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PTSD Abstracts posted by "A Matter of Mind"


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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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. <>

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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. <>

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, RWTH Aachen.

In recent years, the definitions of trauma and individual criteria of posttraumatic disorders as defined in ICD-10 and DSM-IV have been critically discussed. The category of acute stress disorder is questioned due to an over-emphasis on dissociative symptoms and a pathologizing of normal reactions after trauma. The criteria for posttraumatic stress disorder, especially those with regard to childhood and adolescence, need revision. Scheeringa and co-workers have since defined PTSD-criteria that are more suitable and specific for posttraumatic reactions and disorders in toddlers and children. Moreover, the "Complex Trauma Taskforce" of the National Child Traumatic Stress Network proposes a diagnosis called Developmental Trauma Disorder to better capture the problems of children suffering from early and complex traumata.

Publication Types:      English Abstract

PMID: 18622975 [PubMed - indexed for MEDLINE]


BMJ. 2008 Apr 26;336(7650):913.

One in five US soldiers have depression or post-traumatic stress disorder, study  finds.

Charatan F.

Publication Types:      News

PMID: 18436940 [PubMed - indexed for MEDLINE]


Health Qual Life Outcomes. 2008 Apr 23;6:29.

Prevalence of and factors influencing posttraumatic stress disorder among mothers of children under five in Kabul, Afghanistan, after decades of armed conflicts.

Seino K, Takano T, Mashal T, Hemat S, Nakamura K.

International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Bunkyo, Tokyo 113-8519, Japan.

BACKGROUND: In the period following wars and other forms of armed conflict, health and quality of life of mothers is a major concern as they have the closest contact with children. The present study was performed to examine the impact of exposure to events related to armed conflicts on post traumatic stress disorder (PTSD) among women raising children, and to identify factors that alleviate the negative consequences of exposure to traumatic events. METHODS: A structured interview survey was conducted in Kabul Province, Afghanistan, in 2006. The subjects were the mothers of children less than 5 years old randomly selected from 1400 households in Kabul Province, Afghanistan. Symptoms of PTSD were assessed according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Exposure to traumatic events related to armed conflict, experience of hardship with regard to basic needs, resources that the subjects seek for mental health support, and socioeconomic variables were evaluated. Logistic regression analysis was performed to determine the association between PTSD symptoms and predictor variables. RESULTS: The prevalence rate of PTSD among 1172 women participated in this study was 29.8%. The most prevalent symptom was arousal (74.8%), followed by re-experiencing (54.9%) and avoidance (33.7%). The prevalence rate of PTSD symptoms among subjects who reported having experienced at least one event related to armed conflict (52.7%) was significantly higher than that among those who reported no such experiences (9.6%). Experience of food shortage was independently associated with PTSD. Seeking support for mental health was related to lower prevalence of PTSD symptoms among those who reported no direct experience of events related to  armed conflict. However, no such relationship was observed with PTSD symptoms among those who reported having direct experience of events related to armed conflict. CONCLUSION: Direct exposure to traumatic events was significantly associated with PTSD symptoms among women raising children. For those who had experienced armed conflict-related events, food security mitigated the occurrence of PTSD symptoms; however, support seeking behavior did not show a significant mitigating influence on PTSD. Means to alleviate the negative influence of exposure to armed conflicts on the quality of life of women should be developed from the viewpoint of quality of mental health support and avoidance of material  hardship.

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

PMID: 18433474 [PubMed - indexed for MEDLINE]


JAMA. 2008 Apr 23;299(16):1885-6.

VA, military seek office-based PTSD care.

Kuehn BM.

Publication Types:      News

PMID: 18430900 [PubMed - indexed for MEDLINE]


Neuroscience. 2008 Apr 22;153(1):20-30. Epub 2008 Feb 16.

Stress-induced changes in sleep and associated neuronal activity in rat hippocampus and amygdala.

Hegde P, Singh K, Chaplot S, Shankaranarayana Rao BS, Chattarji S, Kutty BM, Laxmi TR.

Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore-560029, Karnataka, India.

Stress increases vulnerability to anxiety and depression. We have investigated the effect of acute immobilization stress in amygdalohippocampal circuits by measuring the electroencephalogram (EEG) in male Wistar rats during rapid eye movement (REM) sleep. Electrodes were implanted stereotaxically in the hippocampus (CA1 and CA3 subregions of the hippocampus) and the amygdala (lateral nucleus). Prior to the stress, two baseline recordings were taken. Twenty-four hours later rats were exposed once to acute immobilization stress (AIS) session for 2 h. After the release and on subsequent days, electrophysiological changes that occurred due to stress during REM sleep were analyzed by comparing them with baseline measurements. Our results suggest that acute immobilization stress induced significant increase in REM sleep in the first 24 h after the exposure. In addition to changes in the sleep patterns, we have observed increased theta oscillations in CA1 area of the hippocampus with decreased coherence at theta range (4-8 Hz) between hippocampus and amygdala. These results suggest that single exposure to aversive experience such as immobilization stress can lead to  dynamic changes in neuronal activities with altered sleep morphology. The results obtained in the present study are comparable to those seen in human patients suffering from panic, and anxiety due to posttraumatic stress disorder (PTSD).

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

PMID: 18358618 [PubMed - indexed for MEDLINE]


Am J Health Syst Pharm. 2008 Apr 15;65(8):716-22.

Prazosin for treatment of nightmares related to posttraumatic stress disorder.

Taylor HR, Freeman MK, Cates ME.

Walgreens' Pharmacy, Selma, AL, USA.

PURPOSE: The efficacy of prazosin for the treatment of posttraumatic stress disorder (PTSD)-related nightmares is reviewed. SUMMARY: PTSD is an anxiety disorder that can occur after experiencing or witnessing a life-threatening event, such as military combat, natural disasters, terrorist attacks, serious accidents, or violent personal assaults. The event that induced PTSD is often relived through nightmares or flashbacks. Sleep disturbances affect approximately 70% of patients with PTSD. Several medications have been evaluated for reducing PTSD-related nightmares, with limited success. Prazosin is a centrally and peripherally acting alpha(1)-adrenergic antagonist whose mechanism of action, favorable adverse-effect profile, and low cost make it a promising agent for the  treatment of PTSD. To date, two case reports, two chart reviews, three open-label trials, and two placebo-controlled trials have been published documenting the efficacy and safety of prazosin in the treatment of PTSD-related nightmares. Therapy with prazosin resulted in a reduction in nightmares in patients with both combat- and noncombat-related trauma. A therapeutic benefit occurred with prazosin dosages as low as 1 mg daily, and suppression of nightmare symptoms occurred within one week of prazosin initiation. The most frequently reported adverse event was orthostatic hypotension. The variability in the populations studied (e.g., combat, noncombat, recent traumatic experiences) leaves additional unanswered questions that must be addressed in large, randomized, controlled trials. CONCLUSION: Prazosin appears to be a promising and well-tolerated agent for the management of PTSD-related nightmares. Further well-designed trials are warranted to establish its place in the treatment of PTSD.

Publication Types:      Review

PMID: 18387899 [PubMed - indexed for MEDLINE]


J Trauma Manag Outcomes. 2008 Apr 15;2:3.

Investment in online self-evaluation tests: A theoretical approach.

de Gara F, Gallo WT, Bisson JI, Endrass J, Vetter S.

Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland.

ABSTRACT: BACKGROUND: Large-scale traumatic events may burden any affected public health system with consequential charges. One major post-disaster, expense factor emerges form early psychological interventions and subsequent, posttraumatic mental health care. Due to the constant increase in mental health care costs, also post-disaster public mental health requires best possible, cost-effective care systems. Screening and monitoring the affected population might be one such  area to optimize the charges. METHODS: This paper analyzes the potential cost-effectiveness of monitoring a psychologically traumatized population and to  motivate individuals at risk to seek early treatment. As basis for our model served Grossman's health production function, which was modified according to fundamental concepts of cost-benefit analyzes, to match the basic conditions of online monitoring strategies. We then introduce some fundamental concepts of cost-benefit analysis. RESULTS: When performing cost-benefit analyses, policy makers have to consider both direct costs (caused by treatment) and indirect costs (due to non-productivity). Considering both costs sources we find that the  use of Internet-based psychometric screening instruments may reduce the duration  of future treatment, psychological burden and treatment costs. CONCLUSION: The identification of individuals at risk for PTSD following a disaster may help organizations prevent both the human and the economic costs of this disease. Consequently future research on mental health issues should put more emphasis on  the importance of monitoring to detect early PTSD and focus the most effective resources within early treatment and morbidity prevention.

PMID: 18412943 [PubMed - in process]


Psychiatry Res. 2008 Apr 15;162(3):256-61. Epub 2008 Mar 4.

Corpus callosum in maltreated children with posttraumatic stress disorder: a diffusion tensor imaging study.

Jackowski AP, Douglas-Palumberi H, Jackowski M, Win L, Schultz RT, Staib LW, Krystal JH, Kaufman J.

Child Study Center, Yale University School of Medicine, New Haven, CT, United States.

Contrary to expectations derived from preclinical studies of the effects of stress, and imaging studies of adults with posttraumatic stress disorder (PTSD),  there is no evidence of hippocampus atrophy in children with PTSD. Multiple pediatric studies have reported reductions in the corpus callosum--the primary white matter tract in the brain. Consequently, in the present study, diffusion tensor imaging was used to assess white matter integrity in the corpus callosum in 17 maltreated children with PTSD and 15 demographically matched normal controls. Children with PTSD had reduced fractional anisotropy in the medial and  posterior corpus, a region which contains interhemispheric projections from brain structures involved in circuits that mediate the processing of emotional stimuli  and various memory functions--core disturbances associated with a history of trauma. Further exploration of the effects of stress on the corpus callosum and white matter development appears a promising strategy to better understand the pathophysiology of PTSD in children.

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: 18296031 [PubMed - indexed for MEDLINE]


Psychiatry Res. 2008 Apr 15;158(3):374-80. Epub 2008 Feb 21.

Measuring symptom exaggeration in veterans with chronic posttraumatic stress disorder.

Freeman T, Powell M, Kimbrell T.

Mental Health Service, Central Arkansas Veterans Healthcare System, Little Rock,  AR 72205-5484, USA. THOMAS.FREEMAN@MED.VA.GOV <THOMAS.FREEMAN@MED.VA.GOV>

Veteran subjects with chronic, combat-related posttraumatic stress disorder (PTSD) are frequently used as research subjects in the study of PTSD. However, questions have consistently been raised regarding PTSD symptom exaggeration in veteran populations due to the relationship between PTSD symptoms and disability  payments within the Veterans Affairs (VA) system. We used a variety of standardized forensic instruments frequently utilized in measuring symptom exaggeration - including the MMPI-2, the Structured Interview for Reported Symptoms (SIRS), the Structured Inventory of Malingered Symptomatology (SIMS), and the Miller Forensic Assessment Test (MFAST) - to examine symptom report in a  group of veterans presenting for treatment at a VA residential PTSD treatment program. The majority of Vietnam veteran subjects in our study (53%) exhibited clear symptom exaggeration by SIRS criteria. Within the entire subject group, total SIRS scores correlated significantly with reported PTSD symptom severity as measured by the Clinician Administered PTSD Scale (CAPS).

Publication Types:      Comparative Study

PMID: 18294699 [PubMed - indexed for MEDLINE]


Psychiatry Res. 2008 Apr 15;158(3):363-73. Epub 2008 Feb 5.

Measures of endothelial dysfunction in plasma of patients with posttraumatic stress disorder.

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

Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital Berne, Switzerland. <>

Posttraumatic stress disorder (PTSD) confers an increased cardiovascular risk. In 14 otherwise healthy patients with PTSD and in 14 age- and gender-matched non-PTSD controls, we investigated whether the categorical diagnosis of PTSD and  severity of PTSD symptom clusters (i.e. re-experiencing, avoidance, arousal, and  overall score) would be associated with plasma concentrations of three markers of endothelial dysfunction [soluble tissue factor (sTF), von Willebrand factor (VWF), and soluble intercellular adhesion molecule (sICAM)-1]. Compared with controls, patients had significantly higher sTF; this difference became nonsignificant when controlling for psychological distress. VWF and sICAM-1 levels were not significantly different between patients and controls. In the entire sample virtually all PTSD symptom clusters correlated significantly and positively with sTF and VWF but not with sICAM-1. The correlation between symptoms of re-experiencing and sTF was significantly different between patients  and controls. Controlling for symptoms of anxiety and depression (i.e. psychological distress) rendered most associations between PTSD symptom clusters  and sTF nonsignificant, whereas controlling for age retained significance of associations with VWF. Posttraumatic stress showed a continuous relationship with sTF and VWF, with the former relationship being partly affected by psychological  distress. This suggests one mechanism by which posttraumatic stress could contribute to atherosclerosis.

Publication Types:      Comparative Study

PMID: 18252265 [PubMed - indexed for MEDLINE]


Proc Natl Acad Sci U S A. 2008 Apr 8;105(14):5567-72. Epub 2008 Apr 7.

Decreased corticolimbic allopregnanolone expression during social isolation enhances contextual fear: A model relevant for posttraumatic stress disorder.

Pibiri F, Nelson M, Guidotti A, Costa E, Pinna G.

Psychiatric Institute, Department of Psychiatry, University of Illinois, 1601 West Taylor Street, Chicago, IL 60612, USA.

Mice subjected to social isolation (3-4 weeks) exhibit enhanced contextual fear responses and impaired fear extinction. These responses are time-related to a decrease of 5alpha-reductase type I (5alpha-RI) mRNA expression and allopregnanolone (Allo) levels in selected neurons of the medial prefrontal cortex, hippocampus, and basolateral amygdala. Of note, the cued fear response was not different between group housed and socially isolated mice. In socially isolated mice, S-norfluoxetine, a selective brain steroidogenic stimulant (SBSS), in doses (0.45-1.8 mumol/kg) that increase brain Allo levels but fail to inhibit  serotonin reuptake, greatly attenuates enhanced contextual fear response. SKF 105,111 (a potent 5alpha-RI inhibitor) decreases corticolimbic Allo levels and enhances the contextual fear response in group housed mice, which suggests that social isolation alters emotional responses by reducing the positive allosteric modulation of Allo at GABA(A) receptors in corticolimbic circuits. Thus, these procedures model emotional hyperreactivity, including enhanced contextual fear and impaired contextual fear extinction, which also is observed in posttraumatic  stress disorder (PTSD) patients. A recent clinical study reported that cerebrospinal fluid Allo levels also are down-regulated in PTSD patients and correlate negatively with PTSD symptoms and negative mood. Thus, protracted social isolation of mice combined with tests of fear conditioning may be a suitable model to study emotional behavioral components associated with neurochemical alterations relating to PTSD. Importantly, drugs like SBSSs, which  rapidly increase corticolimbic Allo levels, normalize the exaggerated contextual  fear responses resulting from social isolation, suggesting that selective activation of neurosteroidogenesis may be useful in PTSD therapy.

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

PMID: 18391192 [PubMed - indexed for MEDLINE]


Eur J Pharmacol. 2008 Apr 7;583(2-3):365-71. Epub 2008 Jan 24.

Glucocorticoids for the treatment of post-traumatic stress disorder and phobias:  a novel therapeutic approach.

de Quervain DJ, Margraf J.

Division of Psychiatry Research, University of Zürich, Lenggstr. 31, 8032 Zürich, Switzerland.

Post-traumatic stress disorder (PTSD) and phobias belong to the most common anxiety disorders and to the most common psychiatric illnesses in general. In both disorders, aversive memories are thought to play an important role in the pathogenesis and symptomatology. Previously, we have reported that elevated glucocorticoid levels inhibit memory retrieval in animals and healthy humans. We  therefore hypothesized that the administration of glucocorticoids might also inhibit the retrieval of aversive memory, thereby reducing symptoms in patients with PTSD and phobias. In recent clinical studies, we found first evidence to support this hypothesis. In patients with PTSD, low-dose cortisol treatment for one month reduced symptoms of traumatic memories without causing adverse side effects. Furthermore, we found evidence for a prolonged effect of the cortisol treatment. Persistent retrieval and reconsolidation of traumatic memories is a process that keeps these memories vivid and thereby the disorder alive. By inhibiting memory retrieval, cortisol may weaken the traumatic memory trace, and  thus reduce symptoms even beyond the treatment period. In patients with social phobia, we found that a single oral administration of cortisone 1 h before a socio-evaluative stressor significantly reduced self-reported fear during the anticipation-, exposure-, and recovery phase of the stressor. In subjects with spider phobia, repeated oral administration of cortisol 1 h before exposure to a  spider photograph induced a progressive reduction of stimulus-induced fear. This  effect was maintained when subjects were exposed to the stimulus again two days after the last cortisol administration, indicating that cortisol facilitated the  extinction of phobic fear. In conclusion, by a common mechanism of reducing the retrieval of aversive memories, glucocorticoids may be suited for the treatment of PTSD as well as phobias. More studies are needed to further evaluate the therapeutic efficacy of glucocorticoids in the treatment of anxiety disorders and to explore the potential of combining glucocorticoid treatment with psychotherapy.

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

PMID: 18275950 [PubMed - indexed for MEDLINE]


Eur J Pharmacol. 2008 Apr 7;583(2-3):340-9. Epub 2008 Jan 19.

Involvement of vasopressin in affective disorders.

Surget A, Belzung C.

EA3248 Psychobiologie des émotions, Université François Rabelais Tours, UFR Sciences et Techniques, Parc Grandmont, F-37200 Tours, France.

Affective disorders comprise mood disorders such as unipolar depression and anxiety disorders, including generalized anxiety, post-traumatic stress disorder, panic, phobia and obsessive-compulsive disorder. The etiology of these disorders  is related to stress. Further, they are characterized by alterations of the hypothalamus-pituitary-adrenal (HPA) axis function, controlling the endocrine response to stress. Vasopressin is a nonapeptide that is mainly expressed and/or  released in the hypothalamus and the pituitary, but also in other brain areas particularly in limbic regions. It strongly contributes to the endocrine and neural response to stress. Therefore, it has been suggested that vasopressin may  be involved in affective disorders. Here, we review both clinical and preclinical data that investigated this hypothesis. Several studies show an increased plasmatic level of vasopressin in anxiety disorders as well as in unipolar depression. Further, a single nucleotide polymorphism (SNP) of the vasopressin V(1b) receptor has been found to protect against depression. Preclinical data are convergent with the clinical findings. For example, Brattleboro rats, that display decreased vasopressin function, show reduced anxiety, reduced depressive-like behavior and decreased HPA function. Rats selected for high anxiety behavior exhibit increased HPA function related to a SNP in the vasopressin locus resulting in an overexpression of vasopressin. Antagonism of the V(1b) receptor decreases anxiety and depressive-like behaviors in rodents, as well as HPA responsivity to stress. Taken together, these data indicate that affective disorders may be related to excessive vasopressin function and consequently that a treatment with vasopressin receptor antagonists may be an effective treatment.

Publication Types:      Review

PMID: 18255056 [PubMed - indexed for MEDLINE]


AAOHN J. 2008 Apr;56(4):159-65; quiz 166-7.

Health effects following 9/11: implications for occupational health nurses.

Pak VM, O'Hara M, McCauley LA.

University of Pennsylvania, Philadelphia, PA , USA.

The attacks on the World Trade Center in 2001 resulted in hazardous environmental exposures of enormous magnitude, bringing about persistent respiratory and psychological problems among survivors. Approximately 40,000 men and women worked at Ground Zero, the former site of the World Trade Center in New York City, and at the Staten Island landfill, the main wreckage depository, in the days, weeks,  and months following 9/11. First responders such as firefighters and police, construction workers, and utility and public sector workers were involved. These  individuals were at high risk for injury, respiratory complications, and psychological distress from the traumatic event. This article highlights the controversy surrounding 9/11 research and reports, identifies populations at high risk for exposure, and examines the health effects. Occupational health nurses should not only be empowered to provide the best care for workers affiliated with 9/11, but also contribute to research to protect worker health in future disaster responses.

Publication Types:      Review

PMID: 18444404 [PubMed - indexed for MEDLINE]


AIDS Patient Care STDS. 2008 Apr;22(4):313-21.

The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV.

Vranceanu AM, Safren SA, Lu M, Coady WM, Skolnik PR, Rogers WH, Wilson IB.

Department of Psychology, Massachusetts General Hospital, Harvard Medical School, and the Fenway Community Health Center, Boston, Massachusetts, USA.

In HIV/AIDS, symptoms of depression or post-traumatic stress may interfere with important self-care behaviors such as the ability to adhere to one's medical treatment regimen. However, these problems may frequently go undetected in HIV care settings. The present study used brief self-report screening measures of depression and post-traumatic stress disorder (PTSD) in the HIV/AIDS care settings to examine (1) frequency of positive screens for these diagnoses; (2) the degree to which those with a positive screen were prescribed antidepressant treatment; and (3) the association of continuous PTSD and depression symptom scores, and categorical (screening positive or negative) PTSD and depression screening status, to each other and to ART adherence as assessed by the Medication Event Monitoring System, regardless of antidepressant treatment. Participants were 164 HIV-infected individuals who took part in a multisite adherence intervention study in HIV treatment settings in Massachusetts. Available data from 5 time points was used, yielding 444 data points. Participants screened positive for PTSD at 20% of visits, and depression at 22% of visits. At visits when participants screened positive for both depression and  PTSD, 53.6% of the time they were on an antidepressant. Those who screened positive for PTSD were more likely to also screen positive for depression. In multiple regression analyses that included both continuous and dichotomous PTSD and depression and controlled for shared variance due to clustering of multiple observations, only depression contributed significant unique variance, suggesting the primary role of depression and the secondary role of PTSD in poor adherence in individuals with HIV.

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

PMID: 18338960 [PubMed - indexed for MEDLINE]


Am J Clin Hypn. 2008 Apr;50(4):343-50.

The future orientation of constructive memory: an evolutionary perspective on therapeutic hypnosis and brief psychotherapy.

Rossi E, Erickson-Klein R, Rossi K.

We explore a new distinction between the future, prospective memory system being  investigated in current neuroscience and the past, retrospective memory system, which was the original theoretical foundation of therapeutic hypnosis, classical  psychoanalysis, and psychotherapy. We then generalize a current evolutionary theory of sleep and dreaming, which focuses on the future, prospective memory system, to conceptualize a new evolutionary perspective on therapeutic hypnosis and brief psychotherapy. The implication of current neuroscience research is that activity-dependent gene expression and brain plasticity are the psychobiological  basis of adaptive behavior, consciousness, and creativity in everyday life as well as psychotherapy. We summarize a case illustrating how this evolutionary perspective can be used to quickly resolve problems with past obstructive procrastination in school to facilitate current and future academic success.

Publication Types:      Case Reports

PMID: 18524301 [PubMed - indexed for MEDLINE]


Am J Orthopsychiatry. 2008 Apr;78(2):249-58.

African American inner-city youth exposed to violence: coping skills as a moderator for anxiety.

