.4, 95% CI 1.7 to 7.1) and inconvenience due to closure of public services (women: OR(a) = 4.1, 95% CI 1.6 to 9.9). CONCLUSIONS: Individual vulnerability, exposure and post-trauma factors  were associated with S-PTSD. Vulnerable subgroups, defined by low socioeconomic characteristics may warrant focused screening after such disasters.

PMID: 18413460 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 May;23(5):635-51. Epub 2008 Feb 13.

PTSD compromises battered women's future safety.

Perez S, Johnson DM.

Kent State University and Summa-Kent State Center for the Treatment and Study of  Traumatic Stress, Akron, OH 44310, USA.

Intimate partner violence continues to be a social crisis that results in a complex array of physical and mental health problems. Although resources to counteract the effects of the violence are sometimes available, the posttrauma sequelae may prevent access by those in need. Using the Chicago Women's Health Risk Study, a naturalistic longitudinal study of 320 abused women, the current study examined the impact of posttraumatic stress disorder (PTSD) and depression  on battered women's safety at follow-up. Participants completed both a baseline and follow-up interview, including data on abuse experiences. Results suggest symptoms of PTSD predict severity of violence at follow-up over the impact of help-seeking behaviors, perceived helpfulness of these behaviors, and social support. Implications of results are discussed.

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

PMID: 18272729 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 May;23(5):652-69. Epub 2008 Feb 13.

Intimate partner violence and miscarriage: examination of the role of physical and psychological abuse and posttraumatic stress disorder.

Morland LA, Leskin GA, Block CR, Campbell JC, Friedman MJ.

National Center for PTSD, Honolulu, HI 96813, USA. leslie.morland@med.va.gov

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.

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

PMID: 18272727 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 May;196(5):425-8.

posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA health care.

Jakupcak M, Luterek J, Hunt S, Conybeare D, McFall M.

VA Puget Sound Health Care System, Seattle, Washington, USA. matthew.jakupcak@va.gov

The relationship between posttraumatic stress and physical health functioning was examined in a sample of Iraq and Afghanistan War veterans seeking postdeployment  VA care. Iraq and Afghanistan War veterans (N = 108) who presented for treatment  to a specialty postdeployment care clinic completed self-report questionnaires that assessed symptoms of posttraumatic stress disorder (PTSD), chemical exposure, combat exposure, and physical health functioning. As predicted, PTSD symptom severity was significantly associated with poorer health functioning, even after accounting for demographic factors, combat and chemical exposure, and  health risk behaviors. These results highlight the unique influence of PTSD on the physical health in treatment seeking Iraq and Afghanistan War veterans.

PMID: 18477887 [PubMed - indexed for MEDLINE]

 

J Neuroendocrinol. 2008 May;20(5):632-8. Epub 2008 Mar 15.

Biology of post-traumatic stress disorder in childhood and adolescence.

Pervanidou P.

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

Diverse patterns of cortisol secretion with consistently high circulating catecholamines have been reported in post-traumatic stress disorder (PTSD), an anxiety state that develops after exposure to traumatic life events. Indeed, peripheral cortisol levels have been reported to be low or normal in the majority of adult chronic PTSD studies, whereas, in most paediatric studies, high cortisol values have been documented. Longitudinal studies on PTSD biology, including the  transition from childhood to adulthood, may shed light on these discrepancies. In children, elevated evening salivary cortisol in the aftermath of the trauma was predictive of PTSD development 6 months later, whereas plasma interleukin-6 correlated positively with evening cortisol and was equally predictive of later PTSD. Longitudinal assessment of PTSD children 1 and 6 months later revealed progressive normalisation of cortisol levels, whereas noradrenaline concentrations became gradually higher. We hypothesise that, in adults with chronic PTSD, low cortisol levels, together with high catecholamines, may reflect a late event in the natural history of the disorder, months or years after the trauma. The progressive divergence of cortisol and noradrenaline concentrations over time may be responsible for PTSD maintenance in children and explain the differences between the child and adult PTSD endophenotypes. In adults studied immediately after the trauma, and by contrast to children, low cortisol levels are predictive of later PTSD development. Our hypothesis that low cortisol levels may reflect a previous trauma, earlier in development, is supported by the well established observation that prior trauma is a risk factor for a new PTSD diagnosis. The developmental stage of an individual in relation to previous exposure to trauma and PTSD vulnerability are crucial variables that may determine clinical and biological PTSD phenotypes and explain the discrepancies between adults and children in reported cortisol levels.