Edlynn ES, Gaylord-Harden NK, Richards MH, Miller SA.

Department of Psychology, Loyola University Chicago, Chicago, IL 60626, USA.

The current study examined types of coping as either protective or vulnerability  factors for youth exposed to community violence in a sample of 240 inner-city, African American pre- and early adolescents across sixth and seventh grade. Coping was conceptualized within a contextually relevant framework. It was predicted that avoidant coping would interact with exposure to violence to predict reductions in anxiety, cross-sectionally and longitudinally, whereas approach coping was expected to interact with violence exposure to predict increases in anxiety. Youth and parents both reported on youth exposure to community violence and anxiety symptoms; youth provided self-reports of their coping strategies. Data were analyzed by using hierarchical multiple regression analyses. As predicted, avoidant coping showed a protective function on anxiety symptoms; contrary to predictions, approach coping was unrelated to anxiety. Implications for future research on contextually and culturally relevant coping are discussed. Copyright 2008 APA, all rights reserved.

PMID: 18954188 [PubMed - indexed for MEDLINE]


Am J Orthopsychiatry. 2008 Apr;78(2):240-8.

Person--job match among frontline staff working in residential treatment centers: the impact of personality and child psychopathology on burnout experiences.

Leon SC, Visscher L, Sugimura N, Lakin BL.

Department of Psychology, Loyola University Chicago, Damen Hall, 653, Chicago, IL 60626, USA.

Prior research has shown that the personality variables extraversion and neuroticism predict burnout among frontline staff working in residential treatment centers. This study tested the hypothesis that the effect of personality on burnout would be moderated by the psychiatric characteristics of the youth served on the milieu. Two hundred and three frontline staff working in  21 residential treatment centers in Illinois serving troubled youth completed surveys regarding opinions about their jobs, the Big Five Inventory (BFI), a youth presenting problems scale for the entire milieu, and the Maslach Burnout Inventory (MBI). Results indicated that the effect of neuroticism on burnout is moderated by psychosis and posttraumatic stress disorder (PTSD); high and moderate milieu ratings of psychosis and PTSD showed a positive relationship between neurosis and burnout, while low ratings of these conditions showed no relationship. These findings suggest that the optimal work setting is a function  of the interaction between specific personality characteristics and specific work environments, with implications for personnel selection and future research on person-environment fit. Copyright 2008 APA, all rights reserved.

Publication Types:      Comparative Study

PMID: 18954187 [PubMed - indexed for MEDLINE]


Am J Orthopsychiatry. 2008 Apr;78(2):229-39.

Assessing mental health and psychosocial status in communities exposed to traumatic events: Sri Lanka as an example.

Fernando GA.

Department of Psychology, California State University, Los Angeles, CA 90032, USA.

The purpose of this study was to develop a measure of psychosocial status that could reliably and accurately assess psychosocial functioning in Sinhalese Sri Lankans impacted by traumatic events. A culturally grounded methodology using qualitative data was used to develop and validate the Sri Lankan Index of Psychosocial Status--Adult Version (SLIPSS-A). The SLIPPS-A is a 26-item measure  assessing local indicators of distress, with items placed on a frequency scale from 0 (never) to 4 (6-7 days per week). The instrument was administered to 170 Sinhalese Sri Lankans (72% women) between the ages of 21 and 71 years with differing types of trauma exposure. The measure demonstrated excellent reliability (alpha = .92) and was significantly correlated with the Postraumatic  Stress Disorder (PTSD) Checklist. Scores on the SLIPSS-A significantly predicted  exposure to the tsunami. Factor analysis resulted in the extraction of five factors. The results suggest that the SLIPSS-A could be used as a general measure to assess psychosocial functioning in Sri Lankan rural Sinhalese adults impacted  by trauma. Copyright 2008 APA, all rights reserved.

Publication Types:      Comparative Study

PMID: 18954186 [PubMed - indexed for MEDLINE]


Am J Orthopsychiatry. 2008 Apr;78(2):220-8.

Toward assessing traumatic events and stress symptoms in preschool children from  low-income families.

Graham-Bermann SA, Howell K, Habarth J, Krishnan S, Loree A, Bermann EA.

Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1043, USA.

Traumatic events can seriously disrupt the development of preschool children. Yet few studies capture developmentally specific examples of traumas and the expression of distress for this age group. Mothers and teachers of 138 preschoolers from low-income families were interviewed about traumatic events and completed a new measure assessing their child's traumatic stress symptoms. They reported traumatic events as the death of a person, death of a pet, family violence, high conflict divorce, sudden family loss, accident or injury, and viewing the World Trade Center attack. Factor analysis of 17 trauma symptoms revealed three internally consistent and valid scales: Intrusions, Emotional Reactivity, and Fears, plus a Total omnibus score. Traumatic stress symptoms varied by the type of event. Scores were higher for traumatic events involving close family members than for distal events. Copyright 2008 APA, all rights reserved.

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

PMID: 18954185 [PubMed - indexed for MEDLINE]


Am J Public Health. 2008 Apr;98(4):714-20. Epub 2008 Feb 28.

Comment in:     Am J Public Health. 2008 Sep;98(9):1542; author reply 1542-3.

Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from  Iraq and Afghanistan.

Seal KH, Bertenthal D, Maguen S, Gima K, Chu A, Marmar CR.

San Francisco VA Medical Center, Division of General Internal Medicine, Box 111A-1, 4150 Clement St, San Francisco, CA 94121, USA.

OBJECTIVES: We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms. METHODS: Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or  high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive  for particular mental health problems, and predictors of VA mental health clinic  attendance. RESULTS: Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR]=13.3; 95% confidence interval [CI]=8.31, 21.3) and at a VA community clinic (AOR=3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR=0.45; 95% CI=0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit. CONCLUSIONS: A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help  overcome a "don't ask, don't tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases  mental health clinic attendance among Iraq and Afghanistan veterans.

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

PMID: 18309130 [PubMed - indexed for MEDLINE]


Arch Gen Psychiatry. 2008 Apr;65(4):431-7.

A second look at prior trauma and the posttraumatic stress disorder effects of subsequent trauma: a prospective epidemiological study.

Breslau N, Peterson EL, Schultz LR.

Department of Epidemiology, Michigan State University, College of Human Medicine, B645 West Fee Hall, East Lansing, MI 48824, USA.

CONTEXT: Previous studies showed increased probability of a posttraumatic stress  disorder (PTSD) effect of trauma in persons who had experienced prior trauma. The evidence comes chiefly from retrospective data on earlier events, obtained from trauma-exposed persons with and without PTSD. A generally overlooked major limitation is the failure to assess the PTSD response to the prior trauma. OBJECTIVE: To estimate the risk of PTSD after traumas experienced during follow-up periods in relation to respondents' prior traumatic events and PTSD. DESIGN: A cohort study of young adults interviewed initially in 1989, with repeated assessments during a 10-year follow-up. SETTING AND PARTICIPANTS: The sample was randomly selected from a large health maintenance organization in Southeast Michigan, representing the geographic area. MAIN OUTCOME MEASURES: The  relative risk of PTSD precipitated by traumatic events occurring during follow-up periods in relation to prior exposure and PTSD that had occurred during preceding periods, estimated by general estimating equations (n = 990). RESULTS: The conditional risk of PTSD during the follow-up periods was significantly higher among trauma-exposed persons who had experienced prior PTSD, relative to those with no prior trauma (odds ratio, 3.01; 95% confidence interval, 1.52-5.97). After adjustment for sex, race, education, and preexisting major depression and anxiety disorders, the estimates were only marginally revised. In contrast, the conditional risk of PTSD during follow-up among trauma-exposed persons who had experienced prior traumatic events but not PTSD was not significantly elevated, relative to trauma-exposed persons with no prior trauma. The difference between the 2 estimates was significant (P = .005). CONCLUSIONS: Prior trauma increases the risk of PTSD after a subsequent trauma only among persons who developed PTSD  in response to the prior trauma. The findings suggest that preexisting susceptibility to a pathological response to stressors may account for the PTSD response to the prior trauma and the subsequent trauma.

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

PMID: 18391131 [PubMed - indexed for MEDLINE]


Arch Sex Behav. 2008 Apr;37(2):305-16. Epub 2007 Aug 3.

Treatment of gay men for post-traumatic stress disorder resulting from social ostracism and ridicule: cognitive behavior therapy and eye movement desensitization and reprocessing approaches.

Carbone DJ.

Department of Social Sciences, The State University of New York-FIT, Seventh Avenue at 27th Street, B634, New York, NY 10001, USA.

This report describes the clinical treatment of a sample of four gay men suffering from Post-Traumatic Stress Disorder (PTSD) attributed to their repeated experiences with peer ridicule and ostracism throughout childhood and adolescence, caused by their gender variant appearance and behavior. All of the men in the sample shared the following features: (1) a childhood history of ridicule and ostracism from both peers and adults focused on their gender variant presentation designed to elicit gender norm compliance; (2) a lack of social support networks to assist them in coping with the stress; (3) self-destructive coping responses that began in childhood and continued into adulthood in an attempt to lessen the experience of shame; and (4) symptoms of PTSD. A treatment  model utilizing cognitive-behavioral therapy and eye movement desensitization and reprocessing was discussed.

Publication Types:      Case Reports

PMID: 17674178 [PubMed - indexed for MEDLINE]


Aust N Z J Psychiatry. 2008 Apr;42(4):309-14.

Spinal cord injury and mental health.

Migliorini C, Tonge B, Taleporos G.

Monash University Centre for Developmental Psychology and Psychiatry, Monash Medical Centre, Clayton, Vic., Australia.

OBJECTIVES: The aim of the study was to examine the mental health of adults with  spinal cord injury living in the community. METHODS: The study was a representative community cross-sectional cohort self-report survey, carried out in adults with traumatic spinal cord injury registered on the Victorian Spinal Cord Injury Register and adults with non-traumatic spinal cord injury attending a specialist non-traumatic spinal cord injury rehabilitation clinic. Participants (n=443) completed a self-report survey by internet, telephone or hard copy, which used reliable and valid measures of depression, anxiety and stress (Depression, Anxiety and Stress Scale) and post-traumatic stress disorder (Impact of Events Scale-Revised). RESULTS: Nearly half (48.5%) of the population with spinal cord injury suffered mental health problems of depression (37%), anxiety (30%), clinical-level stress (25%) or post-traumatic stress disorder (8.4%). Overall, there was a twofold or more increase in the probability of emotional disorders compared to the general population. Of those with one mental health disorder, 60% also had at least one other emotional disorder, representing a substantial 56% increase over the general population in the probability of comorbidity of psychopathology. Better health and time since injury were associated with decreasing the risk of psychopathology. CONCLUSION: The results of the present study underscore the vulnerability of the population with spinal cord injury to emotional disorders. This study highlights the complexity of mental health problems experienced by many individuals with spinal cord injury living in the community. The delivery of mental health services to this vulnerable population requires recognition of comorbidity and problems of mobility, access and stigma.

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

PMID: 18330773 [PubMed - indexed for MEDLINE]


Australas Psychiatry. 2008 Apr;16(2):109-13.

Comment in:     Australas Psychiatry. 2008 Oct;16(5):369-70.

Psychiatry's problem child: PTSD in the forensic context (part 2).

Gaughwin P.

Nurses and Midwives Board of Western Australia, Perth, WA, Australia.

OBJECTIVE: The aim of this paper was to consider whether the Courts in their application of Criterion A for post-traumatic stress disorder (PTSD) in the civil forensic context are in harmony or in conflict with psychiatry. METHOD: Discussed are five cases from the civil forensic jurisdiction that considered plaintiffs' submissions that, as a consequence of some wrong, they suffered PTSD. RESULTS: The Courts have been quite consistent in their approach to PTSD--where there has  been conflicting expert evidence as to whether a plaintiff has PTSD, the stressor which brings about this disorder must be extreme (i.e. objectively life-threatening). CONCLUSIONS: The Courts have been consistent in their application of Criterion A and, as such, are consistent with what the DSM-IV-TR requires before the diagnosis can be made. Such an approach ensures that merely unpleasant events, irrespective of how subjectively upsetting they may be, do not qualify for the diagnosis of PTSD. Psychiatrists, therefore, have an enormous responsibility when they provide expert evidence in relation to psychiatric issues that arise in legal matters.

Publication Types:      Review

PMID: 18335367 [PubMed - indexed for MEDLINE]


Australas Psychiatry. 2008 Apr;16(2):104-8.

Comment in:     Australas Psychiatry. 2008 Oct;16(5):369-70.

Psychiatry's problem child: PTSD in the forensic context: (part 1).

Gaughwin P.

Nurses and Midwives Board of Western Australia, Perth, WA, Australia.

OBJECTIVE: The aim of this paper was to consider some of the recent literature that has raised questions about the prevalence of, and problems with, post-traumatic stress disorder (PTSD) in the forensic context and whether it is a failure by experts to consider adequately Criterion A (1), which leads them into  error and results in a skewed picture of the prevalence of PTSD in litigation. METHOD: The nature of the stressor criterion for PTSD from DSM-III to DSM-IV-TR,  and recent literature relating to problems with the manner in which that stressor criterion is applied in forensic contexts, are considered. RESULTS: It becomes clear that, notwithstanding that the class of persons who can suffer PTSD after a particularly traumatic event has widened since it was included in the DSM-III, the nature of the stressor required before a diagnosis of PTSD can be made has remained fairly constant. CONCLUSIONS: Whether it is because PTSD is commonly associated with receiving a benefit (e.g. through post-war disability benefits, victims of crime compensation or because of a desire to use it as an ideological  weapon), PTSD has become a ubiquitous presence in the forensic context, notwithstanding objective (i.e. non-forensic) clinical studies which refer to its rarity. It is clear now that PTSD symptoms can be readily simulated when the simulator is seeking a benefit. It is also becoming clear that some psychiatrists are not being as rigorous in the forensic context as they might be in a clinical  context. Thus, with discussion now underway regarding DSM-V, it may be timely to  reconsider the utility of PTSD as a clinical condition.

Publication Types:      Review

PMID: 18335366 [PubMed - indexed for MEDLINE]


Australas Psychiatry. 2008 Apr;16(2):98-103.

Motivations for self-injury in an adolescent inpatient population: development of a self-report measure.

Swannell S, Martin G, Scott J, Gibbons M, Gifford S.

Department of Psychiatry, University of Queensland, Herston, Qld, Australia.

OBJECTIVE: The aim of this study was to develop and pilot an instrument for the assessment of self-injury in adolescent inpatients. METHODS: The Self-Injury Motivation Scale was modified for use in adolescents. Thirty-eight consenting adolescent inpatients with a history of self-injury completed the Self-Injury Motivation Scale-Adolescent version (SIMS-A) and the Self-Injury Interview (SII)  to collect information about a range of factors associated with self-injury, other clinical variables and demographic details. RESULTS: The SIMS-A was acceptable to this adolescent sample and motivations for self-injury were similar to those of adults using the original SIMS scale. Adolescents were, however, more likely to use self-injury for communicating to/influencing others compared to adults. The participants most frequently reported self-injury by hitting, cutting and burning. The clinical diagnosis most frequently associated with self-injury was major depression. Females reported earlier onset, higher frequency and multiple methods of self-injury compared to males. Distraction from emotional pain was the most common motivation for self-injury in both males and females. CONCLUSIONS: This pilot study suggests the SIMS-A is a useful self-report measure to assist clinicians and adolescent patients to understand a behaviour that may be associated with shame, guilt or other difficult emotions for the adolescent. Results also support the contention that there are often multiple and conflicting motivations for self-injury. Self-injury in this population was more common and severe in female adolescents compared to males, while clinical depression was a risk factor for self-injury in both males and females. The small sample size of adolescent inpatients is an important limitation of this pilot study, and research using the SIMS-A in larger samples is warranted.

Publication Types:      Validation Studies

PMID: 18335365 [PubMed - indexed for MEDLINE]


Behav Res Ther. 2008 Apr;46(4):548-56. Epub 2008 Feb 1.

Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth.

Leen-Feldner EW, Feldner MT, Reardon LE, Babson KA, Dixon L.

Department of Psychology, Arkansas Institute of Developmental Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA.

Total and factor scores of the Childhood Anxiety Sensitivity Index (CASI) were examined in relation to posttraumatic stress symptom levels within a community-based sample of 68 (43 females) traumatic event-exposed youth between the ages of 10 and 17 years (M age=14.74 years). Findings were consistent with hypotheses; global anxiety sensitivity (AS) levels, as well as disease, unsteady, and mental incapacitation concerns, related positively to posttraumatic stress levels, whereas social concerns were unrelated to symptom levels. These results suggest that fears of the physical and mental consequences of anxiety are associated with relatively higher levels of posttraumatic stress subsequent to traumatic event exposure. Findings are discussed in terms of potential implications for the role of AS in developmentally sensitive etiological models of posttraumatic stress disorder (PTSD).

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

PMID: 18328463 [PubMed - indexed for MEDLINE]


Brain Inj. 2008 Apr;22(4):361-4.

Resolution of low voltage electrical injury induced psychosis with olanzapine.

Haq MZ, Prakash R, Soy A, Gupta A, Akhtar S.

Central Institute of Psychiatry, Ranchi, India.

BACKGROUND: The number of electrical injuries are rising in proportion to the increased use of electricity in both domestic and industrial sectors. There are multiple ways in which electricity can cause tissue damage, which can be due to direct effects, electroporation and thermal effects. However, these mechanisms fail to explain the enigmatous occurrences of diffuse and delayed neurological and psychological manifestations, especially those remote to the theoretical current pathway and in absence of any gross neurological abnormalities. Immediate neuropsychological sequelae have been well reported in the literature in the form of transient anxiety, emotional instability and memory disturbances. Among psychiatric manifestations, neurotic disorders like post-traumatic stress disorder, conversion and adjustment disorders have been appreciated many a times  as a frequent accompaniment of these injuries. Occasional reports of occurrence of mania have also been recorded. CASE STUDY: This study reports a case of schizophrenia like illness following a low voltage electrical injury. A discussion regarding the ways in which electrical injury and schizophrenia like illness could be related has been put forth. A brief review of the literature regarding the occurrence of psychiatric disorders in such injuries is also presented.

Publication Types:      Case Reports

PMID: 18365850 [PubMed - indexed for MEDLINE]


Brain Inj. 2008 Apr;22(4):353-60.

Use of the emotional Stroop to assess psychological trauma following traumatic brain injury.

Coates RC.

Department of Clinical Psychology, London, UK.

PRIMARY OBJECTIVE: A modified Stroop task was used to investigate the hypothesis  that implicit memory may be a possible mechanism for the development of acute stress disorder (ASD) in patients who have suffered a closed head injury. RESEARCH DESIGN: Three groups of hospital patients were compared within 1 month post-trauma: road traffic accident (RTA) patients with a brain injury (n = 15), RTA patients without a brain injury (n = 13) and a control group of orthopaedic and plastics patients (n = 15). METHODS AND PROCEDURES: Participants named colours of five types of words: RTA-related words, words related to hospitalization, obsessive-compulsive disorder (OCD) words, positive words and neutral words. Participants were also administered the Acute Stress Disorder Interview and the State-Trait Anxiety Inventory. MAIN OUTCOMES AND RESULTS: Both  RTA patients with and without a brain injury demonstrated significant interference on words related to an RTA. Significant interference was unexpectedly observed for OCD words in RTA patients. Control patients did not display significant interference effects. CONCLUSIONS: Findings suggested that patients, both with and without explicit recall for an RTA, responded similarly on a task involving implicit memory for trauma. Possible implications for ASD and Post-traumatic Stress Disorder are discussed.

PMID: 18365849 [PubMed - indexed for MEDLINE]


Bull Menninger Clin. 2008 Spring;72(2):130-48.

Differential patterns of lifetime multiple anxiety disorder comorbidity between Latino adults with bipolar I and major depressive disorders.

Dilsaver SC, Benazzi F, Akiskal KK, Akiskal HS.

Comprehensive Doctors Medical Group Inc, Arcadia, California and the Rio Grande City Community Mental Health Mental Retardation Clinic, Rio Grande City, Texas, USA.

BACKGROUND: To determine the lifetime rates of panic disorder, obsessive-compulsive disorder (OCD), social phobia, and posttraumatic stress disorder (PTSD) among adult Latino patients with major depressive disorder (MDD)  and bipolar disorder (BPD), and whether there are dose-response relationships between loading for comorbid anxiety disorders, the probability of having BPD, and attributes of severity of illness. METHODS: In a public sector clinic for the indigent located in a semiclosed rural community, 187 consecutively presenting affectively ill Latino patients were evaluated by use of the Structured Clinical  Interview for DSM-IV. Polarity and the lifetime prevalence of panic disorder, OCD, social phobia, and PTSD were determined. Logistic regression was used to test associations. Trends in positive predictive values (PPVs) and likelihood ratios were assessed to determine whether dose-response relationships existed between loading for comorbid anxiety disorders and the likelihood of having BPD as opposed to MDD, psychosis, suicidal ideation, and suicide attempts. Results: Of 187 subjects, 118 (63.1%) had MDD and 69 (36.9%) had BPD. The odds ratio of a  patient with BPD, relative to MDD, of having panic disorder was 4.6 (p< .0001), OCD 7.6 (p< .0001), social phobia 6.0 (p< .0001) and PTSD 5.3 (p< .0001). The PPV of having BPD was 91.3% and of having psychotic features 83.0% if one had all four anxiety disorders. There was a dose-response relationship between loading for comorbid anxiety disorders and the likelihood of having had a suicide attempt (but not suicidal ideation). CONCLUSIONS: As previously reported by us for juvenile patients, Latino adults with BPD had a remarkably high risk of having each anxiety disorder relative to patients with MDD. The results indicate that the risk of having BPD, having a psychosis, and making a suicide attempt becomes  increasingly great as the number of comorbid anxiety disorders increases. These data, which are consistent with the notion of anxious bipolarity, provide further support for a possible anxious diathesis in bipolar disorder.

PMID: 18637749 [PubMed - indexed for MEDLINE]


Curr Pain Headache Rep. 2008 Apr;12(2):94-7.

What are the psychiatric sequelae of burn pain?

Wiechman Askay S, Patterson DR.

University of Washington/Harborview Medical Center, Department of Rehabilitation  Medicine, 325 Ninth Avenue, Box 359740, Seattle, WA 98104, USA.

Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. Practitioners in the field have been concerned about the suboptimal management of acute pain in this population. Recent studies have shown that greater levels of acute pain are associated with negative long-term psychologic effects such as depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. Research in other non-burn trauma populations has also pointed to the potential for unmanaged acute pain to delay wound healing and lead to other medical complications, such as infection and extended hospitalization period. The concept of allostatic load  is presented as a potential explanation for the relationship between acute pain and subsequent psychologic and physiologic outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.

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

PMID: 18474187 [PubMed - indexed for MEDLINE]


Curr Psychiatry Rep. 2008 Apr;10(2):104-8.

Post-traumatic stress disorder and its treatment in children and adolescents.

Najjar F, Weller RA, Weisbrot J, Weller EB.

Institute for Juvenile Research, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 155, Chicago, IL 60608, USA.

This article reviews current concepts of and treatments for post-traumatic stress disorder (PTSD) in children and adolescents. We discuss the DSM-IV-TR diagnostic  criteria and their applicability to children and adolescents. We also review the  history of PTSD and the development of its diagnostic criteria. We present the concept of complex trauma and trauma's effect on the developing child and describe a new diagnosis labeled developmental trauma disorder that would better  describe children and adolescents who have been exposed to abuse and neglect. Finally, we summarize psychotherapeutic and psychopharmacologic approaches to treating PTSD in children and adolescents. More research is needed on the diagnosis and treatment of PTSD in children and adolescents.

Publication Types:      Review

PMID: 18474199 [PubMed - indexed for MEDLINE]


Dev Psychopathol. 2008 Spring;20(2):493-508.

Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms.

MacDonald HZ, Beeghly M, Grant-Knight W, Augustyn M, Woods RW, Cabral H, Rose-Jacobs R, Saxe GN, Frank DA.

Behavioral Sciences Division, Natural Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, 116B-4, Boston, MA 02130, USA.

The purpose of this study was to evaluate whether children with a history of disorganized attachment in infancy were more likely than children without a history of disorganized attachment to exhibit symptoms of posttraumatic stress disorder (PTSD) at school age following trauma exposure. The sample consisted of  78 8.5-year-old children from a larger, ongoing prospective study evaluating the  effects of intrauterine cocaine exposure (IUCE) on children's growth and development from birth to adolescence. At the 12-month visit, children's attachment status was scored from videotapes of infant-caregiver dyads in Ainsworth's strange situation. At the 8.5-year visit, children were administered  the Violence Exposure Scale-Revised, a child-report trauma exposure inventory, and the Diagnostic Interview for Children and Adolescents by an experienced clinical psychologist masked to children's attachment status and IUCE status. Sixteen of the 78 children (21%) were classified as insecure-disorganized/insecure-other at 12 months. Poisson regressions covarying  IUCE, gender, and continuity of maternal care indicated that disorganized attachment status at 12 months, compared with nondisorganized attachment status,  significantly predicted both higher avoidance cluster PTSD symptoms and higher reexperiencing cluster PTSD symptoms. These findings suggest that the quality of  early dyadic relationships may be linked to differences in children's later development of posttraumatic stress symptoms following a traumatic event.

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

PMID: 18423091 [PubMed - indexed for MEDLINE]


Drug Alcohol Depend. 2008 Apr 1;94(1-3):267-71.

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

van der Velden PG, Kleber RJ, Koenen KC.

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

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

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

PMID: 18093750 [PubMed - indexed for MEDLINE]


Emotion. 2008 Apr;8(2):302-6.

Expressive writing buffers against maladaptive rumination.

Sloan DM, Marx BP, Epstein EM, Dobbs JL.

National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA 02130, USA.

This study examined whether ruminative style moderated the effects of expressive  writing. Sixty-nine participants were assessed for ruminative style and depression symptoms at the beginning of their 1st college semester. Participants  were then randomized to either an expressive writing or a control writing condition. Changes in depression symptoms were assessed 2, 4, and 6 months later. Results showed that a brooding ruminative style moderated the effects of expressive writing such that among those assigned to the expressive writing condition, individuals with greater brooding scores reported significantly fewer  depression symptoms at all of the follow-up assessments relative to individuals with lower brooding scores. In contrast, reflective pondering ruminative style did not moderate the effects of expressive writing on depression symptoms. These  findings suggest that expressive writing could be used as a means of reducing depression symptoms among those with a maladaptive ruminative tendency to brood.  (Copyright) 2008 APA.

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

PMID: 18410204 [PubMed - indexed for MEDLINE]


Emotion. 2008 Apr;8(2):199-207.

The moderating effects of stimulus valence and arousal on memory suppression.

Marx BP, Marshall PJ, Castro F.

VA Boston Healthcare System, National Center for PTSD (116B-2), 150 South Huntington Avenue, Boston, MA 02130, USA.

This study examined the separate and combined effects of stimulus valence and arousal on retrieval inhibition. Participants performed Anderson and Green's (2001) memory suppression task with stimuli varying across dimensions of valence  and arousal. Memory was tested through free and cued recall as well as speeded recognition. Results showed that both stimulus valence and arousal influenced the extent to which participants successfully inhibited retrieval, but not in the ways anticipated. Specifically, the strongest inhibition effects were for highly  arousing, pleasant words. In addition, unpleasant stimuli that were suppressed were better recalled during both cued and free-recall tasks than pleasant stimuli that were suppressed. Across all tests of memory performance, there were no significant differences between the experimental conditions for highly arousing,  unpleasant words. The implications of these findings are discussed. (Copyright) 2008 APA.

PMID: 18410194 [PubMed - indexed for MEDLINE]


Eur Child Adolesc Psychiatry. 2008 Apr;17(3):127-32.

Applying EMDR on children with PTSD.

Ahmad A, Sundelin-Wahlsten V.

Department of Child and Adolescent Psychiatry, Uppsala University Hospital, Uppsala 751 85, Sweden.

OBJECTIVE: To find out child-adjusted protocol for eye movement desensitization and reprocessing (EMDR). METHOD: Child-adjusted modification were made in the original adult-based protocol, and within-session measurements, when EMDR was used in a randomized controlled trial (RCT) on thirty-three 6-16-year-old children with post-traumatic stress disorder (PTSD). RESULTS: EMDR was applicable after certain modifications adjusted to the age and developmental level of the child. The average treatment effect size was largest on re-experiencing, and smallest on hyperarousal scale. The age of the child yielded no significant effects on the dependent variables in the study. CONCLUSIONS: A child-adjusted protocol for EMDR is suggested after being applied in a RCT for PTSD among traumatized and psychosocially exposed children.

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

PMID: 17846813 [PubMed - indexed for MEDLINE]


Exp Clin Psychopharmacol. 2008 Apr;16(2):144-55.

Posttraumatic stress disorder and anxious and fearful reactivity to bodily arousal: a test of the mediating role of nicotine withdrawal severity among daily smokers in 12-hr nicotine deprivation.

Feldner MT, Vujanovic AA, Gibson LE, Zvolensky MJ.

Department of Psychology, University of Arkansas, Fayetteville, AR 72701, USA.

Posttraumatic stress disorder (PTSD) is associated with high rates of smoking and fear of bodily perturbation. The current study examined the role of nicotine withdrawal in the association between PTSD and responding to bodily arousal among 52 participants (27 women; M-sub(age) = 30.50 years). Compared to participants without current axis I psychopathology, persons with current PTSD responded to a  3-min voluntary hyperventilation procedure with greater increases in anxiety and  more intense cognitive and physical panic symptoms, despite no group differences  in physiological arousal. Nicotine withdrawal demonstrated significant mediational effects in the relations between diagnostic group and panic symptoms  elicited by the hyperventilation procedure. Findings suggest nicotine withdrawal  is an important factor to consider in terms of better understanding the nature of fear responding to bodily sensations among persons with PTSD.

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

PMID: 18489018 [PubMed - indexed for MEDLINE]


Expert Opin Pharmacother. 2008 Apr;9(5):787-94.


Tang SW, Helmeste D.

University of California, Psychiatry North Campus Zot 1681, Irvine, California 92697-1681, USA.

BACKGROUND: Paroxetine is a widely used antidepressant that has received attention regarding suicide risk in younger patients. OBJECTIVE: The purpose of this paper is to review the pharmacology, efficacy and safety of paroxetine in the affective disorders. METHODS: The authors performed a PubMed search for all literature in English crossing the words 'paroxetine' and 'Paxil' against the words 'serotonin transporter,' 'clinical trials,' 'depression' and 'SSRI'. A search for paroxetine-related information at the FDA website and under the clinical trial register of the GSK website were also performed. RESULTS/CONCLUSION: Paroxetine is a serotonin re-uptake inhibitor with good selectivity and no significant active metabolites. Paroxetine is approved (ages >or= 18 years) for the treatment of major depressive disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder (social phobia), post-traumatic stress disorder, and generalized anxiety disorders. Drug - drug interactions involving the CYP enzyme system have been documented, as well as concern for increased suicidality risk in younger adults and recent FDA alerts regarding teratogenicity, serotonin syndrome and persistent pulmonary hypertension.

Publication Types:      Review

PMID: 18345955 [PubMed - indexed for MEDLINE]


Fam Pract. 2008 Apr;25(2):92-7. Epub 2008 Feb 27.

Infrequent attendance in general practice after a major disaster: a problem? A longitudinal study using medical records and self-reported distress and functioning.

Donker GA, van der Velden PG, Kerssens JJ, Yzermans CJ.

Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands.

OBJECTIVE: To assess the characteristics and implications for care of infrequent  attendance in general practice in the aftermath of disaster. METHODS: A study of  the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires administered 3 weeks and 18 months post-disaster. The disaster (explosion of a firework depot in Enschede, The Netherlands) caused 23 deaths, about 1000 people injured and 1200 people who had to relocate. Sample included survivors (N = 922) who participated  in two surveys and whose data could be linked to EMRs of GPs. A comparison of reported morbidity in 'infrequent' (a maximum of three times in men and four times in women in the first two post-disaster years) and 'more frequent attenders' (frequency determined post-disaster) in general practice examined in relation to health status (measured by diagnoses in EMRs, symptom checklist and quality of life instrument) was the MAIN OUTCOME MEASURE: RESULTS: Infrequent attenders reported approximately three times as few contacts as more frequent attenders in the pre-disaster year (P < 0.001). Multivariate logistic regression  analyses revealed that infrequent attenders were likely to be younger, less depressed, have better subjective health and physical functioning and exhibited more hostile behaviour (measured by questionnaire). Infrequent attenders were less often personally bereaved by the disaster, but more often relocated, and had a lower prevalence of psychological problems pre- and post-disaster although this increased stronger (by 10-fold). CONCLUSIONS: Both groups showed the same type of psychological problems post-disaster, but differed in the frequency of contacting the GP.

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

PMID: 18304972 [PubMed - indexed for MEDLINE]


Harv Ment Health Lett. 2008 Apr;24(10):6.

Getting help for post-combat mental health problems. Delayed symptoms, stigma, and concerns about insurance pose barriers.

[No authors listed]

PMID: 18649413 [PubMed - indexed for MEDLINE]


Headache. 2008 Apr;48(4):517-22.

Post-traumatic stress disorder in episodic and chronic migraine.

Peterlin BL, Tietjen G, Meng S, Lidicker J, Bigal M.

Drexel University College of Medicine-Neurology, Philadelphia, PA 19102, USA.

OBJECTIVE: To assess and contrast the relative frequency of self-reported post-traumatic stress disorder (PTSD) in patients with episodic migraine and chronic/ transformed migraine. BACKGROUND: Several risk factors have been identified as risk factors for chronification of headache disorders. Childhood abuse has been suggested as a risk factor for chronic pain in adulthood. In addition depression, as well as several other psychiatric disorders, are co-morbid with migraine. Recent data suggest that PTSD may be more common in headache sufferers than in the general population. METHODS: This was a prospective, pilot study conducted at a headache center. Adult subjects with episodic, chronic, or transformed migraine were included. Demographic information, depression history, body mass index (BMI), and headache characteristics were obtained. PTSD was assessed using the life events checklist  (LEC) and the PTSD checklist, civilian version (PCL-C). We contrasted the data from episodicmigraineurs and chronic/transformed migraine participants (CM) and conducted multivariate analyses, adjusting for covariates. RESULTS: Of the 60 participants included, 91.7% were female with a mean age of 41.4+/-12.5 years old. EM was diagnosed in 53.3% and CM in 46.7%. The mean BMI was not significantly different between groups. In contrast, the relative frequency of depression was significantly greater in subjects with CM (55.2%) than EM (21.9%,  P=.016). There was no significant difference in the percentage of participants reporting at least 1 significant traumatic life event (LE) or in the mean number  of traumatic LEs between EM and CM participants. However, the relative frequency  of PTSD reported on the PCL in CM (42.9%) was significantly greater as compared to EM (9.4%, P=.0059. After adjusting for depression and other potential confounders, the difference remained significant P=.023). CONCLUSION: PTSD is more common in CM than in episodic migraineurs. This suggests that PTSD may be a  risk factor for headache chronification, pending longitudinal studies to test this hypothesis.

PMID: 18377377 [PubMed - indexed for MEDLINE]


Int J Eat Disord. 2008 Apr;41(3):195-202.

The influence of reported trauma and adverse events on eating disturbance in young adults.

Smyth JM, Heron KE, Wonderlich SA, Crosby RD, Thompson KM.

Department of Psychology, Syracuse University, Syracuse, New York 13244-2340, USA.

OBJECTIVE: Early experiences of trauma or adverse events may be associated with eating disturbance later in life, but evidence is scarce. This study examined whether reported history of adverse life events predicted eating disturbance upon college entry and prospective changes over the first semester of college. METHOD: First semester college students (n = 249) reported trauma/adverse event histories and completed disordered eating questions (with two factors, restriction and binging/purging) at the beginning and end of their first semester. RESULTS: At college entry, trauma type, frequency, and overall trauma severity were related to restricted eating, and trauma type and severity was related to binging/purging. Prospective increases in reported restricted eating were predicted by trauma type. Prospective increases in binging/purging were associated with trauma type and total trauma severity. CONCLUSION: These data suggest that reports of past trauma and adverse events cross-sectionally predict  reported disordered eating at college entry as well as prospective increases in disordered eating over the first semester of college. Research and clinical implications for these findings are discussed. Copyright 2007 by Wiley Periodicals, Inc.

PMID: 18008320 [PubMed - indexed for MEDLINE]


Int J Emerg Ment Health. 2008 Spring;10(2):137-47.

Hardiness and psychological distress in a cohort of police officers.

Andrew ME, McCanlies EC, Burchfiel CM, Charles LE, Hartley TA, Fekedulegn D, Violanti JM.

Centers for Disease Control and Prevention, National Institute of Occupational Safety and Health, Health Effects Laboratory Division, Biostatistics and Epidemiology Branch in Morgantown, VW 26505, USA.

Since police officers are frequently exposed to high stress situations, individual differences in the response to stress and trauma are of interest. We examined the association of hardiness components (commitment, control and challenge) with depression, posttraumatic stress disorder (PTSD) symptoms, and symptoms of general psychological distress in police officers. The random sample  included 105 officers (40 women and 65 men) from the Buffalo Cardio-Metabolic Police Stress (BCOPS) study baseline visit. Components of hardiness were measured using a 15-item hardiness scale. Depressive symptoms were measured using the Center for Epidemiological Studies Depression scale (CES-D), PTSD symptoms were measured using the impact of events scale (IES), and symptoms of general psychological distress were measured using the Brief Symptoms Inventory (BSI). Associations were assessed using linear regression analysis. Models were adjusted for age, education and marital status. Because of significant gender interactions, analyses were stratified by gender. The hardiness control dimension was significantly and negatively associated with CES-D for both genders but was not associated with IES. Hardiness commitment was significantly and negatively associated with both CES-D and IES in women. Men had negative but non-significant associations for commitment with CES-D and IES. Hardiness commitment was negatively associated with the overall BSI score for both men and women but the association was only significant for men, though the strength of the association  was stronger for women. This is likely a result of the impact of the smaller sample size for women. The magnitude of gender differences in these associations  shows that for depressive and PTSD symptoms, the commitment dimension of hardiness may be more protective in female police officers than in male officers.

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

PMID: 18788348 [PubMed - indexed for MEDLINE]


Int J Emerg Ment Health. 2008 Spring;10(2):125-35.

Law enforcement response to terrorism: the role of the resilient police organization.

Paton D, Violanti JM.

School of Psychology, University of Tasmania, Launceston, Tasmania, Australia

Since September 11 the environment of contemporary policing has changed substantially. At the same time, it has become increasingly evident that police officers often demonstrate considerable resilience in the face of the critical incidents they face. This paper examines how resilience can be developed to promote officer well-being and performance when responding to acts of terrorism.  It argues that to achieve this objective, it is necessary to expand the conceptualization of resilience in two important ways. First, terrorism has created an operating environment that differs qualitatively from that in which police agencies had been used to operating. Second, the agency itself plays a more important role in developing resilience than has hitherto been acknowledged. These new perspectives are integrated to argue that, when developing police resilience, the focus should be on recognizing the reality of contemporary policing and understanding how agencies and officers can learn from their experience of challenging events to develop in ways that facilitate their capacity to adapt and cope with challenges posed by their response to acts of terrorism. The ways in which agency and officer learning can occur and how the lessons learned can be sustained in the form of enhanced resilience are discussed.

PMID: 18788347 [PubMed - indexed for MEDLINE]


Int J Emerg Ment Health. 2008 Spring;10(2):109-24.

Stress and resilience in law enforcement training and practice.

Miller L.

For law enforcement and emergency services professionals, stress and resilience are not academic topics or luxuries; they are essential to the physical and mental health, as well as to optimum job functioning. This article traces the history of the stress and resilience concepts in psychology, the military, and law enforcement, outlines the major risk and protective factors for traumatic stress responses, and presents a general psychophysiological model of stress and  coping. The article next applies these concepts to the proactive fostering of mental toughness and resilience, using lessons learned from sports psychology and the mental conditioning literature. It then describes psychological debriefing, mental health counseling, and psychotherapeutic strategies for facilitating resilient recovery from critical incidents and traumatic events. Although directed mainly to law enforcement, the principles set out in this article may be productively applied to emergency medicine, public safety, military, and civilian trauma counseling settings.

PMID: 18788346 [PubMed - indexed for MEDLINE]


Int J Emerg Ment Health. 2008 Spring;10(2):95-107.

Stress shield: a model of police resiliency.

Paton D, Violanti JM, Johnston P, Burke KJ, Clarke J, Keenan D.

School of Psychology, University of Tasmania, Launceston, Tasmania, Australia.

This paper discusses the development of a new model of police officer resiliency. Following Antonovsky's definition of resilience, the model is built on the view that the resilience of a person or group reflects the extent to which they can call upon their psychological and physical resources and competencies in ways that allow them to render challenging events coherent, manageable, and meaningful. The model posits that a police officer's capacity to render challenging experiences meaningful, coherent, and manageable reflects the interaction of person, team, and organizational factors. The paper argues that a  model that encompasses these factors can be developed using theories drawn from the literatures of occupational health and empowerment. The development of the model is also informed by the need to ensure that it can accommodate the importance of learning from past experiences to build resilience in ways that increase officers' capacity to adapt to future risk and uncertainty. By building  on recent empirical research, this paper outlines a new multi-level model of resilience and adaptive capacity. The Stress Shield model of resilience integrates person, team and organizational factors to provide a proactive framework for developing and sustaining police officer resilience.

PMID: 18788345 [PubMed - indexed for MEDLINE]


Int J Emerg Ment Health. 2008 Spring;10(2):87-93.

Crisis intervention and fostering resiliency.

Lating JM, Bono SF.

Loyola College in Maryland, 4501 North Charles Street, 220 D Beatty Hall, Baltimore, MD 21210-2699, USA.

Current estimates are that most people living in the United States will experience at least one violent or life-threatening event during their lives. Recent data suggest, however that most people exposed to traumatic events do not  experience serious disruptions in normal life functioning, and are in fact resilient. The purpose of this article is to review the constructs of resilience  and recovery, and to suggest how early crisis intervention, historically linked with the mitigation or prevention of psychological distress, may more accurately  be conceptualized in terms of fostering or enhancing resiliency.

PMID: 18788344 [PubMed - indexed for MEDLINE]


Int J Psychoanal. 2008 Apr;89(2):331-53.

Trauma and traumatic neurosis: Freud's concepts revisited.

Zepf S, Zepf FD.

University of Saarland, Narzissenstrasse 5, Saarbrucken, D-66119, Germany.

The authors examine Freud 's concepts of 'trauma', 'protective shield against stimuli ' and 'traumatic neurosis' in the light of recent findings. 'Protective shield against stimuli' is regarded as a biological concept which appears in mental life as the striving to avoid unpleasant affects. 'Trauma' is a twofold concept in that it relates to mental experience and links an external event with  the specific after-effects on an individual 's psychic reality. A distinction needs to be made between mentally destructive trauma and affective trauma. A destructive trauma does not break through the protective shield but does breach the pleasure-unpleasure principle, so that in the course of its subsequent mastery it leads to a traumatic neurosis. An affective trauma can be warded off under the rule of the pleasure-unpleasure principle and leads to a psychoneurosis.

PMID: 18405287 [PubMed - indexed for MEDLINE]


Int J Psychoanal. 2008 Apr;89(2):261-77.

On the determination of autistoid organizations in non-autistic adults.

Nissen B.

Psychogenic autistic phenomena occurring in non-autistic adults are being increasingly discussed in the psychoanalytical literature. The author endeavours  to determine autistoid organizations, which are understood to be a particular form of pathological retreat. Together with the use of autistic objects, two-dimensional levelling out, the failure of unconscious communication, and of projective identification, a characteristic of these retreats is that they are meant to afford protection against paranoid-schizoid fears of the external and unintegrated states of the internal world. The formation of such autistic reactions should be sought not only in traumatic separations and the inadequate containment of primary objects, but also in constitutional weakening. Intolerance accompanying projective identification and damage to primal fantasies/preconceptions are discussed. In conclusion, a clinical illustration with autistoid and hypochondriacal retreats clarifies some of the aspects discussed.

PMID: 18405283 [PubMed - indexed for MEDLINE]


Int J Psychophysiol. 2008 Apr;68(1):27-34. Epub 2008 Jan 10.

Reduced mismatch negativity in posttraumatic stress disorder: a compensatory mechanism for chronic hyperarousal?

Menning H, Renz A, Seifert J, Maercker A.

Department of Psychology, University Zürich, Switzerland, Binzmühlestr. 14/17, 8050 Zürich, Switzerland.