Publication Types:      Comparative Study     Review

PMID: 18363804 [PubMed - indexed for MEDLINE]

 

J Pediatr Psychol. 2008 May;33(4):435-40. Epub 2007 Sep 10.

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, Mayne Medical School, Herston Road, Herston, Queensland 4006, 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.

Publication Types:      Comparative Study

PMID: 17846041 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 May;42(6):487-94. Epub 2007 Jul 2.

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.

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

PMID: 17606271 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 May;42(6):503-6. Epub 2007 Jun 22.

Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder.

Brunet A, Orr SP, Tremblay J, Robertson K, Nader K, Pitman RK.

Department of Psychiatry, McGill University and Douglas Hospital Research Center, Montreal, QC, Canada.

The beta-adrenergic blocker propranolol given within hours of a psychologically traumatic event reduces physiologic responses during subsequent mental imagery of the event. Here we tested the effect of propranolol given after the retrieval of  memories of past traumatic events. Subjects with chronic post-traumatic stress disorder described their traumatic event during a script preparation session and  then received a one-day dose of propranolol (n=9) or placebo (n=10), randomized and double-blind. A week later, they engaged in script-driven mental imagery of their traumatic event while heart rate, skin conductance, and left corrugator electromyogram were measured. Physiologic responses were significantly smaller in the subjects who had received post-reactivation propranolol a week earlier. Propranolol given after reactivation of the memory of a past traumatic event reduces physiologic responding during subsequent mental imagery of the event in a similar manner to propranolol given shortly after the occurrence of a traumatic event.

Publication Types:      Randomized Controlled Trial     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: 17588604 [PubMed - indexed for MEDLINE]

 

J Psychosoc Nurs Ment Health Serv. 2008 May;46(5):26-34.

Perceptions of survivors of loss by homicide: opportunities for nursing practice.

Baliko B, Tuck I.

College of Nursing, University of South Carolina, Columbia, SC 29208, USA. balikob@gwm.sc.edu

Ten adult family members of homicide victims were recruited to participate in interviews describing their experiences related to the loss of their loved ones.  A phenomenological approach was used to guide data collection and analysis, resulting in the identification of four major themes. Participants described intense emotional responses and grief complicated by the suddenness, violence, and intentionality of the homicide; engagement in activities that both buffered the emotional effects of the loss and helped them purposefully integrate it into  their lives; the strengthening and dissolution of relationships; and a transformative, perpetually evolving post-homicide experience that was viewed as  "healing" and that was influenced by many factors. Implications of these findings for research and nursing practice are discussed.

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

PMID: 18548868 [PubMed - indexed for MEDLINE]

 

J Stud Alcohol Drugs. 2008 May;69(3):337-47.

Three potential mediators of the effects of child abuse and neglect on adulthood  substance use among women.

White HR, Widom CS.

Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, New Jersey 08854-8001, USA. hewhite@rci.rutgers.edu

OBJECTIVE: This study examined mechanisms that might account for the association  between early childhood abuse and neglect, and substance use and related problems in adulthood for women. METHOD: Women with documented cases of early childhood abuse and/or neglect and matched controls were interviewed in young adulthood (mean age=29 years) and again in middle adulthood (mean age=40) (n=582). We examined the mediating effects of posttraumatic stress disorder (PTSD) symptoms,  stressful life events, and delinquent and criminal behavior measured in young adulthood on substance use-related problems and illicit drug use measured in middle adulthood. RESULTS: We found that all three potential mediators mediated the effects of abuse and neglect on substance-use problems and illicit drug use.  When all three mediators were considered simultaneously, only stressful life events mediated the effects of child abuse and neglect for substance use-related  problems and PTSD mediated for illicit drug use. These relationships were not moderated by race/ethnicity, although the effects of abuse and neglect on the mediators differed for white and non-white women. CONCLUSIONS: These findings suggest that interventions are needed with maltreated girls to recognize and attend to their PTSD symptoms and to assist them in developing coping strategies  to deal with stressful life events in an attempt to reduce risk of subsequent substance use and related problems.

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

PMID: 18432375 [PubMed - indexed for MEDLINE]

 

J Trauma. 2008 May;64(5):1349-56.

Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity.

Dyster-Aas J, Willebrand M, Wikehult B, Gerdin B, Ekselius L.

Departments of Neurosciences Psychiatry, University Hospital, Uppsala, Sweden.

BACKGROUND: Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors. A rigorous, prospective, longitudinal approach was  used to study psychiatric history in a population-based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder (PTSD) at a 12-month follow-up. METHODS: Seventy-three consecutive patients admitted to  the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for psychiatric disorders, of whom 64 were also assessed after 12 months. RESULTS: Forty-eight patients (66%) presented with at least one lifetime psychiatric diagnosis; major depression (41%), alcohol abuse or dependence (32%), simple phobia (16%), and panic disorder (16%) were most prevalent. At 12-months postburn, 10 patients (16%) met criteria for major depression, 6 (9%) for PTSD, and 11 (17%) for subsyndromal PTSD. Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months, whereas those with lifetime affective disorder, substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD. CONCLUSIONS: Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders. Those with a psychiatric history have a higher risk of postburn psychiatric problems.

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

PMID: 18469660 [PubMed - indexed for MEDLINE]

 

J Urban Health. 2008 May;85(3):411-27. Epub 2008 Mar 25.

Vicarious exposure to terrorist attacks and substance use: results from an urban  household survey.

Lippert AM, Fendrich M, Johnson TP.

Center for Addiction and Behavioral Health Research, Milwaukee, WI, USA. alippert@uwm.edu

This study investigated the impact of the 9/11 attacks on substance use in Chicago, Illinois. The study design was a cross-sectional, audio-computer-assisted self-interview survey conducted in 2001 and 2002. Biological samples were also collected for toxicological analyses. Using a multistage area probability design, residents between the ages of 18 and 40 years were randomly selected. Compared to pre-9/11 interviewees, post-9/11 interviewees showed significantly less self-reported marijuana use, marijuana use per test results, and cocaine use per test results. Law enforcement and social-structural  explanations for the findings are discussed.

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

PMID: 18363107 [PubMed - indexed for MEDLINE]

 

Man Ther. 2008 May;13(2):93-102. Epub 2008 Jan 24.

Physical and psychological aspects of whiplash: Important considerations for primary care assessment.

Sterling M, Kenardy J.

Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Mayne Medical School, Herston Road, Herston, Qld. 4066, Australia. m.sterling@uq.edu.au

Whiplash is a heterogenous and in many, a complex condition involving both physical and psychological factors. Primary care practitioners are often the first healthcare contact for individuals with a whiplash injury and as such play  an important role in gauging prognosis as well as providing appropriate management for whiplash injured patients. It is imperative that factors associated with poor outcome are recognized and managed in the primary care environment at the crucial early acute stage post injury. This paper outlines the heterogeneity of the whiplash condition in terms of both physical (particularly the sensory presentation) and psychological characteristics and the relationships between these features. The clinical assessment of these factors will be explored as well as direction for appropriate early interventions. An early co-ordinated inter-professional management approach, particularly in patients with a complex clinical presentation involving central hyperexcitability and symptoms of posttraumatic stress will be required.

Publication Types:      Review

PMID: 18221907 [PubMed - indexed for MEDLINE]

 

Mil Med. 2008 May;173(5):411-21.

Structured clinical interview guide for postdeployment psychological screening programs.

Wright KM, Adler AB, Bliese PD, Eckford RD.

U.S. Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Heidelberg, Germany.

Brief structured clinical interviews are a key component of the Department of Defense postdeployment health reassessment program. Such interviews are critical  for recommending individuals for follow-up assessment and care. To standardize the interview process, U.S. Army Medical Research Unit-Europe developed a structured interview guide, designed in response to both clinical requirements and research findings. The guide includes sections on depression, suicidality, post-traumatic stress disorder, anger, relationship problems, alcohol problems, and sleep problems. In addition, there is an open-ended section on other problems and a section for case dispositions. Data from a 2005 blinded validation study with soldiers returning from a 1-year-long combat deployment are included to demonstrate the utility of the structured interview. Guidelines and implementation considerations for the use of the structured interview are discussed.