Mismatch Negativity (MMN) is yet poorly understood in the context of Posttraumatic Stress Disorder (PTSD, e.g. [Morgan 3rd, C.A., Grillon, C., 1999. Abnormal mismatch negativity in women with sexual assault-related posttraumatic stress disorder. Biol. Psychiatry 45, 827-832.]). PTSD symptoms like hyperarousal, emotional pressure and avoidance may interfere with pre-attentive sensory processing. We tested this in an optimized MMN design [Näätänen, R., Pakarinen, S., Rinne, T., Takegata, R. (2004) The mismatch negativity (MMN): towards the optimal paradigm. Clin. Neurophysiol. 115: 140-144.] with PTSD victims and a control group without PTSD. A group of PTSD subjects was compared with gender and age-matched, healthy comparison subjects without PTSD. A "memory  trace" was elicited by frequently presented "standard" auditory stimuli (50% occurrence) of 1 kHz, 75 ms duration, intermittently with 8 rare "deviants", which differed in frequency (higher/lower), intensity (louder/softer), duration (shorter), direction (left/right) or by the presence of a gap in the sound. During presentation of tones a silent film was shown. Psychometric data were collected by SCID, BSI, Attentiveness Inventory, Edinburgh Handedness Questionnaire, and the PTSD Screening Scale by Breslau et al. [Breslau, N., Peterson, E.L., Kessler, R.C., Schultz, L.R. (1999) Short screening scale for DSM-IV posttraumatic stress disorder. Am. J. Psychiatry 156: 908-911.]. Group comparisons of the MMN were performed for left/right-frontal/temporal, and for midline electrode sites. A good differentiation of both groups was found in psychometric and electrophysiological data. The PTSD group revealed on most BSI scales enhanced values of psychic aberration. The amplitude of the MMN was significantly reduced in the PTSD compared to non-PTSD subjects. MMN was significantly correlated with the total PTSD score. The data suggest a reduction  in pre-attentive auditory sensory memory in PTSD due to specific symptom variables such as hyperarousal, sleeplessness, impaired concentration and a general enhanced excitation of the nervous system. This protective inhibition is  thought to be a fine-tuning process in PTSD in order to prevent arousal overload.

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

PMID: 18262297 [PubMed - indexed for MEDLINE]


Intensive Care Med. 2008 Apr;34(4):664-74. Epub 2008 Jan 16.

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

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

Collaborators: van Ruler O, Boer KR, Reitsma JB, Mahler CW, Reuland EA, van Till  JW, Opmeer BC, Bossuyt PM, Schultz MJ, Sprangers MA, Obertop H, Gouma DJ, de Borgie CA, Boermeester MA, Steller EP, Tanis P, Hart H, Gerhards MF, Guijt M, Oudemans HM, Bosscha K, Ritchie E, Vermeer M, de Graaf PW, van Etten B, Haazer C, Salm E, Lamme B, Hesselink EJ, Rommes H, Oostenbroek RJ, te Velde L, Govaert G, Ponssen HH, Gooszen HG, Dinkelman MK, Leenen LP, Pierik EG, Lansink KW, Bakker J.

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

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

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

PMID: 18197398 [PubMed - indexed for MEDLINE]


J Affect Disord. 2008 Apr;107(1-3):259-63. Epub 2007 Sep 20.

Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder.

Maia DB, Marmar CR, Mendlowicz MV, Metzler T, Nóbrega A, Peres MC, Coutinho ES, Volchan E, Figueira I.

Institute of Psychiatry, Universidade Federal of Rio de Janeiro (IPUB-UFRJ), Rio  de Janeiro, Brazil.

BACKGROUND: To measure the serum lipid composition of a sample of Brazilian police officers with and without PTSD regularly exposed to potentially traumatic  situations. METHODS: A cross-sectional survey was conducted with 118 active duty  male police officers. Serum concentrations for total cholesterol, LDL-C, HDL-C, and triglycerides were enzymatically determined. Body mass index (BMI) was obtained for each participant. RESULTS: Officers with PTSD exhibited significantly higher serum total cholesterol, LDL-C and triglycerides levels than those without PTSD. Total cholesterol and triglycerides, but not LDL-C, remained  associated with PTSD diagnosis after controlling for confounding influences (i.e. socio-demographics, BMI, and tobacco, alcohol and medication use). LIMITATIONS: The sample size was small. A nutritional interview was employed instead of established scales to assess alimentary habits, tobacco or alcohol consumption. A self-report screening tool was used to assess the prevalence of PTSD. CONCLUSIONS: The association between PTSD and abnormal serum lipid profile and a  tendency to exhibit higher BMI suggests that individuals with PTSD may be at increased risk for developing metabolic syndrome, a condition that by itself could account for many of the most serious PTSD-related physical health problems.

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

PMID: 17888517 [PubMed - indexed for MEDLINE]


J Affect Disord. 2008 Apr;107(1-3):193-7. Epub 2007 Aug 27.

Peritraumatic tonic immobility predicts a poor response to pharmacological treatment in victims of urban violence with PTSD.

Fiszman A, Mendlowicz MV, Marques-Portella C, Volchan E, Coutinho ES, Souza WF, Rocha V, Lima AA, Salomão FP, Mari JJ, Figueira I.

Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-FRJ), Brazil.

INTRODUCTION: Tonic immobility is the last defense against predation in animals and is characterized by paralysis and analgesia. In humans, it has only been reported in women victims of sexual abuse. OBJECTIVE: This study evaluated the prevalence of peritraumatic tonic immobility (PTI) in patients with PTSD and investigated its association with response to treatment. METHOD: Victims of urban violence with PTSD diagnosed through the SCID-IV (n=23) underwent a naturalistic  pharmacological treatment according to the recommended guidelines for PTSD. The Post-Traumatic Stress Disorder Checklist--Civilian Version (PCL-C) and the Clinical Global Impressions (CGI) Severity scores were applied at baseline and endpoint. PTI was assessed using the Tonic Immobility Scale. RESULTS: PTI was reported by both genders in 43% of the sample. Patients with PTI responded significantly poorly to treatment than those without it, either considering the PCL-C or the CGI scores. LIMITATIONS: This study probed PTI retrospectively and was based on a small sample recruited in a tertiary clinic. CONCLUSIONS: We have  expanded the scope of the two previous investigations on PTI by showing its occurrence also in men and during non-sexual violence. In addition, the finding of a significant relationship between PTI and poor response to treatment of PTSD  indicates that PTI may carry a prognostic value in this disorder and suggests that PTI should be routinely assessed in traumatized patients.

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

PMID: 17719650 [PubMed - indexed for MEDLINE]


J Anal Psychol. 2008 Apr;53(2):169-88.

Trauma, forgiveness and the witnessing dance: making public spaces intimate.

Gobodo-Madikizela P.

Department of Psychology, University of Cape Town, Rondebosch, South Africa.

In this paper I explore the concept of forgiveness as a response to gross human rights violations. I present a conceptual examination of the effects of massive trauma in relation to what I refer to as the 'unfinished business' of trauma. Using a psychoanalytic framework, I consider the process of 'bearing witness' about trauma and examine how this process opens up the possibility of reciprocal  expressions of empathy between victim and perpetrator. I then argue that, in this context of trauma testimony and witnessing, empathy is essential for the development of remorse on the part of perpetrators, and of forgiveness on the part of victims. Using a case study from South Africa's Truth and Reconciliation  Commission (TRC) I clarify the relationship between empathy and forgiveness, and  show how the restorative model of the TRC can open up an ethical space and create the possibility of transformation for victims, perpetrators and bystanders. In my conclusion I suggest that forgiveness in politics is the only action that holds promise for the repair of brokenness in post-conflict societies, particularly if, as in South Africa, victims have to live together with perpetrators and beneficiaries in the same country.

PMID: 18352945 [PubMed - indexed for MEDLINE]


J Behav Med. 2008 Apr;31(2):115-25.

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

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

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

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

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

PMID: 18095150 [PubMed - indexed for MEDLINE]


J BUON. 2008 Apr-Jun;13(2):285-9.

Cigarette smoking in Serbia. Impact of the 78-day NATO bombing campaign.

Sokolova-Djokic L, Zizic-Borjanovic S, Igic R.

Department of Public Health, Sombor, Serbia.

PURPOSE: To estimate short-term and long-term influence of protracted stress caused by the NATO bombing of Serbia on self-reported cigarette smoking, we performed and analyzed smoking survey data. MATERIALS AND METHODS: The survey included 320 adult citizens from Sombor, Novi Sad, and Belgrade, three cities that were bombed during the NATO campaign along with other Serbian target cities. We queried participants about their smoking habits before, during, and 8 years after the military intervention. We recorded smoking prevalence rates, intentions to stop smoking, and the age at which smoking began. We also recorded smoking history and cessation attempts. RESULTS: Prior to bombing, 48% of the women and 63% of the men were smokers. During the bombing period, smoking prevalence in male smokers increased significantly. During this period, 32% of the women and 36% of the men increased their smoking by as much as two packs of cigarettes per  week. A month after the bombing, the rate of consumption returned to the prewar levels. At present, 44% of the women, and 59% of the men smoke. The average age of current smokers is 43 years (standard deviation /SD/, 14.4) for women and 45 (SD, 16.3) years for men. Female smokers expressed greater interest in quitting smoking than their male counterparts, and they were slightly more successful than men at maintaining abstinence (20 vs. 18%). The participants in our study acknowledged that a compounding factor for successful abstinence was information  on depleted uranium (DU) and other pollutants introduced into the environment by  the war. CONCLUSION: Prolonged stress imposed by war causes a short-term increase in smoking prevalence in male smokers and higher cigarette consumption both in male and female smokers. Even though these increases dissipated after the war was over, the prevalence of smoking within the population of urban Serbia remains very high. Counseling and pharmacological support for abstinence relapse in Serbia ere insufficient to sustain smoking cessation during the 8-year period after the NATO bombing. Motivation for smoking cessation stems primarily from governmental regulatory measures and awareness of the dangers to health posed by  tobacco smoking.

Publication Types:      Comparative Study

PMID: 18555480 [PubMed - indexed for MEDLINE]


J Clin Child Adolesc Psychol. 2008 Apr;37(2):363-75.

Psychiatric impairment among adolescents engaging in different types of deliberate self-harm.

Jacobson CM, Muehlenkamp JJ, Miller AL, Turner JB.

Columbia University/New York State Psychiatric Institute, USA.

This retrospective chart review study of 227 participants examined the psychiatric profiles of outpatient adolescents ages 12 to 19 years (M = 15.08 years, SD = 1.72 years) engaging in different types of deliberate self-harm (DSH) behaviors. Participants were divided into four groups: no deliberate self-harm (NoDSH; n = 119), nonsuicidal self-injury only (NSSI only; n = 30), suicide attempt only (n = 38), and suicide attempt plus NSSI (n = 40). Those who attempted suicide were more likely to have major depressive disorder and/or posttraumatic stress disorder than those who engaged in NSSI only. Those who engaged in any type of DSH were more likely to have features of borderline personality disorder than those who did not engage in DSH. The suicidal ideation  levels of those in the NSSI group were similar to those in the NoDSH group. Findings offer empirical support for the importance of distinguishing between suicidal and nonsuicidal self-harm behaviors.

PMID: 18470773 [PubMed - indexed for MEDLINE]


J Clin Psychiatry. 2008 Apr;69(4):680; author reply 680-1.

Comment on:     J Clin Psychiatry. 2007 May;68(5):711-20.

Comments on a randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting.

Hussain HM.

Publication Types:      Comment     Letter

PMID: 18507493 [PubMed - indexed for MEDLINE]


J Clin Psychiatry. 2008 Apr;69(4):621-32.

Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials.

Hofmann SG, Smits JA.

Department of Psychology, Boston University, Mass 02215, USA.

OBJECTIVE: Cognitive-behavioral therapy (CBT) is frequently used for various adult anxiety disorders, but there has been no systematic review of the efficacy  of CBT in randomized placebo-controlled trials. The present study meta-analytically reviewed the efficacy of CBT versus placebo for adult anxiety disorders. DATA SOURCES: We conducted a computerized search for treatment outcome studies of anxiety disorders from the first available date to March 1, 2007. We searched MEDLINE, PsycINFO, PubMed, Scopus, the Institute of Scientific Information, and Dissertation Abstracts International for the following terms: random*, cognitive behavior*therap*, cognitive therap*, behavior*therap*, GAD, generalized anxiety disorder, OCD, obsessive compulsive disorder, social phobia,  social anxiety disorder, specific phobia, simple phobia, PTSD, post-traumatic stress disorder, and acute stress disorder. Furthermore, we examined reference lists from identified articles and asked international experts to identify eligible studies. STUDY SELECTION: We included studies that randomly assigned adult patients between ages 18 and 65 years meeting DSM-III-R or DSM-IV criteria  for an anxiety disorder to either CBT or placebo. Of 1165 studies that were initially identified, 27 met all inclusion criteria. DATA EXTRACTION: The 2 authors independently identified the eligible studies and selected for each study the continuous measures of anxiety severity. Dichotomous measures reflecting treatment response and continuous measures of depression severity were also collected. Data were extracted separately for completer (25 studies for continuous measures and 21 studies for response rates) and intent-to-treat (ITT)  analyses (6 studies for continuous measures and 8 studies for response rates). DATA SYNTHESIS: There were no significant differences in attrition rates between  CBT and placebo. Random-effects models of completer samples yielded a pooled effect size (Hedges' g) of 0.73 (95% CI = 0.88 to 1.65) for continuous anxiety severity measures and 0.45 (95% CI = 0.25 to 0.65) for depressive symptom severity measures. The pooled odds ratio for completer treatment response rates was 4.06 (95% CI = 2.78 to 5.92). The strongest effect sizes were observed in obsessive-compulsive disorder and acute stress disorder, and the weakest effect size was found in panic disorder. The advantage of CBT over placebo did not depend on placebo modality, number of sessions, or study year. CONCLUSIONS: Our review of randomized placebo-controlled trials indicates that CBT is efficacious  for adult anxiety disorders. There is, however, considerable room for improvement. Also, more studies need to include ITT analyses in the future.

Publication Types:      Meta-Analysis

PMID: 18363421 [PubMed - indexed for MEDLINE]


J Clin Psychiatry. 2008 Apr;69(4):597-602.

Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data.

Elhai JD, Grubaugh AL, Kashdan TB, Frueh BC.

Disaster Mental Health Institute, the University of South Dakota, Vermillion 57069-2390, USA.

OBJECTIVE: Recently, changes have been proposed to DSM-IV diagnostic criteria for post-traumatic stress disorder (PTSD) to refine the diagnosis because of concerns about its construct validity. Specifically, Spitzer et al. suggested narrowing the PTSD definition of trauma, specifying a symptom onset time frame after the trauma, and removing symptoms that overlap with other anxiety and mood disorders. We examined whether removing these overlapping anxiety/mood disorder symptoms resulted in differences (compared to the original DSM-IV PTSD criteria) in PTSD prevalence rates, diagnostic caseness, comorbidity and mental health-related disability, structural validity, and internal consistency. METHOD: Cross-sectional data were examined from the National Comorbidity Survey Replication (N = 5692), a multistage area household probability sample of U.S. residents. PTSD diagnostic and symptom data and diagnostic data for other Axis I  disorders were taken from the Composite International Diagnostic Interview. The study was conducted from February 2001 to December 2003. RESULTS: After removing  PTSD symptoms overlapping with those of other anxiety and mood disorders, we found that the lifetime PTSD prevalence dropped only from 6.81% to 6.42%. Nevertheless, a sizeable proportion of PTSD-diagnosed persons would consequently  lose PTSD caseness. Little difference was found between the criteria sets in diagnostic comorbidity and disability, structural validity, and internal consistency. CONCLUSIONS: These data provide evidence that PTSD's overlapping anxiety and mood disorder symptoms are not responsible for PTSD's prevalence, diagnostic comorbidity, and construct validity. Although the proposed symptom criteria revision would result in fewer symptoms by which to evaluate PTSD, it may not address questions raised about the diagnosis' construct validity.

PMID: 18294026 [PubMed - indexed for MEDLINE]


J Clin Psychiatry. 2008 Apr;69(4):520-5.

Placebo-controlled trial of risperidone augmentation for selective serotonin reuptake inhibitor-resistant civilian posttraumatic stress disorder.

Rothbaum BO, Killeen TK, Davidson JR, Brady KT, Connor KM, Heekin MH.

Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30329, USA.

OBJECTIVE: Treatment of posttraumatic stress disorder (PTSD) with pharmacotherapy is promising, although the response to medication has generally been modest, and  strategies to improve the response to antidepressant medications are needed. The  primary objective of this study was to examine risperidone augmentation in civilians with PTSD currently receiving sertraline without an optimal response. METHOD: Male and female participants aged 18 to 65 years were recruited from 3 academic medical centers between June 2004 and September 2006. Those who met eligibility criteria with a DSM-IV diagnosis of PTSD subsequent to a civilian trauma and a Clinician-Administered PTSD Scale (CAPS) score greater than or equal to 50 at screen and baseline were entered into phase 1. In phase 1, patients were treated for 8 weeks with open-label sertraline. Those who did not remit (defined  as a 70% decrease in PTSD symptoms as measured by the CAPS) were entered into phase 2. In phase 2, patients remained on sertraline and were randomly assigned to augmentation with risperidone or matching pill placebo for 8 weeks. Symptoms of PTSD and depression and psychotic symptoms were measured prospectively throughout the 16-week study. RESULTS: Of the 45 patients enrolled, 34 completed  phase 1, and 25 of those patients were randomly assigned to phase 2; 20 completed phase 2. For all patients across all phases, PTSD and related symptoms improved with no significant differences between groups. In post hoc analyses, the group that received risperidone augmentation had significantly more improvement than the placebo group on the Davidson Trauma Scale (DTS) sleep item (p = .03) and demonstrated a trend toward significantly more improvement on the Clinical Global Impressions-Improvement scale (p = .066), the positive (p = .065) and paranoia (p = .1) subscales of the Positive and Negative Syndrome Scale, and the CAPS sleep item (p = .09). CONCLUSION: Participants responded well to sertraline in phase 1, sustained their response, and displayed a placebo response comparable with that of risperidone in phase 2. There is some evidence to support the conclusion that  risperidone augmentation was helpful in those subjects who did not remit with sertraline alone, particularly in the areas of global improvement, positive affect, and sleep. TRIAL REGISTRATION: Identifier: NCT00133822.

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

PMID: 18278987 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):272-81.

Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat.

Bliese PD, Wright KM, Adler AB, Cabrera O, Castro CA, Hoge CW.

US Army Medical Research Unit--Europe, Heidelberg, Germany.

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics of both the PC-PTSD and the PCL. A validation study conducted with a sample of 352 service members showed that both  the PC-PTSD and PCL had good diagnostic efficiency. The overall diagnostic efficiency assessed by the area under the curve (AUC) was virtually the same for  both the PC-PTSD and PCL. The most efficient cutoff values for the PC-PTSD were either 2 or 3 "yes" responses with the latter favoring specificity. For the PCL,  the most efficient cutoff values were between 30 and 34, mirroring recommended PCL cutoff values from some studies in primary care settings. The examination of  item characteristics suggested a 4-item PCL with an AUC virtually identical to that of the full PCL. Item analyses also identified that the most discriminate item in both scales pertained to symptoms of avoidance. Implications and limitations are discussed. PsycINFO Database Record (c) 2008 APA, all rights reserved.

PMID: 18377123 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):259-71.

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

Mueser KT, Rosenberg SD, Xie H, Jankowski MK, Bolton EE, Lu W, Hamblen JL, Rosenberg HJ, McHugo GJ, Wolfe R.

Department of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Concord, New hampshire, USA.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared  with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly  more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD.  Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. PsycINFO Database Record (c) 2008 APA, all rights reserved.

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

PMID: 18377122 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):243-58.

A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence.

Resick PA, Galovski TE, O'Brien Uhlmansiek M, Scher CD, Clum GA, Young-Xu Y.

Women's Health Sciences Division, National Center for PTSD, Veterans Affiairs Boston Healthcare System, Boston, MA 02130, USA.

The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components--cognitive therapy only (CPT-C) and written accounts (WA)--for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment,  2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent  ratings of adherence and competence were also conducted. Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition. PsycINFO Database Record (c) 2008 APA, all rights reserved.

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

PMID: 18377121 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):231-42.

Reduced autobiographical memory specificity predicts depression and posttraumatic stress disorder after recent trauma.

Kleim B, Ehlers A.

Department of Psychology, King's College, London, United Kingdom.

In this prospective longitudinal study, the authors examined the relationship between reduced specificity in autobiographical memory retrieval and the development of depression, posttraumatic stress disorder (PTSD), and specific phobia after injury in an assault. Assault survivors (N = 203) completed the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986) at 2 weeks  after the trauma as well as structured clinical interviews at 2 weeks and 6 months. Participants with acute stress disorder or major depression at 2 weeks, but not those with phobia, retrieved fewer specific autobiographical memories than those without the respective disorder. Reduced memory specificity at 2 weeks also predicted subsequent PTSD and major depression at 6 months over and above what could be predicted from initial diagnoses and symptom severity. Moderator analyses showed that low memory specificity predicted later depression in participants with prior episodes of major depression but not in those without prior depression. Mediation analyses suggested that rumination partly mediated and perceived permanent change fully mediated the effects of low memory specificity on posttrauma psychopathology at follow-up. PsycINFO Database Record  (c) 2008 APA, all rights reserved.

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

PMID: 18377120 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):219-30.

Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study.

Ehring T, Ehlers A, Glucksman E.

Department of Psychology, King's College, London, United Kingdom.

The study investigated the power of theoretically derived cognitive variables to  predict posttraumatic stress disorder (PTSD), travel phobia, and depression following injury in a motor vehicle accident (MVA). MVA survivors (N = 147) were  assessed at the emergency department on the day of their accident and 2 weeks, 1  month, 3 months, and 6 months later. Diagnoses were established with the Structured Clinical Interview for DSM-IV. Predictors included initial symptom severities; variables established as predictors of PTSD in E. J. Ozer, S. R. Best, T. L. Lipsey, and D. S. Weiss's (2003) meta-analysis; and variables derived from cognitive models of PTSD, phobia, and depression. Results of nonparametric multiple regression analyses showed that the cognitive variables predicted subsequent PTSD and depression severities over and above what could be predicted  from initial symptom levels. They also showed greater predictive power than the established predictors, although the latter showed similar effect sizes as in the meta-analysis. In addition, the predictors derived from cognitive models of PTSD  and depression were disorder-specific. The results support the role of cognitive  factors in the maintenance of emotional disorders following trauma. PsycINFO Database Record (c) 2008 APA, all rights reserved.

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

PMID: 18377119 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):208-18.

Anger and posttraumatic stress disorder symptoms in crime victims: a longitudinal analysis.

Orth U, Cahill SP, Foa EB, Maercker A.

Department of Psychology, University of California, Davis, CA 95616, USA.

Among trauma-exposed individuals, severity of posttraumatic stress disorder (PTSD) symptoms is strongly correlated with anger. The authors used 2 longitudinal data sets with 282 and 218 crime victims, respectively, to investigate the temporal sequence of anger and PTSD symptoms following the assault. Cross-lagged regression analyses indicated that PTSD symptoms predicted  subsequent level of anger, but that anger did not predict subsequent PTSD symptoms. Testing alternative models (common factor model, unmeasured 3rd variable model) that might account for spuriousness of the relation strengthened  confidence in the results of the cross-lagged analyses. Further analyses suggested that rumination mediates the effect of PTSD symptoms on anger. PsycINFO Database Record (c) 2008 APA, all rights reserved.

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

PMID: 18377118 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):194-207.

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes.

Campbell R, Greeson MR, Bybee D, Raja S.

Department of Psychology, Michigan State University, Lansing, MI 48824-1116, USA.

This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital women's clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of women's lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of  posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed. PsycINFO Database Record (c) 2008 APA, all rights reserved.