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

PMID: 18543560 [PubMed - indexed for MEDLINE]

 

Mt Sinai J Med. 2008 May-Jun;75(3):248-62.

Anxiety disorders: a comprehensive review of pharmacotherapies.

Hoffman EJ, Mathew SJ.

Department of Psychiatry, Division of Child and Adolescent Psychiatry, Mount Sinai School of Medicine, New York, NY 10 019, USA.

This article reviews the evidence from randomized, placebo-controlled trials and  meta-analyses of pharmacological treatments of the following anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. There is evidence from multiple randomized, placebo-controlled trials to support the use of selective serotonin reuptake inhibitors as first-line pharmacotherapy in these disorders, and a number of the  selective serotonin reuptake inhibitors have received US Food and Drug Administration approval for these indications. Serotonin-norepinephrine reuptake  inhibitors are now emerging as first-line treatments for these anxiety disorders  alongside the selective serotonin reuptake inhibitors and have been US Food and Drug Administration-approved for some of these indications as well. Benzodiazepines are also effective treatments for anxiety disorders, and although this medication class has the advantage of a rapid onset of action, their use is  limited by their potential for abuse and lack of antidepressant properties. In addition to reviewing the clinical trials that have investigated the anxiolytic effects of these commonly used medications, we review the evidence for novel uses of other agents, including anticonvulsants and atypical antipsychotics, in anxiety disorders.

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

PMID: 18704983 [PubMed - indexed for MEDLINE]

 

Nervenarzt. 2008 May;79(5):577-86.

[Post-traumatic stress disorder in Germany. Results of a nationwide epidemiological study]

[Article in German]

Maercker A, Forstmeier S, Wagner B, Glaesmer H, Brähler E.

Fachrichtung Psychopathologie und Klinische Intervention, Universität Zürich, Binzmühlestrasse 14/17, Zürich, Switzerland. maercker@psychologie.unizh.ch

In a representative epidemiological study (n=2426) with a broad age range of respondents (14-93 years), prevalence rates of traumatic life events, post-traumatic stress disorder (PTSD), and partial PTSD were estimated. A standardized interview using the trauma checklist of the Composite International  Diagnostic Interview and a DSM-IV PTSD symptom checklist (Modified PTSD Symptom Scale) were applied. One-month prevalence rates were 2.3% for DSM-IV PTSD and 2.7% for partial PTSD. There were no gender differences but age-group differences did appear: among persons older than 60, the prevalence of PTSD was 3.4%, whereas the prevalence was estimated at 1.3% among persons aged 14-29 years and 1.9% among those aged 30-59 years. Partial PTSD exhibited the same age distribution, with 3.8% in the elderly, 2.4% in the middle-aged, and 1.3% in young adults. The  results correspond with those of other international studies taking war-related consequences for older age groups into account. Our representative study provides the first evidence of higher PTSD prevalence rates among older age groups in the  German population, which is assumed to be related to consequences of World War II.

Publication Types:      English Abstract

PMID: 18437339 [PubMed - indexed for MEDLINE]

 

Nervenarzt. 2008 May;79(5):531-42.

[Process--development--personality change. Psychotraumatological considerations on basic concepts of psychopathology]

[Article in German]

Schmidt-Degenhard M.

Klinik für Psychiatrie und Psychotherapie der Kaiserswerther Diakonie, Zeppenheimer Weg 7, Düsseldorf, Germany. schmidt-degenhard@kaiserswerther-diakonie.de

The"erlebnisbedingte Persönlichkeitswandel" (reactive personality change) described by Venzlaff in 1958 is characterized here as a prototype of "enduring personality change after catastrophic experience" (ICD-10 F62.0). The symptoms of this post-traumatic syndrome indicate profound and irreversible changes in the individual's view of the world and herself. Referring to more anthropologically oriented psychotraumatological studies by Straus and Müller-Suur, Venzlaff interprets this syndrome as an "incurable disruption of the patient's existence"  ("unheilbarer Bruch der Daseinsordnung"). The author attempts to integrate the phenomenon of reactive personality change into the wider context of the psychopathological problem of process and development and to understand it, in the term of Jaspers' "general psychopathology", as a "psychic process".

Publication Types:      English Abstract     Review

PMID: 18264815 [PubMed - indexed for MEDLINE]

 

Neurosci Behav Physiol. 2008 May;38(4):427-34.

Prediction of outbreaks of post-traumatic stress disorder after large-scale terrorist acts.

Yastrebov VS, Boev BV.

Scientific Center for Mental Health, Russian Academy of Medical Science, Russia.

An original computer technology--a mathematical model and computer programs running under Windows--for the operative assessment of outbreaks of post-traumatic stress disorders (PTSD) and prediction of their sequelae among victims of terrorist attacks is described. The structure of the mathematical model is described, along with the relationship between the mathematical model and the calculating algorithm for prediction of the development of outbreaks of PTSD. The computer program allowed predictions of the numbers of mental disorders with subsequent behavioral impairment, addictive disorders, personality changes,  and signs of maladaptation in victims of terrorist acts. A model of an epidemic of mass panic in a population sensitive to negative information on the consequences of terrorist acts is described.

Publication Types:      Evaluation Studies

PMID: 18401737 [PubMed - indexed for MEDLINE]

 

Pediatr Crit Care Med. 2008 May;9(3):252-60.

Comment in:     Pediatr Crit Care Med. 2008 May;9(3):336-7.

Developing the Children's Critical Illness Impact Scale: capturing stories from children, parents, and staff.

Rennick JE, McHarg LF, Dell'Api M, Johnston CC, Stevens B.

Department of Nursing Research, the Montreal Children's Hospital of the McGill University Health Centre, School of Nursing, McGill University, Montreal, Quebec, Canada H3H 1P3. janet.rennick@muhc.mcgill.ca

OBJECTIVE: With the evolution of pediatric critical care medicine has come an awareness of the ethical imperative of healthcare professionals to attend to the  psychological sequelae of technologically intensive care. Recent attempts to measure psychological outcomes in these children have been limited. The purpose of this study was to develop a measure of posthospitalization distress, the Children's Critical Illness Impact Scale (CCIIS), for children aged 6-12 yrs following pediatric intensive care unit hospitalization. DESIGN: A measurement development study consisting of two phases: 1) item generation and scale formatting; and 2) item reduction and scale revisions. Items were generated following thematic analysis of qualitative data from focus groups and individual  interviews with children, parents, and healthcare professionals. Children reviewed items for interpretability and importance and assessed scaling technique and item presentation; healthcare professionals further evaluated item relevance. SETTING: The pediatric intensive care units of three quaternary care, Canadian pediatric teaching hospitals. PATIENTS: Phase 1 included 18 children, 22 parents, and 12 healthcare professionals (n = 52). Phase 2 included eight children and four healthcare professionals (n = 12). MEASUREMENTS AND MAIN RESULTS: Five key domains were identified in the thematic analyses: worries, fears, friends and family, sense of self, and behaviors. Thirty-six items were initially generated,  and subsequent item reduction resulted in 23 items that were retained on the final scale. Items were generally rated extremely relevant and were judged to capture the content area (content validity index = 0.87). The CCIIS was easily understood, and the scaling format worked well. Older children preferred written  items, while younger children will require a modified, pictorial version. CONCLUSIONS: The CCIIS is a new self-report measure with demonstrated content validity and specific relevance for young school-aged children following pediatric intensive care unit hospitalization. Valid, accessible, and developmentally appropriate measures are essential to identify high-risk children and, ultimately, promote healthy growth and development.

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

PMID: 18446107 [PubMed - indexed for MEDLINE]

 

Pharmacotherapy. 2008 May;28(5):656-66.

Prazosin for the treatment of posttraumatic stress disorder sleep disturbances.

Miller LJ.

Department of Pharmacy, Michael E. DeBakey Veterans Administration Medical Center, Houston, Texas, USA.

An estimated 70-87% of patients who suffer from posttraumatic stress disorder (PTSD) experience sleep disruption. These patients have distressing dreams or nightmares in which the traumatic event is reexperienced, and they also have difficulty in falling or staying asleep. Selective serotonin reuptake inhibitors  are the treatment of choice for PTSD, but with the exception of fluvoxamine, they are often ineffective or only partially effective for sleep problems. Sedative-hypnotics may be helpful in the short term but are associated with tolerance and addiction potential. In the central nervous system, alpha(1)-adrenergic receptors are known to be important in both the startle and sleep responses. Stimulation of these receptors may contribute to PTSD-related trauma-content nightmares. Prazosin, a highly lipophilic alpha(1)-adrenergic receptor blocker that is traditionally used to treat hypertension and benign prostatic hyperplasia, has been shown to decrease the occurrence of trauma nightmares in both combat veterans and patients with non-combat-related PTSD. The available data, although mostly from open-label trials, suggest that this agent also improves sleep quality and patients' sense of wellbeing and ability to function in daily activities. The optimum dose is unknown; however, a dose-related response appears to be evident. Clinicians should monitor for orthostatic hypotension, usually seen early in therapy, when prazosin is started  in patients with PTSD.