PMID: 18377117 [PubMed - indexed for MEDLINE]


J Consult Clin Psychol. 2008 Apr;76(2):184-93.

Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination.

Ellis BH, MacDonald HZ, Lincoln AK, Cabral HJ.

Department of Psychiatry, Children's Hospital Boston, MA 02115, USA.

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants  were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview  battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development. PsycINFO Database Record (c) 2008 APA, all rights reserved.

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

PMID: 18377116 [PubMed - indexed for MEDLINE]


J Interpers Violence. 2008 Apr;23(4):474-89. Epub 2008 Feb 14.

Female sex offenders: exploring issues of personality, trauma, and cognitive distortions.

Strickland SM.

University of Georgia, USA.

Few studies have investigated the characteristics of female sex offenders and factors and/or causes of female deviance. Research to date has been descriptive in nature, with few comparison studies. Using a correlational design and three valid instruments, female sexual offenders and a matched group of female nonsexual offenders are compared in the areas of personality disorders, chemical  dependency, childhood trauma, sexual trauma, emotional neediness, cognitive distortions, and social competence. A sample of 130 incarcerated females, 60 sex  offenders, and 70 nonsexual offenders is used. Significant results are found in the areas of total childhood trauma and severity of sexual abuse suffered and social and sexual adequacy. No differences are found in abuse of substances, personality disorders, emotional neediness, or cognitive distortions.

Publication Types:      Comparative Study

PMID: 18276846 [PubMed - indexed for MEDLINE]


J Marital Fam Ther. 2008 Apr;34(2):193-209.

Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma.

Landau J, Mittal M, Wieling E.

Linking Human Systems, LLC, and LINC Foundation, Boulder, CO 80301, USA.

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.

Publication Types:      Review

PMID: 18412826 [PubMed - indexed for MEDLINE]


J Marital Fam Ther. 2008 Apr;34(2):177-92.

Parenting practices as potential mechanisms for child adjustment following mass trauma.

Gewirtz A, Forgatch M, Wieling E.

Department of Family Social Sciences & Institute of Child Development, University of Minnesota, St. Paul, MN 55108, USA.

Trauma research has identified a link between parental adjustment and children's  functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be  mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma.

Publication Types:      Review

PMID: 18412825 [PubMed - indexed for MEDLINE]


J Marital Fam Ther. 2008 Apr;34(2):165-76.

Beyond individual war trauma: domestic violence against children in Afghanistan and Sri Lanka.

Catani C, Schauer E, Neuner F.

Department of Psychology, University of Konstanz and Vivo, Konstanz, Germany.

To date, research on the psychosocial consequences of mass trauma resulting from  war and organized violence on children has primarily focused on the individual as the unit of treatment and analysis with particular focus on mental disorders caused by traumatic stress. This body of research has stimulated the development  of promising individual-level treatment approaches for addressing psychological trauma. In contrast, there is virtually no literature addressing the effects of mass trauma on the family and community systems. Research conducted in Sri Lanka  and Afghanistan, two long-standing war-torn societies, found that in addition to  multiple exposure to war or disaster-related traumatic events children also indicated high levels of exposure to family violence. These findings point to the need for conjoint family- and community-based programs of prevention and intervention that are specifically tailored for the context of the affected society. In particular, programs should take issues such as poverty, child labor, and parental alcohol use into account in assessing and treating children in the aftermath of mass trauma.

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

PMID: 18412824 [PubMed - indexed for MEDLINE]


J Marital Fam Ther. 2008 Apr;34(2):149-64.

Evaluating a multiple-family group access intervention for refugees with PTSD.

Weine S, Kulauzovic Y, Klebic A, Besic S, Mujagic A, Muzurovic J, Spahovic D, Sclove S, Pavkovic I, Feetham S, Rolland J.

Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA.

The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The  results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing  trauma mediated the intervention effect. Further well-designed studies of family  interventions are needed for developing evidence-based interventions for refugee  families.

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

PMID: 18412823 [PubMed - indexed for MEDLINE]


J Marital Fam Ther. 2008 Apr;34(2):132-48.

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina.

Rowe CL, Liddle HA.

University of Miami Miller School of Medicine, Miami, FL 33101, USA.

Hurricane Katrina brought to the surface serious questions about the capacity of  the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its  consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple  interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing  service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.

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

PMID: 18412822 [PubMed - indexed for MEDLINE]


J Marital Fam Ther. 2008 Apr;34(2):127-31.

JMFT special section on mass trauma.

Wieling E, Mittal M.

Family Social Science, University of Minnesota, St. Paul, MN 55108, USA.

Publication Types:      Introductory Journal Article

PMID: 18412821 [PubMed - indexed for MEDLINE]


J Nerv Ment Dis. 2008 Apr;196(4):340-4.

The psychological impact of a catastrophic earthquake: a retrospective study 50 years after the event.

Lazaratou H, Paparrigopoulos T, Galanos G, Psarros C, Dikeos D, Soldatos C.

Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece.

Aim of the present study was to retrospectively assess the impact of a catastrophic earthquake in a sample of 121 survivors, 50 years after the event. Mean age +/- SD of the responders was 72.2 +/- 6.1 years. The majority of the victims (78%) acknowledged a strong overall impact of the earthquake on their lives, and almost all of them had intense recollection of the event at its anniversary. The most frequent symptom during the 6 months after the earthquake was persistent remembering or "reliving" of the event; women had considerably more often recurrent dreams of the earthquake and distress than did men. Women and young adults at the time of the earthquake appear to be the most vulnerable groups regarding the psychological effects of the event.

PMID: 18414131 [PubMed - indexed for MEDLINE]


J Pediatr Nurs. 2008 Apr;23(2):81-91.

The impact of unintentional pediatric trauma: a review of pain, acute stress, and posttraumatic stress.

Gold JI, Kant AJ, Kim SH.

Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027-6062, USA.

This article reviews current research on acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) resulting from pediatric simple (i.e., single, unpredictable, and unintentional) physical injury and how pain may act as both a trigger and a coexisting symptom. Although several studies have explored predictors of ASD and PTSD, as well as the relationship between these conditions  in adults, there is less research on ASD and PTSD in children and adolescents. This review highlights the importance of early detection of pain and acute stress symptoms resulting from pediatric unintentional physical injury in the hopes of preventing long-term negative outcomes, such as the potential development of PTSD and associated academic, social, and psychological problems.

Publication Types:      Review

PMID: 18339334 [PubMed - indexed for MEDLINE]


J Psychiatr Ment Health Nurs. 2008 Apr;15(3):219-28.

'It is still so deep-seated, the fear': psychological stress reactions as consequences of intimate partner violence.

Scheffer Lindgren M, Renck B.

Faculty of Social & Life Sciences, Department of Health and Environmental Sciences, Public Health, Karlstad University, Karlstad, Sweden.

The negative mental health consequences of intimate partner violence have been well documented in recent years. One aim of the present study was to examine psychological distress and mental problems in assaulted women who have left their relationships. Another aim was to explore these women's sense of coherence (SOC). A combination of qualitative in-depth interviews and quantitative measurement instruments was used. Data were collected from 14 assaulted women with a mean age of 38, living in different places in Sweden. Impact of event scale-revised and symptom checklist-90-R show that the violence creates long-term psychological stress reactions and confirm previous research on the subject. Twelve of the 14 women have symptoms of post-traumatic stress disorder (PTSD). The result of the interviews confirmed complex PTSD and disorders of extreme stress not otherwise specified. On the other hand we found a surprisingly high SOC level among several of the respondents, a fact which could explain why these women finally managed to leave mainly by their own efforts. We call for more both qualitative and quantitative studies on this serious public health issue.

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

PMID: 18307651 [PubMed - indexed for MEDLINE]


J Psychiatr Res. 2008 Apr;42(5):371-83. Epub 2007 Apr 20.

Individual differences predict susceptibility to conditioned fear arising from psychosocial trauma.

Walker FR, Hinwood M, Masters L, Deilenberg RA, Day TA.

Laboratory of Brain and Behaviour, University of Newcastle, NSW 2308, Australia. <>

BACKGROUND: Classical Pavlovian fear conditioning has been widely used in preclinical studies to gain insights into anxiety-related disorders. In this study we examined whether pre-existing behavioral differences, and/or behavioral  differences displayed during fear induction, predict the severity of the conditioned fear response that can develop after an episode of psychosocial conflict. METHODS: Prior to conditioning, male rats (intruders) were behaviorally assessed using the novel environment exploration and defensive burying tests. These animals were subsequently placed in the territory of an older male (resident) that invariably attacked the intruder. RESULTS: Upon return to this territory 24 h later, intruders moved less than controls and produced more distress vocalizations, indicating conditioned fear to context. Additionally, analyses revealed that both pre-existing behavioral differences, and the animal's response during social conflict, predicted the magnitude of the subsequent conditioned fear response. Specifically, animals that engaged in higher levels of novel environment exploration, that exhibited a greater number of defensive burying behaviors, and that demonstrated higher levels of fighting and guarding during social conflict, displayed less evidence of conditioned fear. CONCLUSION:  These findings show that the behavioral variability existent within a normal outbred population can predict the magnitude of the conditioned fear response.

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

PMID: 17449061 [PubMed - indexed for MEDLINE]


J Psychiatr Res. 2008 Apr;42(5):422-3. Epub 2007 Apr 2.

The impact of exposure to war stress on hospital staff: a preliminary report.

Ben-Ezra M, Palgi Y, Essar N.

Publication Types:      Comparative Study     Letter

PMID: 17400250 [PubMed - indexed for MEDLINE]


J Psychosom Res. 2008 Apr;64(4):383-91.

Psychological comorbidity and health-related quality of life and its association  with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors.

Mehnert A, Koch U.

Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

OBJECTIVE: Psychosocial comorbidity and quality of life (QOL) and its association with knowledge, utilization, and need for psychosocial support have been studied  in long-term breast cancer survivors. METHODS: One thousand eighty-three patients were recruited through a population-based cancer registry an average of 47 months following diagnosis (66% response rate). Self-report measures (e.g., Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist--Civilian Version, and Short-Form Health Survey) were used. RESULTS: Thirty-eight percent of patients had moderate to high anxiety, and 22% had moderate to high depression; posttraumatic stress disorder was observed in 12%. The overall psychological comorbidity was 43% and 26% for a possible and probable psychiatric disorder. Disease progress, detrimental interactions, less social support, a lower educational level, and younger age were predictors of psychological comorbidity (P<.004). Lower QOL (P<.01) and higher levels of anxiety (P<.001) were observed in cancer survivors compared to age-adjusted normative comparison groups. Time since diagnosis had no significant impact on psychological comorbidity as well as QOL. Forty-six percent of women felt insufficiently informed about support offers. Insufficient knowledge was associated with older age and lower education (P<.05). Since diagnosis, 57% had participated in cancer  rehabilitation and 24% in other psychosocial support programs. Fifteen percent of all patients and 23% of those with a possible psychiatric disorder expressed their need for psychosocial support. Women with distress and perceived support needs who did not participate in past support programs were older, less educated, and less informed (P<.05). CONCLUSION: Findings show the long-term impact of breast cancer and indicate need for patient education, screening for psychosocial distress, and implementation of psychological interventions tailored in particular for older women.

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

PMID: 18374737 [PubMed - indexed for MEDLINE]


J Sch Nurs. 2008 Apr;24(2):78-82.

The impact of hurricanes Katrina and Rita on Louisiana school nurses.

Broussard L, Myers R, Meaux J.

University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, Lafayette, LA, USA.

In the fall of 2005, the coast of Louisiana was devastated by two hurricanes, Katrina and Rita. Not only did these natural disasters have detrimental effects for those directly in their path, the storms had an impact on the lives of everyone in Louisiana. The professional practice of many Louisiana school nurses  was affected by several factors, including a sudden influx of students with no medical records. A qualitative descriptive study was conducted to gain an understanding of school nurses' feelings and experiences related to the hurricanes and their aftermath. Forty-one school nurses participated in the study, and findings revealed significant effects on their personal and professional lives. Themes within each area were identified: uncertainty, hopelessness and helplessness, thankfulness, practice challenges, and practice rewards. Implications for school nursing practice include the need for support during natural disasters and the importance of school nurse involvement in disaster preparedness.

PMID: 18363442 [PubMed - indexed for MEDLINE]


J Spec Pediatr Nurs. 2008 Apr;13(2):98-110.

A meta-analysis of risk factors that predict psychopathology following accidental trauma.

Cox CM, Kenardy JA, Hendrikz JK.

School of Psychology, University of Queensland, Brisbane, Queensland, Australia.

PURPOSE: This meta-analysis aimed to explore the risk factors that place a child  at risk of psychopathology following accidental trauma. DESIGN AND METHODS: The predictive power of 8 factors was examined via transforming and combining the effect sizes to yield a weighted average effect size for each factor. RESULTS: The results indicated that the majority of effect sizes, although significant, were inconsistent across the studies, yielding little conclusive evidence. However, pretrauma psychopathology and threat to life were strong and consistent  predictors. PRACTICE IMPLICATIONS: Information gathered from such meta-analyses could be used in the identification of at-risk children and the development of screening tools. However, further widespread and comprehensive reviews of the potential risk factors and their relationships to psychopathology need to be investigated.

Publication Types:      Meta-Analysis

PMID: 18366377 [PubMed - indexed for MEDLINE]


J Trauma. 2008 Apr;64(4):1001-9.

Factors influencing outcome after orthopedic trauma.

Ponsford J, Hill B, Karamitsios M, Bahar-Fuchs A.

Department of Psychology, Monash University, Melbourne, Australia.

BACKGROUND: Some recent studies have suggested that certain types of orthopedic trauma result in ongoing disability and that factors other than injury severity or location may influence outcome. This study aimed to evaluate outcome 12 months and 2 years after severe orthopedic trauma, as measured on the Short Form (SF)-36 Health Survey, relative to a control group, to examine change over time and to examine which demographic, injury-related and psychological factors are associated with persisting disability. METHODS: One hundred thirteen orthopedic trauma patients, recruited during rehabilitation, and 61 demographically similar  uninjured controls were followed up at 1 and 2 years postinjury. Measures included the SF-36 Health Survey, Symptom Checklist-90-R, Brief Pain Inventory, Hospital Anxiety and Depression Scales, and Posttraumatic Stress Disorder Checklist-Specific. RESULTS: Results indicated presence of significant ongoing disability in all SF-36 physical and mental health domains, significant ongoing psychologic adjustment problems, including posttraumatic stress disorder (PTSD) symptoms, and pain, with little or no improvement between 1 and 2 years postinjury. The presence of ongoing pain, anxiety, depression or PTSD symptoms were the strongest predictors of outcome on most variables, with older age also contributing to negative outcomes. Injury severity and type did not predict outcome, although those with lower limb fractures had greater pain and poorer physical outcomes that those with fractures in other locations. CONCLUSIONS: This study has highlighted pain and PTSD symptoms as frequent and disabling factors after othropedic trauma. There is clearly a need to focus on alleviating these problems as part of the rehabilitation process.

Publication Types:      Comparative Study

PMID: 18404068 [PubMed - indexed for MEDLINE]


J Trauma. 2008 Apr;64(4):969-74.

Predictors of general health after major trauma.

Harris IA, Young JM, Rae H, Jalaludin BB, Solomon MJ.

Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, Australia.

BACKGROUND: Traumatic injury is a leading contributor to the global burden of disease, yet there has been little research on possible predictors of general health after major trauma. This study aims to explore possible predictors of general health after major physical trauma. METHODS: A survey was performed of 731 surviving consecutive adult patients presenting to a major trauma center with accidental major trauma, between 1 year and 5 years postinjury. Data pertaining to general patient factors, injury severity factors, socioeconomic factors, and claim-related factors were abstracted from the hospital trauma database and the questionnaire. Multiple linear regression was used to develop a predictive model  for the main outcome, the physical and mental component summaries of the SF-36 General Health Survey. RESULTS: One hundred and forty nine patients were excluded, 93 refused to participate, and 134 did not respond, leaving 355 participants. On multivariate analysis, better physical health was significantly  associated with increasing time since the injury and lower Injury Severity Scores (p = 0.03 and 0.02, respectively). Having a settled compensation claim, having an unsettled compensation claim, and using a lawyer were independently associated with poor physical health (p = 0.02, 0.006, and <0.0001, respectively). Measures  of injury severity or socioeconomic status were not associated with mental health. However, having an unsettled compensation claim was strongly associated with poor mental health (p < 0.0001). CONCLUSION: General health after major physical trauma is more strongly associated with factors relating to compensation than with the severity of the injury. Processes involved with claiming compensation after major trauma may contribute to poor patient outcomes.

PMID: 18404063 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):218-22.

Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder.

Davis RG, Ressler KJ, Schwartz AC, Stephens KJ, Bradley RG.

Department of Psychiatry, Emory University, Grady Memorial Hospital, Atlanta, GA, USA.

African Americans in low-income, urban communities are at high risk for exposure  to traumatic events as well as for symptoms of posttraumatic stress disorder (PTSD). Approximately 22% of 220 participants recruited from urban hospital medical clinics met survey criteria for PTSD. Among the common traumas were having relatives/friends murdered (47%), being attacked with weapons (64% of men), and being sexually attacked (36% of women). Although desiring mental health services, only 13.3% of those with PTSD had prior trauma-focused treatment. Barriers to treatment included limited transportation and finances, family disapproval, and unfamiliarity with accessing treatment, among others. These data highlight the need for an awareness of the high prevalence of trauma and PTSD in  this population.

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

PMID: 18404649 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):209-13.

Virtual reality exposure therapy using a virtual Iraq: case report.

Gerardi M, Rothbaum BO, Ressler K, Heekin M, Rizzo A.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention  options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD.  Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.

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

PMID: 18404648 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):243-6.

Meta-analysis of alexithymia in posttraumatic stress disorder.

Frewen PA, Dozois DJ, Neufeld RW, Lanius RA.

Department of Psychology, The University of Western Ontario, Ontario, Canada.

The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.

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

PMID: 18404647 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):199-208.

Entering exile: trauma, mental health, and coping among Tibetan refugees arriving in Dharamsala, India.

Sachs E, Rosenfeld B, Lhewa D, Rasmussen A, Keller A.

Department of Psychology, Fordham University, Bronx, NY 10458, USA.

Each year thousands of Tibetans escape Chinese-controlled Tibet. The authors present findings on the experiences, coping strategies, and psychological distress (depression, anxiety, somatization, and posttraumatic stress disorder) of 769 Tibetan refugees arriving in Dharamsala, India (2003-2004). Distress increased significantly with greater trauma exposure. However, despite a high prevalence of potentially traumatizing events, levels of psychological distress were extremely low. Coping activity (primarily religious) and subjective appraisals of trauma severity appeared to mediate the psychological effects of trauma exposure. The potential impact of other variables, including culturally determined attitudes about trauma and timing of assessment, are discussed.

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

PMID: 18404641 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):190-8.

Resting electroencephalogram asymmetry and posttraumatic stress disorder.

Shankman SA, Silverstein SM, Williams LM, Hopkinson PJ, Kemp AH, Felmingham KL, Bryant RA, McFarlane A, Clark CR.

Department of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, IL 60607, USA.

The valence-arousal (W. Heller, 1993) and approach-withdrawal (R. J. Davidson, 1998a) models hypothesize that particular patterns of hemispheric brain activity  are associated with specific motivational tendencies and psychopathologies. We tested several of these predictions in two groups-a posttraumatic stress disorder (PTSD) and a "supercontrol" group, selected to be maximally different from those  with PTSD. Contrary to almost all hypotheses, individuals with PTSD did not differ from controls on resting electroencephalogram (EEG) asymmetry. Particular  aspects of PTSD were also not related to EEG hemisphere differences. Our null findings are consistent with the few studies that have examined resting EEG asymmetries in PTSD and suggest that PTSD may be associated with different processes than psychopathologies previously examined in studies of hemispheric brain activity (e.g., major depressive disorder, panic disorder).

Publication Types:      Comparative Study

PMID: 18404640 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):142-9.

Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder.

Forbes D, Parslow R, Creamer M, Allen N, McHugh T, Hopwood M.

Australian Centre for Posttraumatic Mental Health, Heidelberg, Victoria, Australia.

Research has identified anger as prominent in, and an influence on, treatment outcome for military veterans with posttraumatic stress disorder (PTSD). This study examined factors influencing the relationship between anger and outcome to  improve treatment effectiveness. Participants comprised 103 veterans attending PTSD treatment. Measures of PTSD and comorbidity were obtained at intake and 9-month follow-up. Measures also included potential mediators of therapeutic alliance, social support, problematic/undermining relationships and fear of emotion. Path analyses supported anger as a predictor of treatment outcome, with  only fear of anger and alcohol comorbidity accounting for the variance between anger and outcome. To improve treatment effectiveness, clinicians need to assess  veterans' anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors.

Publication Types:      Comparative Study

PMID: 18404639 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):173-80.

PTSD symptom clusters are differentially related to substance use among community women exposed to intimate partner violence.

Sullivan TP, Holt LJ.

Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA.

Women who experience intimate partner violence (IPV) have higher rates of posttraumatic stress disorder (PTSD) and substance abuse compared to women who do not experience IPV. However, the extent to which IPV-related PTSD symptoms are related to women's substance use involvement largely has been unexplored. The current study investigated PTSD symptomatology and substance use in a community sample of 212 IPV-exposed women. Drug-using women reported higher PTSD severity scores compared to women who reported no substance use or alcohol use only. Moreover, the reexperiencing, avoidance and numbing, and arousal clusters demonstrated unique associations with substance use involvement. Findings not only elucidate the associations among IPV-related PTSD symptoms and substance use, but they also can inform community-based preventive interventions.

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

PMID: 18404637 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):165-72.

PTSD diagnoses, subsyndromal symptoms, and comorbidities contribute to impairments for breast cancer survivors.

Shelby RA, Golden-Kreutz DM, Andersen BL.

Department of Psychology, Ohio State University, Columbus, OH, USA.

The clinical importance of posttraumatic stress disorder (PTSD) symptomatology for cancer patients is unclear. The association between the magnitude of cancer-related PTSD symptoms, comorbidity, and functioning is tested. Breast cancer patients (N = 74) were assessed at diagnosis/surgery, followed, and screened for cancer-related PTSD 18 months later. Participants then completed diagnostic interviews and PTSD (n = 12), subsyndromal PTSD (n = 5), and no symptom (n = 47) patient groups were identified. Posttraumatic stress disorder cases were distinguished by having experienced violent traumas and anxiety disorders predating cancer, whereas subsyndromal cases were not. Also, longitudinal data show that PTSD covarys with poorer functioning and lower quality of life among breast cancer survivors. Both PTSD and subsyndromal PTSD were associated with employment absenteeism and the seeking of mental health services.

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

PMID: 18404636 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):150-7.

A field test of group based exposure therapy with 102 veterans with war-related posttraumatic stress disorder.