Publication Types:      Review

PMID: 18447662 [PubMed - indexed for MEDLINE]

 

Prehosp Disaster Med. 2008 May-Jun;23(3):s20-6.

Comparative analysis of the Japanese version of the revised impact of event scale: a study of firefighters.

Mitani S.

Kyoto Prefectural University of Medicine, Graduate School of Medical Science Kamigyo-ku, Kyoto 606-8566 Japan. mitani@koto.kpu-m.ac.jp

INTRODUCTION: The Impact of Event Scale Revised (IES-R) has been used in various  epidemiological studies to assess the prevalence of post-traumatic stress disorder (PTSD). Previous studies using the IES-R Japanese version to assess the  mental health of firefighters were based on the premise that firefighters had experienced a traumatic event(s) as a matter of course. However, use of the IES-R-J does not indicate whether or not a traumatic event was experienced. The purpose of this study is to clarify the differences between: (1) IES-R-J high and low score groups; and (2) those who report symptoms similar to those of PTSD with and without having been being exposed to a traumatic event. METHODS: Questionnaire packets distributed to all 157 workers in a Japanese fire station included the IES-R, the Japan Brief Job Stress Questionnaire, a questionnaire regarding traumatic event experiences, and demographic questions. Participants who scored > or = 25 points on the IES-R-J scale were defined as the PTSD high risk (HR) group; those with scores < 25 points as the PTSD low risk (LR) group. RESULTS: One hundred thirty-one of the 157 subjects (83.4%) responded to the questionnaire; three were excluded from the analysis because of missing data. The mean total IES-R-J score was 14.9 +/- 15.2. Twenty-eight subjects scored in the PTSD HR group (> or = 25); 100 scored in the LR group (< 25). A total of 54 (42.2%) participants had experienced a traumatic event; 57.8% had not. In the HR  group, 14 subjects had experienced a traumatic event and 14 had not. Participants who had experienced a traumatic event reported a higher incidence of intrusion/re-experience symptoms than did those who had not experienced a traumatic event. The level of social support significantly affected the risk for  PTSD. Firefighters who scored > or = 25 on the IES-R-J and, thus, considered to be at high risk for the development of PTSD, were less confident about their health, experienced more job stressors and had less social support than did those whose IES-R-J scores were < 25. Having experienced a traumatic event was reported by only 42% of all the participants and by only 50% of those in the high risk PTSD group. CONCLUSIONS: Although the IES-R is an easily-administered tool useful in epidemiological studies evaluating psychological stress, it is recommended that the questionnaire be amended to include a question regarding the existence of a threatened experience or event and to analyze the data using positive and negative predictive value methodology.

Publication Types:      Comparative Study

PMID: 18702284 [PubMed - indexed for MEDLINE]

 

Psychol Health Med. 2008 May;13(3):257-73.

Understanding psychological distress in Meniere's disease: a systematic review.

Kirby SE, Yardley L.

School of Psychology, University of Southampton, University of Southampton, Highfield, Southampton, UK. sek@soton.ac.uk

It has long been suspected that psychological disturbance is common in Meniere's  disease (MD), but there has been no systematic review of research on this topic since 1977. The aim of this review was to investigate whether components of post-traumatic stress disorder (PTSD) or health anxiety contribute to distress, so that support and psychological therapy can be tailored better to the particular problems of people with MD. We systematically identified all studies of psychological factors associated with MD between 1977 and 2004. We then tabulated the findings from each of the 28 studies to match them to the components of PTSD and health anxiety. Levels of psychosocial impairment and distress were comparable to patients with similar illness. Evidence was found for some of the components of both PTSD and health anxiety. We conclude that more specific research into PTSD-like symptoms and health anxiety in MD is needed. There was a general lack of research into psychological mechanisms contributing to distress in this population, many studies had methodological weaknesses, and only one qualitative and one longitudinal study had been carried out.