Ready DJ, Thomas KR, Worley V, Backscheider AG, Harvey LA, Baltzell D, Rothbaum BO.

Mental Health Service Line, VA Medical Center-Atlanta, Decatur, GA 30033, USA.

Group-based exposure therapy (GBET) was field-tested with 102 veterans with war-related posttraumatic stress disorder (PTSD). Nine to 11 patients attended 3  hours of group therapy per day twice weekly for 16-18 weeks. Stress management and a minimum of 60 hours of exposure was included (3 hours of within-group war-trauma presentations per patient, 30 hours of listening to recordings of patient's own war-trauma presentations and 27 hours of hearing other patients' war-trauma presentations). Analysis of assessments conducted by treating clinicians pre-, post- and 6-month posttreatment suggests that GBET produced clinically significant and lasting reductions in PTSD symptoms for most patients  on both clinician symptoms ratings (6-month posttreatment effect size delta = 1.22) and self-report measures with only three dropouts.

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

PMID: 18404634 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):231-4.

Symptom comparison across multiple solicitation methods among Burundians with traumatic event histories.

Yeomans PD, Herbert JD, Forman EM.

Department of Psychology, Drexel University, Philadelphia, PA 19102-1192, USA.

Debate continues over whether posttraumatic stress disorder (PTSD) symptoms are more biologically based and therefore relatively universal or are more culturally constructed. This study aimed to describe traumatic stress reactions in a Burundian sample and to investigate the influences of the solicitation method (open-ended questions and standardized measures) and psychoeducation (as a process of acculturation) on symptoms reported. Standardized measures showed that distress was manifested in somatization, anxiety, and depression, and less so in  specific PTSD symptoms. Content analysis of open-ended questions revealed frequent material complaints. Prior exposure to Western ideas about trauma was predictive of more severe PTSD symptoms. The implications of the findings are discussed in terms of how methodological and cultural factors may influence posttraumatic reactions in nonindustrialized settings.

Publication Types:      Comparative Study

PMID: 18404633 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):214-7.

Strengths of character and posttraumatic growth.

Peterson C, Park N, Pole N, D'Andrea W, Seligman ME.

Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1043, USA.

How are strengths of character related to growth following trauma? A retrospective Web-based study of 1,739 adults found small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths. It was concluded that  growth following trauma may entail the strengthening of character.

Publication Types:      Comparative Study

PMID: 18404632 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):158-64.

The factor structure of the posttraumatic growth inventory: a comparison of five  models using confirmatory factor analysis.

Taku K, Cann A, Calhoun LG, Tedeschi RG.

Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.

There are different views about the dimensions of the positive changes resulting  from the struggle with traumatic events. Using Posttraumatic Growth Inventory (PTGI) data reported by participants (N = 926) experiencing a variety of traumatic events, five models of the underlying structure of the PTGI were tested via confirmatory factor analyses to examine whether the PTGI comprises three domains (Changed Perception of Self, Changed Interpersonal Relationships, and Changed Philosophy of Life), five factors (Relating to Others, New Possibilities, Personal Strength, Spiritual Change, and Appreciation of Life), or a unitary dimension. Results indicated an oblique 5-factor model best fit the data, thus revealing the PTGI was multidimensional. Present findings offer implications for  understanding the nature of posttraumatic growth.

Publication Types:      Comparative Study

PMID: 18404631 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):133-41.

War-related posttraumatic stress disorder in Black, Hispanic, and majority White  Vietnam veterans: the roles of exposure and vulnerability.

Dohrenwend BP, Turner JB, Turse NA, Lewis-Fernandez R, Yager TJ.

Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.

Elevated prevalence rates of chronic posttraumatic stress disorder (PTSD) have been reported for Black and Hispanic Vietnam veterans. There has been no comprehensive explanation of these group differences. Moreover, previous research has relied on retrospective reports of war-zone stress and on PTSD assessments that fail to distinguish between prevalence and incidence. These limitations are  addressed by use of record-based exposure measures and clinical diagnoses of a subsample of veterans from the National Vietnam Veterans Readjustment Study (NVVRS). Compared with Majority White, the Black elevation is explained by Blacks' greater exposure; the Hispanic elevation, by Hispanics' greater exposure, younger age, lesser education, and lower Armed Forces Qualification Test scores.  The PTSD elevation in Hispanics versus Blacks is accounted for mainly by Hispanics' younger age.

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

PMID: 18404630 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):123-32.

Elevated rates of current PTSD among Hispanic veterans in the NVVRS: true prevalence or methodological artifact?

Lewis-Fernández R, Turner JB, Marshall R, Turse N, Neria Y, Dohrenwend BP.

Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.

The elevated rate of current posttraumatic stress disorder (PTSD) among Hispanic  Vietnam veterans has been attributed to culturally based expressiveness that inflates symptom self-reports. To investigate this possibility, the authors conducted three hypothesis-driven analyses with National Vietnam Veterans Readjustment Study (NVVRS) data from the Structured Clinical Interview for DSM-III-R (SCID-) diagnosed subsample of male Vietnam Theater veterans (N = 260). First, persistence of the Hispanic elevation after adjusting for war-zone stress  exposure initially suggested the effect of greater expressiveness. Second, symptom-based analyses isolated this effect to the self-report Mississippi Scale  for Combat-Related PTSD and not to the clinician-rated SCID interview. Third, objective measures of functioning did not reveal a unique Hispanic pattern of lower impairment associated with current PTSD. These tests suggest that greater Hispanic expressiveness does not account for the Hispanic elevation in current PTSD in the NVVRS SCID-diagnosed subsample.

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

PMID: 18404629 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):235-8.

Unpacking the relationship between posttraumatic numbing and hyperarousal in a sample of help-seeking motor vehicle accident survivors: replication and extension.

Palyo SA, Clapp JD, Beck JG, Grant DM, Marques L.

Department of Psychology, University at Buffalo-SUNY, Buffalo, NY 14260, USA.

The current study is a replication and extension of previous research that has found support for a relationship between posttraumatic numbing and hyperarousal.  This study examined this association while controlling for depression in 345 motor vehicle accident survivors. Additionally, the relationships among specific  hyperarousal symptoms and numbing were explored. Results provided further evidence for an association between hyperarousal and numbing, even while controlling for the influence of depression, and revealed that all hyperarousal symptoms (except hypervigilance) contribute to this association.

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

PMID: 18404628 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):223-6.

Accumulated childhood trauma and symptom complexity.

Briere J, Kaltman S, Green BL.

Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

The relationship between accumulated exposure to different types of traumatic events (cumulative trauma) in childhood and the total number of different types of symptomatology reported (symptom complexity) in adulthood was examined in a sample of 2,453 female university students. There was a linear relationship between the number of trauma types experienced by participants before 18 and symptom complexity. This effect remained even when controlling for specific traumatic events, suggesting a generalized effect of cumulative trauma.

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

PMID: 18404627 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):239-42.

A cohort study of the long-term impact of a fire disaster on the physical and mental health of adolescents.

Dorn T, Yzermans JC, Spreeuwenberg PM, Schilder A, van der Zee J.

Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.

The literature on adult trauma survivors demonstrates that those exposed to traumatic stress have a poorer physical health status than nonexposed individuals. Studies on physical health effects in adolescent trauma survivors, in contrast, are scarce. In the current study, it was hypothesized that adolescents who have been involved in a mass burn incident (N = 124) will demonstrate more physical and mental health problems than an unaffected cohort from the same community (N = 1,487). Health data were extracted from electronic medical records, covering 1-year prefire and 4-years postfire. When compared to the prefire baseline, survivors showed significantly larger increases in mental,  respiratory, and musculoskeletal problems than community controls during the first year after the fire, but not during the later years.

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

PMID: 18404625 [PubMed - indexed for MEDLINE]


J Trauma Stress. 2008 Apr;21(2):227-30.

Disaster mental health workers responding to Ground Zero: one year later.

Daly ES, Gulliver SB, Zimering RT, Knight J, Kamholz BW, Morissette SB.

VA Boston Healthcare System, Jamaica Plain, MA 02130, USA.

The current study examined anniversary reactions in mental health disaster relief workers following traumatic exposure at the site of the World Trade Center terrorist attacks. Despite relatively low levels of symptom reporting, workers endorsed an increase in both negative mood symptoms and functional impairment at  the one-year anniversary of their traumatic exposure (compared to 6 months postexposure). For those individuals who met at least partial criteria for PTSD immediately following exposure, overall self-reported PTSD symptoms tended to increase from 6 to 12 months. This tendency resulted specifically from an increase in hyperarousal symptoms. Although few endorsed symptoms at clinical levels, our results demonstrate that disaster relief workers may experience an increase in symptomatology at the anniversary of their traumatic exposure.

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

PMID: 18404624 [PubMed - indexed for MEDLINE]


Med Care. 2008 Apr;46(4):388-93.

The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients.

Kartha A, Brower V, Saitz R, Samet JH, Keane TM, Liebschutz J.

Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA.

BACKGROUND: Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. OBJECTIVES: To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: English speaking patients at an academic, urban primary care clinic. MEASURES: Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. RESULTS: Among 592 subjects, 80% had > or =1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1-14.1] but no other increased utilization.  After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9-11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4-3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4-5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1-4.1) but no increase in outpatient and emergency department visits. CONCLUSIONS: PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association.

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

PMID: 18362818 [PubMed - indexed for MEDLINE]


Memory. 2008 Apr;16(3):288-304.

Collective memory: a perspective from (experimental) clinical psychology.

Wessel I, Moulds ML.

Division of Clinical and Developmental Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands.

This paper considers the concept of collective memory from an experimental clinical psychology perspective. Exploration of the term collective reveals a broad distinction between literatures that view collective memories as a property of groups (collectivistic memory) and those that regard these memories as a property of individuals who are, to a greater or lesser extent, an integral part  of their social environment (social memory). First, we argue that the understanding of collectivistic memory phenomena may benefit from drawing parallels with current psychological models such as the self-memory system theory of individualistic autobiographical memory. Second, we suggest that the social memory literature may inform the study of trauma-related disorders. We argue that a factual focus induced by collaborative remembering may be beneficial to natural recovery in the immediate aftermath of trauma, and propose that shared remembering techniques may provide a useful addition to the treatment of post-traumatic stress disorder.

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

PMID: 18324553 [PubMed - indexed for MEDLINE]


Ment Health Today. 2008 Apr:20.

Efforts to deliver 'trauma therapy' in third world countries.

Fernando S.

European Centre for Study of Migration and Social Care, University of Kent.

PMID: 18446940 [PubMed - indexed for MEDLINE]


Mol Psychiatry. 2008 Apr;13(4):374-84. Epub 2008 Jan 8.

Trends in mental illness and suicidality after Hurricane Katrina.

Kessler RC, Galea S, Gruber MJ, Sampson NA, Ursano RJ, Wessely S.

Department of Healthcare Policy, Harvard Medical School, Boston, MA 02115, USA.

A representative sample of 815 pre-hurricane residents of the areas affected by Hurricane Katrina was interviewed 5-8 months after the hurricane and again 1 year later as the Hurricane Katrina Community Advisory Group (CAG). The follow-up survey was carried out to study patterns-correlates of recovery from hurricane-related post-traumatic stress disorder (PTSD), broader anxiety-mood disorders and suicidality. The Trauma Screening Questionnaire screening scale of  PTSD and the K6 screening scale of anxiety-mood disorders were used to generate DSM-IV prevalence estimates. Contrary to results in other disaster studies, where post-disaster mental disorder typically decreases with time, prevalence increased significantly in the CAG for PTSD (20.9 vs 14.9% at baseline), serious mental illness (SMI; 14.0 vs 10.9%), suicidal ideation (6.4 vs 2.8%) and suicide plans (2.5 vs 1.0%). The increases in PTSD-SMI were confined to respondents not from the New Orleans Metropolitan Area, while the increases in suicidal ideation-plans occurred both in the New Orleans sub-sample and in the remainder of the sample. Unresolved hurricane-related stresses accounted for large proportions of the inter-temporal increases in SMI (89.2%), PTSD (31.9%) and suicidality (61.6%). Differential hurricane-related stress did not explain the significantly higher increases among respondents from areas other than New Orleans, though, as this stress was both higher initially and decreased less among respondents from the New Orleans Metropolitan Area than from other areas affected by the hurricane. Outcomes were only weakly related to socio-demographic variables, meaning that high prevalence of hurricane-related mental illness remains widely distributed in the population nearly 2 years after the hurricane.

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

PMID: 18180768 [PubMed - indexed for MEDLINE]


Neuropsychologia. 2008 Apr;46(5):1522-31. Epub 2008 Jan 19.

An fMRI investigation of memory encoding in PTSD: influence of symptom severity.

Dickie EW, Brunet A, Akerib V, Armony JL.

Douglas Mental Health University Institute, Canada.

Previous studies have shown memory deficits in Post-Traumatic Stress Disorder (PTSD) patients, as well as abnormal patterns of brain activity, especially when  retrieving trauma-related information. This study extended previous findings by investigating the neural correlates of successful memory encoding of trauma-unrelated stimuli and their relationship with PTSD symptom severity. We used the subsequent memory paradigm, in the context of event-related functional magnetic resonance imaging, in 27 PTSD patients to identify the brain regions involved in the encoding of fearful and neutral faces. Symptom severity was assessed by the Clinically Administered PTSD Scale (CAPS) scores. It was found that memory performance was negatively correlated with CAPS scores. Furthermore,  a negative correlation was observed between CAPS scores and ventral medial prefrontal cortex (vmPFC) activity elicited by the subsequently forgotten faces.  Finally, symptom severity predicted the contribution of the amygdala to the successful encoding of fearful faces. These results confirm the roles of the vmPFC and the amygdala in PTSD and highlight the importance of taking into account individual differences when assessing the behavioural and neural correlates of the disorder.

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

PMID: 18321537 [PubMed - indexed for MEDLINE]


Nurs Womens Health. 2008 Apr;12(2):106-13.

Sexual violence and the silent reaction rape: implications for nurses.

Padden ML.

Cumberland County College, Vineland, NJ, USA.

Publication Types:      Review

PMID: 18377571 [PubMed - indexed for MEDLINE]


PLoS Med. 2008 Apr 1;5(4):e61.

Comment in:     PLoS Med. 2008 Apr 1;5(4):e82.

Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war.

Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN, Nasser SC, Chatterji S, Kessler RC.

Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon.

BACKGROUND: There are no published data on national lifetime prevalence and treatment of mental disorders in the Arab region. Furthermore, the effect of war  on first onset of disorders has not been addressed previously on a national level, especially in the Arab region. Thus, the current study aims at investigating the lifetime prevalence, treatment, age of onset of mental disorders, and their relationship to war in Lebanon. METHODS AND FINDINGS: The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation study was carried out on a nationally representative sample of the Lebanese population (n = 2,857 adults). Respondents were interviewed using the fully structured WHO Composite International Diagnostic Interview 3.0. Lifetime prevalence of any Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) disorder was 25.8%. Anxiety (16.7%) and mood (12.6%) were more common than impulse control (4.4%) and substance (2.2%) disorders. Only a minority of people  with any mental disorder ever received professional treatment, with substantial delays (6 to 28 y) between the onset of disorders and onset of treatment. War exposure increased the risk of first onset of anxiety (odds ratio [OR] 5.92, 95%  confidence interval [CI] 2.5-14.1), mood (OR 3.32, 95% CI 2.0-5.6), and impulse control disorders (OR 12.72, 95% CI 4.5-35.7). CONCLUSIONS: About one-fourth of the sample (25.8%) met criteria for at least one of the DSM-IV disorders at some  point in their lives. There is a substantial unmet need for early identification  and treatment. Exposure to war events increases the odds of first onset of mental disorders.

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

PMID: 18384228 [PubMed - indexed for MEDLINE]


Psychiatry. 2008 Spring;71(1):59-70.

The beneficial effect on family life in treating borderline personality.

Gerull F, Meares R, Stevenson J, Korner A, Newman L.

Westmead Psychotherapy Research Program, University of Sydney, Westmead Hospital, Westmead, NSW, Australia.

The harmful effect of borderline patients on their families is an important but relatively neglected aspect of outcome studies. This study concerns changes in perceived quality of relationships with partners and children of 24 patients suffering Borderline Personality Disorder (BPD) after 12 months of treatment with the Conversational Model (CM). They were compared to 21 parents with BPD receiving "Treatment as Usual" (TAU) from their referring clinicians for the same period. Both groups developed naturalistically giving the study a quasi-experimental design. The Social Adjustment Scale (SAS-SR) was administered  on intake and again after 12 months. The subscales dealing with relationships with children, with partners and with the family unit were scored and compared between groups. It was found that the perceived relationships with children and partners improved significantly for the CM group but not for the TAU group.

PMID: 18377206 [PubMed - indexed for MEDLINE]


Psychiatry. 2008 Spring;71(1):35-45.

Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm.

North CS, Hong BA, Suris A, Spitznagel EL.

University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX 75390-8828, USA.

Disaster mental health research has historically focused on assessment of psychopathology, using measures of psychiatric symptoms and disorders. The Oakland/Berkeley firestorm provided an opportunity to explore resilience among highly exposed survivors through consideration of psychiatric variables in the context of personality. The Diagnostic Interview Schedule/Disaster Supplement was administered to 62 firestorm survivors at approximately 4, 16, and 39 months and  the Temperament and Character Inventory administered at 16 months postdisaster. Few individuals had postdisaster psychopathology (16% with any diagnosis, 5%with  PTSD). There was considerable evidence of distress, however, indicated by an abundance of reported posttraumatic symptoms, functional impairments, and endorsement of emotional upset, all of which decreased substantially over time. Group C (avoidance/numbing) posttraumatic symptoms were relatively uncommon and were specifically associated with elevated Self-Transcendence. Groups B (intrusion) and D (hyperarousal) symptoms were prevalent and were associated with high Harm Avoidance and low Self-Directedness. The generally healthy personality  profiles of these firestorm survivors reflected their psychological resilience. Examination of symptoms and distress in the context of psychiatric disorders after this disaster demonstrated that symptomatic distress is not inconsistent with psychological resilience. The choice of research focus and methods can provide very different portraits of outcomes post-disaster.

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

PMID: 18377204 [PubMed - indexed for MEDLINE]


Psychiatry. 2008 Spring;71(1):13-34.

Contributions of psychodynamic approaches to treatment of PTSD and trauma: a review of the empirical treatment and psychopathology literature.

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

The Catholic University of America, Washington, DC, USA.

Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may  result in improved self-esteem, increased ability to resolve reactions to trauma  through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of  more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

Publication Types:      Review

PMID: 18377203 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):563-73.

The latent structure of post-traumatic stress disorder: tests of invariance by gender and trauma type.

Chung H, Breslau N.

Department of Epidemiology, Michigan State University, East Lansing, MI 48823, USA.

BACKGROUND: Measurement invariance of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) criterion symptoms was tested by gender and trauma type, assaultive and non-assaultive. METHOD: Analysis was conducted using latent class analysis (LCA), based on findings that the three-class LCA model from Breslau et al. (Archives of General  Psychiatry 2005, 62, 1343-1351) fits the data across the four groups best. The classes represent three levels of PTSD-related disturbance: no disturbance, intermediate disturbance and pervasive disturbance, with the last one approximating the DSM-IV PTSD diagnosis. RESULTS: Analysis of measurement invariance showed that, with respect to gender, there was no evidence of differential symptom reporting within the same disturbance class. DSM-IV symptom  indicators represent the latent structure of PTSD equally in males and females. We found that more female than male victims of assaultive violence experienced pervasive disturbance. In the absence of measurement variability associated with  gender, the finding is likely to reflect a gender difference in susceptibility. The analysis of measurement invariance detected evidence of variability associated with trauma type. Victims of assaultive violence in the pervasive disturbance class report more severe distress (especially emotional numbing) than do victims of non-assaultive violence in the same class. CONCLUSIONS: The finding of measurement bias associated with type of trauma raises questions about the applicability of a single definition for PTSD associated with assaultive violence and PTSD associated with traumatic events of lesser magnitude.

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

PMID: 18325132 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):511-22. Epub 2008 Jan 29.

Risk factors for post-traumatic stress disorder among UK Armed Forces personnel.

Iversen AC, Fear NT, Ehlers A, Hacker Hughes J, Hull L, Earnshaw M, Greenberg N,  Rona R, Wessely S, Hotopf M.

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

BACKGROUND: There is considerable interest in understanding further the factors that increase the risk of post-traumatic stress disorder (PTSD) for military personnel. This study aimed to investigate the relative contribution of demographic variables; childhood adversity; the nature of exposure to traumatic events during deployment; appraisal of these experiences; and home-coming experiences in relation to the prevalence of PTSD 'caseness' as measured by a score of 50 on the PTSD Checklist (PCL) in UK Armed Forces personnel who have been deployed in Iraq since 2003.METHOD: Data were drawn from the first stage of  a retrospective cohort study comparing UK military personnel who were deployed to the 2003 Iraq War with personnel serving in the UK Armed Forces on 31 March 2003  but who were not deployed to the initial phase of war fighting. Participants were randomly selected and invited to participate. The response rate was 61%. We have  limited these analyses to 4762 regular service individuals who responded to the survey and who have been deployed in Iraq since 2003. RESULTS: Post-traumatic stress symptoms were associated with lower rank, being unmarried, having low educational attainment and a history of childhood adversity. Exposure to potentially traumatizing events, in particular being deployed to a 'forward' area in close contact with the enemy, was associated with post-traumatic stress symptoms. Appraisals of the experience as involving threat to one's own life and  a perception that work in theatre was above an individual's trade and experience  were strongly associated with post-traumatic stress symptoms. Low morale and poor social support within the unit and non-receipt of a home-coming brief (psycho-education) were associated with greater risk of post-traumatic stress symptoms. CONCLUSIONS: Personal appraisal of threat to life during the trauma emerged as the most important predictor of post-traumatic stress symptoms. These  results also raise the possibility that there are important modifiable occupational factors such as unit morale, leadership, preparing combatants for their role in theatre which may influence an individual's risk of post-traumatic  stress symptoms. Therefore interventions focused on systematic preparation of personnel for the extreme stress of combat may help to lessen the psychological impact of deployment.

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

PMID: 18226287 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):481-8. Epub 2007 Nov 30.

The mental health of clean-up workers 18 years after the Chernobyl accident.

Loganovsky K, Havenaar JM, Tintle NL, Guey LT, Kotov R, Bromet EJ.

Research Center for Radiation Medicine, Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.