Publication Types:      Review

PMID: 18569895 [PubMed - indexed for MEDLINE]

 

Psychoneuroendocrinology. 2008 May;33(4):416-24. Epub 2008 Mar 4.

Effects of trauma-related audiovisual stimulation on cerebrospinal fluid norepinephrine and corticotropin-releasing hormone concentrations in post-traumatic stress disorder.

Geracioti TD Jr, Baker DG, Kasckow JW, Strawn JR, Jeffrey Mulchahey J, Dashevsky  BA, Horn PS, Ekhator NN.

Veterans Affairs Medical Center, Research Service, Cincinnati, OH, USA. Thomas.Geracioti@va.gov

BACKGROUND: Although elevated concentrations of both corticotropin-releasing hormone (CRH) and norepinephrine are present in the cerebrospinal fluid (CSF) of  patients with post-traumatic stress disorder (PTSD), the effects of exposure to traumatic stimuli on these stress-related hormones in CSF are unknown. METHODS: A randomized, within-subject, controlled, cross-over design was used, in which patients with war-related PTSD underwent 6-h continuous lumbar CSF withdrawal on  two occasions per patient (6-9 weeks apart). During one session the patients watched a 1-h film containing combat footage (traumatic film) and in the other a  1-h film on how to oil paint (neutral film). At 10-min intervals, we quantified CRH and norepinephrine in CSF, and ACTH and cortisol in plasma, before, during, and after symptom provocation. Subjective anxiety and mood were monitored using 100-mm visual analog scales. Blood pressure and heart rate were obtained every 10min from a left leg monitor. RESULTS: Eight of 10 patients completed two CSF withdrawal procedures each. A major drop in mood and increases in anxiety and blood pressure occurred during the traumatic relative to the neutral videotape. CSF norepinephrine rose during the traumatic film relative to the neutral videotape; this rise directly correlated with magnitude of mood drop. In contrast, CSF CRH concentrations declined during the trauma-related audiovisual stimulus, both absolutely and relative to the neutral stimulus; the magnitude of  CRH decline correlated with degree of subjective worsening of anxiety level and mood. Plasma cortisol concentrations were lower and ACTH levels similar during the stress compared with the neutral videotape. CONCLUSIONS: CSF concentrations of the stress hormones norepinephrine and CRH differentially change after exposure to 1h of trauma-related audiovisual stimulation in chronic, combat-related PTSD. While the CSF norepinephrine increase was postulated, the decline in CSF CRH levels is surprising and could be due to audiovisual stress-induced increased uptake of CSF CRH into brain tissue, increased CRH utilization, increased CRH degradation, or to an acute stress-related inhibition  or suppression of CRH secretion.

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

PMID: 18295412 [PubMed - indexed for MEDLINE]

 

Psychooncology. 2008 May;17(5):430-7.

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. ulrika.poder@pubcare.uu.se

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. (c) 2007 John Wiley & Sons, Ltd.

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

PMID: 17847123 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2008 May;70(4):512-9. Epub 2008 Apr 23.

Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a  systematic review.

Davydow DS, Desai SV, Needham DM, Bienvenu OJ.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ddavydo1@u.washington.edu

OBJECTIVE: Acute lung injury (ALI), including its more severe subcategory, acute  respiratory distress syndrome (ARDS), is a critical illness associated with considerable morbidity and mortality. Our objective was to summarize data on the  prevalence of depressive, posttraumatic stress disorder (PTSD), and other anxiety syndromes amongst survivors of ALI/ARDS, potential risk factors for these syndromes, and their relationships to quality of life. METHODS: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, and PsycINFO. Eligible studies reported data on psychiatric morbidity at least once after intensive care treatment of ALI/ARDS. RESULTS: Ten observational studies met inclusion criteria (total n = 331). Using questionnaires, the point prevalence of "clinically significant" symptoms of depression ranged from 17% to  43% (4 studies); PTSD, 21% to 35% (4 studies); and nonspecific anxiety, 23% to 48% (3 studies). Studies varied in terms of instruments used, thresholds for clinical significance, baseline psychiatric history exclusions, and timing of assessments (range = 1 month to 8 years). Psychiatrist-diagnosed PTSD prevalence  at hospital discharge, 5 years, and 8 years were 44%, 25%, and 24%, respectively. Three studies prospectively assessed risk factors for post-ALI/ARDS PTSD and depressive symptoms; significant predictors included longer durations of mechanical ventilation, intensive care unit stay, and sedation. All four studies  that examined relationships between psychiatric symptoms and quality of life found significant negative associations. CONCLUSIONS: The prevalence of psychiatric morbidity in patients surviving ARDS seems high. Future research should incorporate more in-depth diagnostic and risk factor assessments for prevention and monitoring purposes.

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

PMID: 18434495 [PubMed - indexed for MEDLINE]

 

Psychosomatics. 2008 May-Jun;49(3):225-9.

The effect of pegylated interferon-alpha2b and ribavirin on posttraumatic stress  disorder symptoms.

Dieperink E, Leskela J, Dieperink ME, Evans B, Thuras P, Ho SB.

Dept. of Psychiatry and the Hepatitis C Resource Center at the VA Medical Center, Minneapolis, MN 55417, USA. Eric.Dieperink@med.va.gov

BACKGROUND: Patients with chronic psychiatric diagnoses have a prevalence of chronic hepatitis C (HCV) approximately 11 times higher than the general American population. Posttraumatic stress disorder (PTSD) is particularly common among HCV patients. OBJECTIVE: The authors describe the effect of treatment with pegylated-interferon-alpha(2b) (IFN) and ribavirin for patients with HCV on their posttraumatic stress disorder (PTSD) symptoms. METHOD: Sixteen patients with HCV  and combat-related PTSD were followed for 24 weeks and assessed with self-report  measures of PTSD, hostility, and depression. RESULTS: Depression and Resentment scores significantly increased in five patients treated with IFN and ribavirin, but no significant differences were found in PTSD scores when compared with 11 control patients. CONCLUSION: The results suggest that patients with PTSD and HCV can be safely treated with anti-viral therapies when they are given appropriate psychiatric care.

Publication Types:      Clinical Trial

PMID: 18448777 [PubMed - indexed for MEDLINE]

 

Psychother Psychosom Med Psychol. 2008 May;58(5):192-9. Epub 2007 Sep 10.

[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.

Publication Types:      English Abstract

PMID: 17828686 [PubMed - indexed for MEDLINE]

 

Rheumatol Int. 2008 May;28(7):649-56. Epub 2007 Dec 6.

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 - indexed for MEDLINE]

 

Schizophr Bull. 2008 May;34(3):568-79. Epub 2007 Nov 13.

Childhood trauma and psychotic disorders: a systematic, critical review of the evidence.

Bendall S, Jackson HJ, Hulbert CA, McGorry PD.

ORYGEN Research Centre, 35 Poplar Road, Parkville, Victoria 3056, Australia. sbendall@unimelb.edu.au

There is controversy over whether childhood trauma (CT) is a causal factor in the development of psychosis. This review aims to identify and critically analyze the association between CT and psychotic disorders. Studies investigating CT and psychotic disorder were identified by searches of electronic databases and manual searches of references lists, and 46 studies were identified. Forty studies had no control group, only psychiatric control groups, or unmatched, nonpopulation control groups and thus had methodologies that were inadequate to determine the relationship between CT and psychosis. Six studies used appropriate control groups. Three studies found an association between CT and psychosis, 2 found potentially real associations that failed to reach statistical significance, and  1 found no association, tentatively suggesting a relationship between CT and psychotic disorders. Several methodological problems were found in the studies in the review, including the highest quality studies, which limit the strength of the conclusions that can be drawn from them. These were lack of statistical power, lack of attention to moderating or mediating variables, the way in which CT was measured, and the use of cross-sectional research designs. These problems, some of which may be unavoidable in CT research, suggest the need for new and innovative methodologies in the investigation of CT and psychosis. Directions for further research are explored.

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

PMID: 18003630 [PubMed - indexed for MEDLINE]

 

Z Kinder Jugendpsychiatr Psychother. 2008 May;36(3):151-61.

[Trauma and traumatic disorders in children and adolescents]

[Article in German]

Simons M, Herpertz-Dahlmann B.