BACKGROUND: The psychological aftermath of the Chernobyl accident is regarded as  the largest public health problem unleashed by the accident to date. Yet the mental health of the clean-up workers, who faced the greatest radiation exposure  and threat to life, has not been systematically evaluated. This study describes the long-term psychological effects of Chernobyl in a sample of clean-up workers  in Ukraine.METHOD: The cohorts were 295 male clean-up workers sent to Chernobyl between 1986 and 1990 interviewed 18 years after the accident (71% participation  rate) and 397 geographically matched controls interviewed as part of the Ukraine  World Mental Health (WMS) Survey 16 years after the accident. The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was administered. We examined group differences in common psychiatric disorders, suicide ideation and severe headaches, differential effects of disorder on days lost from work, and in the clean-up workers, the relationship of exposure severity to disorder and current trauma and somatic symptoms. Analyses were adjusted for age in 1986 and mental health prior to the accident. RESULTS: Relatively more clean-up workers than controls experienced depression (18.0% v. 13.1%) and suicide ideation (9.2% v. 4.1%) after the accident. In the year preceding interview, the rates of depression (14.9% v. 7.1%), post-traumatic stress disorder (PTSD) (4.1% v. 1.0%) and headaches (69.2% v. 12.4%) were elevated. Affected workers lost more work days than affected controls. Exposure level was associated with current somatic and PTSD symptom severity. CONCLUSIONS: Long-term mental health consequences of Chernobyl were observed in clean-up workers.

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

PMID: 18047772 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):555-61. Epub 2007 Nov 16.

Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder.

Bryant RA, Felmingham K, Kemp A, Das P, Hughes G, Peduto A, Williams L.

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

BACKGROUND: Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not  respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD.METHOD: Functional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n=14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion. RESULTS: Seven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces. CONCLUSIONS: Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.

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

PMID: 18005496 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):523-31. Epub 2007 Oct 1.

Olfactory identification dysfunction, aggression and impulsivity in war veterans  with post-traumatic stress disorder.

Dileo JF, Brewer WJ, Hopwood M, Anderson V, Creamer M.

Department of Psychology, University of Melbourne, Australia.

BACKGROUND: Due to neuropsychological conceptualizations of orbitoprefrontal cortex (OFC) dysfunction underpinning impulsive aggression and the incidence of such behaviour in post-traumatic stress disorder (PTSD), this study aimed to explore olfactory identification (OI) ability in war veterans with PTSD as a probe of putative OFC dysfunction; and to explore the utility of OI ability in predicting aggressive and impulsive behavior in this clinical population.METHOD:  Participants comprised 31 out-patient male war veterans with PTSD (mean=58.23 years, s.d.=2.56) recruited from a Melbourne Veterans Psychiatry Unit, and 31 healthy age- and gender-matched controls (mean=56.84 years, s.d.=7.24). All participants were assessed on clinical measures of PTSD, depression, anxiety, and alcohol misuse; olfactory identification; neurocognitive measures of dorsolateral prefrontal, lateral prefrontal and mesial temporal functioning; and self-report measures of aggression and impulsivity. RESULTS: War veterans with PTSD exhibited significant OI deficits (OIDs) compared to controls, despite uncompromised performance on cognitive measures. OIDs remained after covaring for IQ, anxiety,  depression and alcohol misuse, and were significant predictors of aggression and  impulsivity. CONCLUSIONS: This research contributes to emerging evidence of orbitoprefrontal dysfunction in the pathophysiology underlying PTSD. This is the  first study to report OIDs as a predictor of aggression and impulsivity in this clinical population. It prompts further exploration of the potential diagnostic utility of OIDs in the assessment of PTSD. Such measures may help delineate the clinical complexity of PTSD, and support more targeted interventions for individuals with a greater susceptibility to aggressive and impulsive behaviors.

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

PMID: 17903334 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):499-510. Epub 2007 Sep 25.

Risk factors for physical symptoms after a disaster: a longitudinal study.

van den Berg B, Grievink L, van der Velden PG, Yzermans CJ, Stellato RK, Lebret E, Brunekreef B.

Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.

BACKGROUND: Although symptoms such as fatigue, headache and pain in bones and muscles are common after disasters, risk factors for these symptoms among disaster survivors have rarely been studied. We examined predisposing, precipitating and perpetuating factors for these physical symptoms among survivors of a man-made disaster. In addition, we examined whether risk factors for physical symptoms differ between survivors and controls.METHOD: Survivors completed a questionnaire 3 weeks (n=1567), 18 months and 4 years after the disaster. Symptoms and risk factors were measured using validated questionnaires. A comparison group was included at waves 2 and 3 (n=821). Random coefficient analysis (RCA) was used to study risk factors for symptoms. RESULTS: Female gender [beta (beta)=1.0, 95% confidence interval (CI) 0.6-1.4], immigrant status  (beta=1.0, 95% CI 0.6-1.4) and pre-disaster psychological problems (beta=0.8, 95% CI 0.1-1.4) were predisposing factors for symptoms. Although disaster-related factors were predictors, the relationship between symptoms and disaster-related factors was not very strong and the magnitude of this association was reduced when perpetuating factors were added. Intrusions and avoidance, depression, anxiety and sleeping problems were important perpetuating factors for physical symptoms among survivors and mediated the association between traumatic stress and physical symptoms. Risk factors for symptoms were comparable between survivors and controls. CONCLUSIONS: The results indicate that health-care workers should be alert for physical symptoms among female survivors, immigrant survivors and individuals with a high level of psychological problems both before and after a disaster.

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

PMID: 17892620 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):533-42. Epub 2007 Sep 10.

Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder.

Norman SB, Stein MB, Dimsdale JE, Hoyt DB.

Department of Psychiatry, University of California, San Diego, CA 92103, USA.

BACKGROUND: Identifying risk factors for the development of post-traumatic stress disorder (PTSD) is important for understanding and ultimately preventing the disorder. This study assessed pain shortly after traumatic injury (i.e. peritraumatic pain) as a risk factor for PTSD.METHOD: Participants (n=115) were patients admitted to a Level 1 Surgical Trauma Center. Admission to this service  reflected a severe physical injury requiring specialized, emergent trauma care. Participants completed a pain questionnaire within 48 h of traumatic injury and a PTSD diagnostic module 4 and 8 months later. RESULTS: Peritraumatic pain was associated with an increased risk of PTSD, even after controlling for a number of other significant risk factors other than acute stress disorder symptoms. An increase of 0.5 s.d. from the mean in a 0-10 pain rating scale 24-48 h after injury was associated with an increased odds of PTSD at 4 months by more than fivefold, and at 8 months by almost sevenfold. A single item regarding amount of  pain at the time of hospital admission correctly classified 65% of participants.  CONCLUSIONS: If these findings are replicated in other samples, high levels of peritraumatic pain could be used to identify individuals at elevated risk for PTSD following traumatic injury.

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

PMID: 17825121 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):467-80. Epub 2007 Sep 6.

Post-traumatic stress disorder following disasters: a systematic review.

Neria Y, Nandi A, Galea S.

Department of Epidemiology, Mailman School of Public Health, Columbia University  Medical Center, New York, NY 10032, USA.

BACKGROUND: Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure  to disasters.MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. RESULTS: We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). CONCLUSIONS: The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to  disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in  this field are discussed.

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

PMID: 17803838 [PubMed - indexed for MEDLINE]


Psychol Med. 2008 Apr;38(4):543-54. Epub 2007 Sep 6.

Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial.

Lindauer RJ, Booij J, Habraken JB, van Meijel EP, Uylings HB, Olff M, Carlier IV, den Heeten GJ, van Eck-Smit BL, Gersons BP.

Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.

BACKGROUND: Functional brain-imaging studies in post-traumatic stress disorder (PTSD) have suggested functional alterations in temporal and prefrontal cortical  regions. Effects of psychotherapy on these brain regions have not yet been examined.METHOD: Twenty civilian PTSD out-patients and 15 traumatized control subjects were assessed at baseline using psychometric ratings. Cerebral blood flow was measured using trauma script-driven imagery during 99mtechnetium hexamethyl-propylene-amine-oxime single-photon emission computed tomography scanning. All 20 out-patients were randomly assigned to treatment or wait-list conditions. Treatment was brief eclectic psychotherapy (BEP) in 16 weekly individual sessions. RESULTS: At baseline, greater activation was found in the right insula and right superior/middle frontal gyrus in the PTSD group than in the control group. PTSD patients treated with BEP significantly improved on all PTSD symptom clusters compared to those on the waiting list. After effective psychotherapy, lower activation was measured in the right middle frontal gyrus, compared to the PTSD patients on the waiting list. Treatment effects on PTSD symptoms correlated positively with activation in the left superior temporal gyrus, and superior/middle frontal gyrus. CONCLUSIONS: BEP induced clinical recovery in PTSD patients, and appeared to modulate the functioning of specific PTSD-related sites in the prefrontal cortical regions.

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

PMID: 17803835 [PubMed - indexed for MEDLINE]


Psychol Rep. 2008 Apr;102(2):614-5.

Possible role of posttraumatic stress disorder in suicide terrorists: an hypothesis.

Lester D.

Psychology Program, The Richard Stockton College of New Jersey, Jimmie Leeds Road, Pomona, NJ 08240-0195, USA.

Recent reports by journalists of suicidal terrorists suggest that exposure to recent violence in traumatic situations, combined with childhood exposure to violence, may lead to posttraumatic stress disorder, which in turn may result in  suicidal violence.

Publication Types:      Case Reports

PMID: 18567233 [PubMed - indexed for MEDLINE]


Psychoneuroendocrinology. 2008 Apr;33(3):313-20. Epub 2008 Jan 22.

Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder.

de Kloet C, Vermetten E, Lentjes E, Geuze E, van Pelt J, Manuel R, Heijnen C, Westenberg H.

Department of Military Psychiatry, Central Military Hospital, Utrecht, The Netherlands.

BACKGROUND: Neuroendocrine studies have shown profound alterations in HPA-axis regulation in posttraumatic stress disorder (PTSD). Based on baseline assessments and the response to dexamethasone, a hypothalamic overdrive with enhanced glucocorticoid feedback inhibition has been suggested. The dexamethasone-corticotrophin releasing hormone (DEX-CRH) test has shown to be a more sensitive test to assess HPA-axis dysregulation in major depression and therefore may provide a useful test tool to probe HPA-axis regulation in PTSD. METHODS: To evaluate the effect of PTSD on HPA-axis regulation, we compared the response to a DEX-CRH test between male veterans with PTSD (n=26) and male veterans, who had been exposed to similar traumatic events during their deployment, without PTSD (n=23). Patients and controls were matched on age, year  and region of deployment. Additionally, we compared the response of PTSD patients with (n=13) and without co-morbid major depressive disorder (MDD) (n=13). RESULTS: No significant differences were observed in ACTH and cortisol response to the DEX-CRH test between patients and controls. PTSD patients with co-morbid MDD showed a significantly lower ACTH response compared to patients without co-morbid MDD. The response to the DEX-CRH test did not correlate with PTSD or depressive symptoms. CONCLUSION: The DEX-CRH test did not reveal HPA-axis abnormalities in PTSD patients as compared to trauma controls. PTSD patients with a co-morbid MDD showed an attenuated ACTH response compared to PTSD patients without co-morbid MDD, suggesting the presence of subgroups with different HPA-axis regulation within the PTSD group. Altered sensitivity of the CRH receptors at the pituitary or differences in AVP secretion might explain these differences in response.

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

PMID: 18215470 [PubMed - indexed for MEDLINE]


Psychoneuroendocrinology. 2008 Apr;33(3):282-91. Epub 2007 Dec 31.

Acoustic startle amplitude predicts vulnerability to develop post-traumatic stress hyper-responsivity and associated plasma corticosterone changes in rats.

Rasmussen DD, Crites NJ, Burke BL.

VA Puget Sound Health Care System, Mental Illness Research, Education and Clinical Center, Seattle, WA 98108, USA.

Following exposure to trauma, a vulnerable sub-population of individuals develops post-traumatic stress disorder (PTSD) with characteristic persistent autonomic hyper-responsivity, associated increased startle response, and commonly altered hypothalamo-pituitary-adrenal regulation. A goal of this investigation was to identify a predictive marker for this vulnerability. Previous investigators have  developed a model for PTSD in which male mice were exposed to a single brief episode of inescapable footshock followed by 1-min contextual reminders of this trauma at weekly intervals for 6 weeks. Exposure to these reminders induced a progressive and persistent increase in the amplitude of acoustic startle consistent with the persistently increased acoustic startle of individuals exhibiting PTSD. We adapted this model to adult male Wistar rats, with added characterization of initial (pre-trauma) startle response. After one episode of inescapable footshock (10 s, 2 mA) or control treatment followed by six weekly 1-min contextual reminders, acoustic startle was re-tested. Data were analyzed after dividing rats within each treatment into LOW vs MID vs HIGH (33% in each group) pre-treatment startle responders. Rats which exhibited pre-treatment LOW-  and MID-range acoustic startle responses did not develop increased acoustic startle responses following subsequent traumatic stress+reminders ([TS+R]) treatment. However, rats which exhibited HIGH pre-treatment startle responses exhibited further significant (p<0.01) [TS+R]-induced persistent enhancement of this already elevated startle response. Furthermore, rats exhibiting HIGH pre-treatment startle responses were also the only subgroup which exhibited increased basal plasma corticosterone levels following [TS+R] treatment. These results suggest that initial pre-stress acoustic startle response can identify subgroups of rats which are predisposed to, or resistant to, developing a PTSD-like syndrome following subsequent trauma.

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

PMID: 18164825 [PubMed - indexed for MEDLINE]


Psychooncology. 2008 Apr;17(4):329-37.

Psychological distress in long-term survivors of hematopoietic stem cell transplantation.

Rusiewicz A, DuHamel KN, Burkhalter J, Ostroff J, Winkel G, Scigliano E, Papadopoulos E, Moskowitz C, Redd W.

Program for Cancer Prevention and Control, Derald H. Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.

The prevalence of psychological distress is higher in cancers with poorer prognoses and speculated as higher in those receiving more aversive treatments. Since hematopoietic stem cell transplant (HSCT) is one of the most taxing cancer  treatments to endure and is therefore likely to have more long-term sequelae, this study examined psychological distress symptoms in long-term HSCT survivors who were at least 1 year post-transplant. Participants in this cross-sectional study were recruited from urban medical centers as part of a larger study of HSCT survivors. The sample comprised 236 adults who were on average 3.4 years since transplant. Psychological distress was measured by a commonly used self-report questionnaire, the Brief Symptom Inventory.Clinically elevated psychological distress caseness was present in 43% of long-term HSCT survivors. Elevations were highest on clinical subscales of obsessive-compulsiveness, somatization, and psychoticism. However, item-level analyses revealed that the content of the most  frequently reported symptoms included trouble with memory and feelings of loneliness. Results of this study suggest that HSCT survivors may experience memory and existential concerns and that such symptoms may not represent psychiatric sequelae. Copyright 2007 John Wiley & Sons, Ltd.

PMID: 17621377 [PubMed - indexed for MEDLINE]


Psychosom Med. 2008 Apr;70(3):378-83. Epub 2008 Feb 6.

Suicide attempts in anorexia nervosa.

Bulik CM, Thornton L, Pinheiro AP, Plotnicov K, Klump KL, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Mitchell J, Nutzinger D, Strober M, Treasure J, Woodside DB, Berrettini WH, Kaye WH.

Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160, USA.

OBJECTIVE: To explore prevalence and patterns of suicidal attempts in persons with anorexia nervosa (AN). METHODS: Participants were the first 432 persons (22  male, 410 female) enrolled in the NIH funded Genetics of Anorexia Nervosa Collaborative Study. All participants had current or lifetime AN. The participants ranged in age from 16 to 76 (mean = 30.4, SD = 11.3). Suicidal behavior and intent was assessed via the Diagnostic Interview for Genetic Studies. We compared frequency and severity of attempts across diagnostic subtypes and comorbidity, and personality features associated with the presence of suicide attempts in persons with AN. RESULTS: About 16.9% of those with AN attempted suicide. Significantly fewer persons with the restricting subtype (7.4%) reported at least one attempt than those with purging AN (26.1%), AN with  binge eating (29.3%), and a mixed picture of AN and bulimia nervosa (21.2%). After controlling for major depression, suicide attempts were associated with substance abuse, impulsive behaviors and traits, Cluster B personality disorders, panic disorder, and post-traumatic stress disorder as well as low self-directedness and eating disorder severity. CONCLUSIONS: Suicide attempts in  AN are not uncommon, are frequently associated with the intention to die, occur less frequently in persons with the restricting subtype of the illness, and after controlling for depression are associated with a constellation of behaviors and traits associated with behavioral and affective dyscontrol.

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

PMID: 18256339 [PubMed - indexed for MEDLINE]


QJM. 2008 Apr;101(4):251-9. Epub 2008 Feb 16.

Why traumatic leg amputees are at increased risk for cardiovascular diseases.

Naschitz JE, Lenger R.

Department of Internal Medicine A, The Flieman Hospital and Rappaport Family Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

BACKGROUND: Post-traumatic lower limb amputees have an increased morbidity and mortality from cardiovascular disease. Risk factors for this amplified morbidity  and the involved pathophysiologic mechanisms have not been comprehensively studied. METHODS: The MEDLINE database was reviewed, with case-controlled studies and nested in cohort studies eligible for inclusion in this analysis. RESULTS: Insulin resistance, psychological stress and patients' deviant behaviors are prevalent in traumatic lower limb amputees. Each of these factors may have systemic consequences on the arterial system and may contribute to the increased  cardiovascular morbidity in traumatic amputees. Abnormalities of arterial flow proximal to the amputation site may hold the explanation for the linkage between  the extent of leg amputation and the magnitude of the cardiovascular risk: proximal leg amputation is associated with greater risk than distal amputation and bilateral amputation with greater risk than unilateral amputation. This review focuses on hemodynamic culprits (shear stress, circumferential strain, reflected waves), hemodynamic consequences in proximity to the occluded femoral artery and hemodynamic consequences at a distance. CONCLUSION: Coronary risk in lower limb amputees may be substantially greater than predicted by available algorithms, given that neither hemodynamic nor psychological factors concern the  current prediction models. It seems reasonable to take early prophylactic measures in lower limb amputees by discouraging smoking, excessive alcohol consumption and adherence to a low fat diet. Studies are needed to evaluate the optimal intensity of physical exercise effects on reflected pulse waves and their possible long-term consequences. Guidelines for optimal blood pressure, blood glucose and lipid control in amputees need to be convened.

Publication Types:      Review

PMID: 18281705 [PubMed - indexed for MEDLINE]


Seizure. 2008 Apr;17(3):247-53. Epub 2007 Aug 16.

Psychiatric diagnoses of patients with psychogenic non-epileptic seizures.

Marchetti RL, Kurcgant D, Neto JG, von Bismark MA, Marchetti LB, Fiore LA.

Projeto de Epilepsia e Psiquiatria, Instituto e Departamento de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São  Paulo, SP, Brazil.

OBJECTIVE: Our purpose was to present and discuss the psychiatric diagnoses of patients who presented psychogenic non-epileptic seizures (PNES) during video-electroencephalographic monitoring (VEEG). METHODS: Out of 98 patients, a total of 28 patients presented PNES during the diagnostic procedure. In those cases in which the PNES that occurred during VEEG were validated by clinical history (clinical validation), and by showing the recorded event on video to an observer close to the patient (observer validation), was defined psychogenic non-epileptic seizure disorder (PNESD). Psychiatric diagnoses were made according to DSM-IV. RESULTS: In 27, psychogenic non-epileptic seizures disorder was diagnosed. Fourteen patients presented only with psychogenic non-epileptic seizure disorder, 13 with both psychogenic non-epileptic seizures disorder and epilepsy, and one patient with epilepsy only. Psychiatric diagnoses were: 17 (63%) patients with conversion disorder, five (19%) with somatization disorder, two (7%) with dissociative disorder NOS, two (7%) with post-traumatic stress disorder and one (4%) with undifferentiated somatoform disorder. CONCLUSIONS: Dissociative-conversion non-epileptic seizures are the most frequent finding, representing the pseudoneurological manifestation of mental disorders that have these symptoms as a common feature. Provisionally, they may be defined as dissociative-conversion non-epileptic seizure disorders.

PMID: 17702610 [PubMed - indexed for MEDLINE]


Sleep. 2008 Apr 1;31(4):497-503.

Long-term effect of cued fear conditioning on REM sleep microarchitecture in rats.

Madan V, Brennan FX, Mann GL, Horbal AA, Dunn GA, Ross RJ, Morrison AR.

Laboratory for Study of the Brain in Sleep, Department of Animal Biology, School  of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6045, USA.

STUDY OBJECTIVES: To study long-term effects of conditioned fear on REM sleep (REMS) parameters in albino rats. DESIGN: We have investigated disturbances in sleep architecture, including muscle twitch density as REMS phasic activity, and  freezing behavior in wakefulness, upon reexposure to a conditioned stimulus (CS)  on Day 1 and Day 14 postconditioning. SUBJECTS: Male Sprague-Dawley rats prepared for polysomnographic recordings. INTERVENTIONS: After baseline sleep recording, the animals in the experimental group received five pairings of a 5-sec tone, co-terminating with a 1-sec, 1 mAfootshock. The control rats received similar numbers of tones and shocks, but explicitly unpaired. On postconditioning days, after reexposure to tones alone, sleep and freezing behavior were recorded. MEASUREMENTS AND RESULTS: Conditioned fear significantly altered REMS microarchitecture (characterized as sequential-REMS [seq-REMS: < or =3 min episode separation] and single-REMS [sin-REMS: >3 min episode separation]) on Day 14. The total amount and number of seq-REMS episodes decreased, while the total amount and number of sin-REMS episodes increased. Further, the CS induced significant increases in freezing and REMS myoclonic twitch density in the experimental group. Reexposure to the CS produced no alterations in controls. CONCLUSIONS: The results suggest that conditioned fear causes REMS alterations, including difficulty in initiating a REMS episode as indicated by the diminution  in the number of seq-REMS episodes. Another finding, the increase in phasic activity, agrees with the inference from clinical investigations that retrieval of fearful memories can be associated with the long-term REMS disturbances characteristic of posttraumatic stress disorder.

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

PMID: 18457237 [PubMed - indexed for MEDLINE]


Soc Sci Med. 2008 Apr;66(8):1841-7. Epub 2008 Feb 14.

Mental health of female survivors of human trafficking in Nepal.

Tsutsumi A, Izutsu T, Poudyal AK, Kato S, Marui E.

Juntendo University, School of Medicine, Department of Public Health, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

Little is known about the mental health status of trafficked women, even though international conventions require that it be considered. This study, therefore, aims at exploring the mental health status, including anxiety, depression and post-traumatic stress disorder (PTSD), of female survivors of human trafficking who are currently supported by local non-governmental organizations (NGOs) in Katmandu, the capital of Nepal, through comparison between those who were forced  to work as sex workers and those who worked in other areas such as domestic and circus work (non-sex workers group). The Hopkins Symptoms Checklist-25 (HSCL-25)  was administered to assess anxiety and depression, and the PTSD Checklist Civilian Version (PCL-C) was used to evaluate PTSD. Both the sex workers' and the non-sex workers' groups had a high proportion of cases with anxiety, depression,  and PTSD. The sex workers group tended to have more anxiety symptoms (97.7%) than the non-sex workers group (87.5%). Regarding depression, all the constituents of  the sex workers group scored over the cut-off point (100%), and the group showed  a significantly higher prevalence than the non-sex workers (80.8%). The proportion of those who are above the cut-off for PTSD was higher in the sex workers group (29.6%) than in the non-sex workers group (7.5%). There was a higher rate of HIV infection in the sex workers group (29.6%) than in the non-sex workers group (0%). The findings suggest that programs to address human trafficking should include interventions (such as psychosocial support) to improve survivors' mental health status, paying attention to the category of work performed during the trafficking period. In particular, the current efforts of the United Nations and various NGOs that help survivors of human trafficking need to more explicitly focus on mental health and psychosocial support.

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

PMID: 18276050 [PubMed - indexed for MEDLINE]


Support Care Cancer. 2008 Apr;16(4):407-14. Epub 2007 Aug 21.

Breast cancer and psychological distress: mothers' and daughters' traumatic experiences.

Baider L, Goldzweig G, Ever-Hadani P, Peretz T.

Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem 91120, Israel.

GOAL OF WORK: The objective of this exploratory retrospective study was to assess the effects of breast cancer diagnosis upon the psychological distress of adult breast cancer patients and their mothers, particularly mothers who experienced past trauma. MATERIALS AND METHODS: Four groups of mother-daughter dyads were evaluated using self-reporting measures of psychological distress [Brief Symptom  Inventory (BSI)], familial support (PFS), and adjustment to cancer (MAC, IES): breast cancer patients whose mothers were Holocaust survivors (group 1), breast cancer patients with non-traumatized mothers (group 2), healthy daughters of Holocaust survivor mothers (group 3), and a control group of healthy daughters with non-traumatized mothers (group 4). MAIN RESULTS: Distress levels of both mothers and daughters in group 1 were significantly higher than distress levels of mothers and daughters in the other three groups. Daughters' distress levels in all four groups were found to be significantly related to mothers' distress levels, with the highest correlation found in both groups of cancer patients. The factors of having a clinically distressed mother and being a second-generation daughter contributed the most to predicting the clinical distress of the daughter. CONCLUSIONS: The outcomes imply that the mother's traumatic past intensifies the distressing effect of cancer diagnosis upon both the patient and  her mother. The findings concerning the impact of cancer diagnosis upon the patients' non-traumatized mothers were more ambiguous. The results support the idea that in the case of breast cancer patients, a complete psychological evaluation must include not only spouses and children but also the familial background of the patient and the history of the patients' mothers.

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

PMID: 17710444 [PubMed - indexed for MEDLINE]


Trauma Violence Abuse. 2008 Apr;9(2):100-13.

Cognitive-behavioral theory and preparation for professionals at risk for trauma  exposure.

Whealin JM, Ruzek JI, Southwick S.

National Center for Posttraumatic Stress Disorder.

Military personnel, emergency first responders, and others whose work environments include exposure to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). To help prevent negative sequelae, there is a strong need to identify well-operationalized, empirically supported, theoretically framed models of healthy adaptation to potentially traumatic events. Cognitive-behavioral theories (CBTs) describe etiological factors in trauma, guide research that has identified risk for PTSD, and help develop interventions that can effectively reduce posttrauma symptomatology. In this article, the authors draw on CBT and empirical research on post-traumatic stress  to propose possible cognitive-behavioral mechanisms in trauma adaptation. They then suggest directions for future research, including areas for prevention interventions for at-risk professionals.

Publication Types:      Review

PMID: 18367753 [PubMed - indexed for MEDLINE]


Turk Psikiyatri Derg. 2008 Spring;19(1):94-100.

[Suggestion of a new diagnostic category: posttraumatic embitterment disorder]

[Article in Turkish]

Hasanoğlu A.

Basel U Tip Fak., Psikiyatri AD, Basel.

Psychological reactions to negative life events have been among the most interesting subjects to researchers for a long time. In recent years post traumatic stress disorder (PTSD), in particular, has been the focus of numerous studies. This disorder is defined as a reaction to an event that is accepted as traumatic by almost everyone, to an extraordinary life-threatening event, or to a disaster. Psychological reaction to events, which are not directly life threatening, is classified as adjustment disorder and is rarely diagnosed in clinical practice. As a result of experiencing such non-life threatening events,  PTSD is claimed to be an adjustment disorder as well. Immigrants frequently report a depressive state in which physical symptoms are in the foreground accompanied by social withdrawal and diminished energy. Negative life events, which are not life threatening and are not experienced everyday, can impair mental health so that the above state may worsen and an immigrant may have a reduction in his performance at work. This state, which is accompanied by such symptoms as embitterment, feelings of injustice, repeated intrusive memories of critical events (injustice at work place, loss of a job, discrimination in a public office, etc.), phobic symptoms, and avoidance behavior towards the place or persons related to the event, might best be described by the term, posttraumatic embitterment disorder (PTED). This disorder, which was initially described in immigrants from East Germany following the fall of the Berlin Wall,  and which does not exactly match the diagnostic criteria of adjustment disorder or PTSD, is presented in a case vignette and its differential diagnosis is discussed.

Publication Types:      English Abstract     Review

PMID: 18330747 [PubMed - indexed for MEDLINE]


Voen Med Zh. 2008 Apr;329(4):30-4.

[Pain syndrome and neuroendocrine disorders in posttraumatic stress disorder]

[Article in Russian]

Khozhenko EV.

PMID: 18540413 [PubMed - indexed for MEDLINE]


Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2008 Apr;33(4):279-83.

[Prevalence and risk factors for posttraumatic stress disorder among survivors from a coal mining accident after 2 and 10 months]

[Article in Chinese]

Hou CL, Li LJ, Zhang Y, Li WH, Li ZX, Yang JL, Li GY.

Department of Mental Health, Guangdong Provincial People's Hospital, Guangzhou, China.

OBJECTIVE: To investigate the prevalence of posttraumatic stress disorder (PTSD)  among survivors from a coal mining accident after 2 and 10 months and factors related to PTSD. METHODS: To estimate the prevalence of PTSD, 104 miners were surveyed through the PTSD Checklist-Civilian Version (PCL-C). Forty survivors including 24 severe PTSD patients and 24 non-PTSD subjects were evaluated thoroughly. RESULTS: The current prevalence rate among survivors from the coal mining accident at 2 months was 50%. There were significant differences in PTSD symptoms, anxiety and depression, personality, and memory performance between the PTSD patients and non-PTSD controls. State anxiety, time to renew the work, depression, neuroticism, and the place they were staying, and length of service were predictors of PTSD. After 10 months of the accident, 30.6% survivors still met the criterion of PTSD. Compared with 2 months after the accident, PTSD symptoms, anxiety, and memory performance improved clearly, while the depressive  symptoms had no significant difference. The state anxiety, time to renew the work, positive coping, emotional balance, and length of service were the factors  of PTSD symptom healing. CONCLUSION: The current prevalence of PTSD among survivors from coal mining accident is high. The mining accident has great influence on victims, and psychological or medication interventions are necessary. There are lots of risk factors for the prevalence of PTSD, such as state anxiety, depression, neuroticism, and shorter duration of service. Positive coping may be a beneficial factor for PTSD recovery.

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

PMID: 18460769 [PubMed - in process]


Child Adolesc Psychiatry Ment Health. 2008 Mar 28;2(1):7.

Resilience and vulnerability among refugee children of traumatized and non-traumatized parents.

Daud A, Af Klinteberg B, Rydelius PA.

Karolinska Institutet, Dept, of Woman and Child Health, Child and Adolescent Psychiatric Unit, Astrid Lindgren's Children's Hospital, Stockholm, Sweden.

ABSTRACT: BACKGROUND: The aim of the study was to explore resilience among refugee children whose parents had been traumatized and were suffering from Post-Traumatic Stress Disorder (PTSD). METHODS: The study comprised 80 refugee children (40 boys and 40 girls, age range 6-17 yrs), divided into two groups. The test group consisted of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden. In accordance with DSM-IV criteria, these children  were further divided in two sub-groups, those who were assessed as having PTSD-related symptoms (n = 31) and those who did not have PTSD-related symptoms (n = 9). The comparison group consisted of 40 children from Egypt, Syria and Morocco whose parents had not been tortured. Wechsler Intelligence Scale for Children, 3rd edn. (WISC-III), Diagnostic Interview for Children and Adolescents- Revised (DICA-R), Post-Traumatic Stress Symptoms checklist (PTSS), "I Think I am" (ITIA) and Strengths and Difficulties Questionnaire (SDQ) were used to assess IQ; PTSD-related symptoms; self-esteem; possible resilience and vulnerability. RESULTS: Children without PTSD/PTSS in the traumatized parents group had more favorable values (ITIA and SDQ) with respect to total scores, emotionality, relation to family, peer relations and prosocial behavior than the children in the same group with PTSD/PTSS and these values were similar to those the children in the comparison group (the non-traumatized parents group). The children in the  non-traumatized parents group scored significantly higher on the IQ test than the children with traumatized parents, both the children with PTSD-related symptoms and those without PTSD-related symptoms. CONCLUSION: Adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience. Further investigation is needed to explore the possible effects of these factors and the effects of IQ. The findings of this study are useful for treatment design in a holistic perspective, especially in planning the treatment for refugee children, adolescents and their  families.

PMID: 18373846 [PubMed - in process]


Neuroscience. 2008 Mar 27;152(3):703-12. Epub 2007 Dec 27.

Effects of single-prolonged stress on neurons and their afferent inputs in the amygdala.

Cui H, Sakamoto H, Higashi S, Kawata M.

Department of Anatomy and Neurobiology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

The amygdala modulates memory consolidation with the storage of emotionally relevant information and plays a critical role in fear and anxiety. We examined changes in neuronal morphology and neurotransmitter content in the amygdala of rats exposed to a single prolonged stress (SPS) as a putative animal model for human post-traumatic stress disorder (PTSD). Rats were perfused 7 days after SPS, and intracellular injections of Lucifer Yellow were administered to neurons of the basolateral (BLA) and central amygdala (CeA) to analyze morphological changes at the cellular level. A significant increase of dendritic arborization in BLA pyramidal neurons was observed, but there was no effect on CeA neurons. Neuropeptide Y (NPY) was abundant in BLA under normal conditions. The local concentration and number of immunoreactive fibers of NPY in the BLA of SPS-exposed rats were increased compared with the control. No differences were observed in this regard in the CeA. Double immunostaining by fluorescence and electron microscopy revealed that NPY immunoreactive terminals were closely associated with calcium/calmodulin II-dependent protein kinase (CaMKII: a marker  for pyramidal neurons)-positive neurons in the BLA, which were immunopositive to  glucocorticoid receptor (GR) and mineralocorticoid receptor (MR). SPS had no significant effect on the expression of CaMKII and MR/GR expression in the BLA. Based on these findings, we suggest that changes in the morphology of pyramidal neurons in the BLA by SPS could be mediated through the enhancement of NPY functions, and this structural plasticity in the amygdala provides a cellular and molecular basis to understand for affective disorders.

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

PMID: 18308474 [PubMed - indexed for MEDLINE]


BMC Public Health. 2008 Mar 19;8:92.

Exposure to the tsunami disaster, PTSD symptoms and increased substance use - an  Internet based survey of male and female residents of Switzerland.

Vetter S, Rossegger A, Rossler W, Bisson JI, Endrass J.

Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland.

BACKGROUND: After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with  mental health services. Although primarily designed for surviving Swiss tourists  as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms. METHODS: One section of the screening covered addiction related behavior. We analyzed the relationship between increased substance use, the level of PTSD symptoms and trauma exposure using multivariable logistic regression with substance use as the dependent variable. Included in the study were only subjects who reported being residents of Switzerland and the analyses were stratified by gender in order to control for possible socio-cultural or gender differences in the use of psychotropic substances. RESULTS: In women PTSD  symptoms and degree of exposure enlarged the odds of increased alcohol, pharmaceuticals and cannabis use significantly. In men the relationship was more  specific: PTSD symptoms and degree of exposure only enlarged the odds of increased pharmaceutical consumption significantly. Increases in alcohol, cannabis and tobacco use were only significantly associated with the degree of PTSD symptoms. CONCLUSION: The tsunami was associated with increased substance use. This study not only replicates earlier findings but also suggests for a gender specificity of post-traumatic substance use increase.

PMID: 18366682 [PubMed - indexed for MEDLINE]


JAMA. 2008 Mar 19;299(11):1291-305.

Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults.

Binder EB, Bradley RG, Liu W, Epstein MP, Deveau TC, Mercer KB, Tang Y, Gillespie CF, Heim CM, Nemeroff CB, Schwartz AC, Cubells JF, Ressler KJ.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30329, USA.

CONTEXT: In addition to trauma exposure, other factors contribute to risk for development of posttraumatic stress disorder (PTSD) in adulthood. Both genetic and environmental factors are contributory, with child abuse providing significant risk liability. OBJECTIVE: To increase understanding of genetic and environmental risk factors as well as their interaction in the development of PTSD by gene x environment interactions of child abuse, level of non-child abuse  trauma exposure, and genetic polymorphisms at the stress-related gene FKBP5. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study examining genetic and  psychological risk factors in 900 nonpsychiatric clinic patients (762 included for all genotype studies) with significant levels of childhood abuse as well as non-child abuse trauma using a verbally presented survey combined with single-nucleotide polymorphism (SNP) genotyping. Participants were primarily urban, low-income, black (>95%) men and women seeking care in the general medical care and obstetrics-gynecology clinics of an urban public hospital in Atlanta, Georgia, between 2005 and 2007. MAIN OUTCOME MEASURES: Severity of adult PTSD symptomatology, measured with the modified PTSD Symptom Scale, non-child abuse (primarily adult) trauma exposure and child abuse measured using the traumatic events inventory and 8 SNPs spanning the FKBP5 locus. RESULTS: Level of child abuse and non-child abuse trauma each separately predicted level of adult PTSD symptomatology (mean [SD], PTSD Symptom Scale for no child abuse, 8.03 [10.48] vs > or =2 types of abuse, 20.93 [14.32]; and for no non-child abuse trauma, 3.58 [6.27] vs > or =4 types, 16.74 [12.90]; P < .001). Although FKBP5 SNPs did not directly predict PTSD symptom outcome or interact with level of non-child abuse trauma to predict PTSD symptom severity, 4 SNPs in the FKBP5 locus significantly  interacted (rs9296158, rs3800373, rs1360780, and rs9470080; minimum P = .0004) with the severity of child abuse to predict level of adult PTSD symptoms after correcting for multiple testing. This gene x environment interaction remained significant when controlling for depression severity scores, age, sex, levels of  non-child abuse trauma exposure, and genetic ancestry. This genetic interaction was also paralleled by FKBP5 genotype-dependent and PTSD-dependent effects on glucocorticoid receptor sensitivity, measured by the dexamethasone suppression test. CONCLUSIONS: Four SNPs of the FKBP5 gene interacted with severity of child  abuse as a predictor of adult PTSD symptoms. There were no main effects of the SNPs on PTSD symptoms and no significant genetic interactions with level of non-child abuse trauma as predictor of adult PTSD symptoms, suggesting a potential gene-childhood environment interaction for adult PTSD.

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

PMID: 18349090 [PubMed - indexed for MEDLINE]


Biol Psychiatry. 2008 Mar 15;63(6):539-41.

Comment on:     Biol Psychiatry. 2008 Mar 15;63(6):550-6.

Regional specificity of traumatic stress-related cortical reduction: further evidence from a twin study of post-traumatic stress disorder.

Botteron KN.

Departments of Child Psychiatry and Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.

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

PMID: 18295657 [PubMed - indexed for MEDLINE]


Biol Psychiatry. 2008 Mar 15;63(6):629-32. Epub 2007 Sep 14.

Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study.

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

Northwest Network VISN 20 Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington 98108, USA.

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

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

PMID: 17868655 [PubMed - indexed for MEDLINE]


Biol Psychiatry. 2008 Mar 15;63(6):550-6. Epub 2007 Sep 7.

Comment in:     Biol Psychiatry. 2008 Mar 15;63(6):539-41.

Evidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder.

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

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

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

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: 17825801 [PubMed - indexed for MEDLINE]


Neurosci Lett. 2008 Mar 15;433(3):183-7. Epub 2008 Jan 11.

Upregulation of Myo6 expression after traumatic stress in mouse hippocampus.

Tamaki K, Kamakura M, Nakamichi N, Taniura H, Yoneda Y.

Laboratories of Molecular Pharmacology, Division of Pharmaceutical Sciences, Kanazawa University Graduate School of Natural Science and Technology, Kakuma-machi, Kanazawa, Ishikawa 920-1192, Japan.

Traumatic stress has been believed to result in a variety of unusual alterations  of the integrity and the functionality in the hippocampus. In this study, we searched for genes responsive to traumatic stress in the mouse hippocampus to elucidate the underlying mechanisms. Adult male mice were subjected to water-immersion restraint stress (WIRS) for 3h as an extremely stressful experience, followed by dissection of the hippocampus and subsequent extraction of RNA for differential display polymerase chain reaction (PCR) analysis. The actin-based molecular motor protein myosin VI (Myo6) was identified as a gene markedly upregulated by traumatic stress in the mouse hippocampus 24h after WIRS. Real-time PCR and Western blotting analyses clearly revealed a significant increase in the expression of both mRNA and corresponding protein for Myo6 in the hippocampus within 24h after WIRS, while WIRS failed to significantly affect the  expression of Myo6 protein in the cerebral cortex, cerebellum and olfactory bulb. Immunohistochemistry analysis revealed that Myo6 protein was ubiquitously expressed throughout the mouse brain, with an extremely high level in the olfactory bulb. These results suggest that Myo6 may be selectively and rapidly upregulated to play a hitherto unidentified role in the maintenance of the integrity and functionality in the hippocampus after traumatic stress.

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

PMID: 18261850 [PubMed - indexed for MEDLINE]


Psychiatry Res. 2008 Mar 15;158(2):164-71. Epub 2008 Feb 6.

Modification effects of coping on post-traumatic morbidity among earthquake rescuers.

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

Department of Psychiatry and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

This study aims to investigate the modification effects of coping strategies on the relationships between rescue effort and psychiatric morbidity (i.e. general psychiatric morbidity and post-traumatic morbidity) in earthquake rescue workers. Firefighters (n=193) who were involved in the rescue effort after the Taiwan Chi-Chi earthquake were invited to complete a questionnaire which contained questions on demographics, exposure to rescue work, general psychiatric morbidity, post-traumatic morbidity, and coping strategies. Multivariate regression models with interaction terms were carried out to investigate the modification effect of coping strategies on the relationships between rescue effort and psychiatric morbidities. Older age and longer job experiences (>3 years) were associated with both general psychiatric and post-traumatic morbidities. Coping strategies such as confrontive coping, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem solving, and positive appraisal significantly modified the effect of exposure to  dead bodies on general psychiatric morbidity. Furthermore, confrontive coping, distancing, and planned problem solving significantly modified the effect of exposure to direct rescue involvement on general psychiatric morbidity. However,  coping strategies were not observed to buffer the effect of rescue involvement or contact with dead bodies on post-traumatic morbidity. More frequent use of coping strategies could reduce the effect that exposure to rescue efforts has on the incidence of general psychiatric morbidity in rescue workers. However, coping strategies do not seem to reduce the influence of such exposure on trauma-related morbidities. This suggests that coping strategies can be used to prevent general  psychiatric morbidity but not trauma-related morbidities.

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

PMID: 18258306 [PubMed - indexed for MEDLINE]


Psychiatry Res. 2008 Mar 15;158(2):262-4. Epub 2008 Jan 29.

The growth of PTSD in anxiety disorder research.

Boschen MJ.

School of Psychology, Griffith University, Parklands Drive, Southport, Australia.

This article examines the growth in research on post-traumatic stress disorder (PTSD), which has expanded dramatically since its introduction in 1980. There are now over 350 articles indexed in Medline each year that refer to PTSD in their title. PTSD accounted for 16% of anxiety disorder research in the early 1980s, growing to one third by 2005.

Publication Types:      Review

PMID: 18234354 [PubMed - indexed for MEDLINE]


Clin Pract Epidemol Ment Health. 2008 Mar 5;4:5.

Post-traumatic stress disorder among people exposed to the Ventotene street disaster in Rome.

Raja M, Onofri A, Azzoni A, Borzellino B, Melchiorre N.

Università di Roma, La Sapienza, Rome, Italy.

ABSTRACT: OBJECTIVE: To test five hypotheses on Post-traumatic stress disorder (PTSD): 1) Is PTSD the most prevalent disorder after trauma? 2) Is the proximity  to the disaster related to the risk of PTSD? 3) Is PTSD associated with child mourning or separation, previous stress, or familiarity for psychiatric disorders? 4) Does the exposition to trauma increase substance abuse or somatization? 5) Can episodic trauma cause long-lasting psychiatric morbidity? METHODS: Clinical assessment of subjects exposed to an explosion in a building caused by a gas-leak. Best estimate clinical diagnoses were made according to DSM-IV-TR criteria. The Zung Depression Rating Scale, the Zung Anxiety Rating Scale, and the Clinician Administered Post Traumatic Stress Disorder Scale were used in the clinical assessment. Statistical analysis was performed by means of t-test with Bonferroni's correction on continuous variables and chi2 or Fisher test on categorical variables. RESULTS: PTSD was the most prevalent disorder after trauma, diagnosed in 32 (36.8%) subjects. The subjects who had not seen dead or injured people were more likely to receive no psychiatric diagnosis. Civil status, parenthood, death of relatives in the disaster, personal injuries,  history of child mourning or separation, of previous stress, as well as familiarity for any psychiatric disorder or substance use disorder were not related with the rate of ascertained psychiatric diagnoses. Nearly two years after trauma, most of patients who had suffered PTSD still met PTSD criteria. CONCLUSION: The 1st and the 5th hypotheses were corroborated, the 3rd and the 4th hypotheses were not confirmed. The 2nd hypothesis was partially confirmed.

PMID: 18321382 [PubMed - in process]


Acta Psychol (Amst). 2008 Mar;127(3):553-66. Epub 2008 Jan 29.

Inducing and modulating intrusive emotional memories: a review of the trauma film paradigm.

Holmes EA, Bourne C.

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.

Highly affect-laden memory intrusions are a feature of several psychological disorders with intrusive images of trauma especially associated with post-traumatic stress disorder (PTSD). The trauma film paradigm provides a prospective experimental tool for investigating analogue peri-traumatic cognitive mechanisms underlying intrusion development. We review several historical papers  and some more recent key studies that have used the trauma film paradigm. A heuristic diagram is presented, designed to simplify predictions about analogue peri-traumatic processing and intrusion development, which can also be related to the processing elements of recent cognitive models of PTSD. Results show intrusions can be induced in the laboratory and their frequency amplified/attenuated in line with predictions. Successful manipulations include competing task type (visuospatial vs. verbal) and use of a cognitive coping strategy. Studies show that spontaneous peri-traumatic dissociation also affects  intrusion frequency although attempts to manipulate dissociation have failed. It  is hoped that further use of this paradigm may lead to prophylactic training for  at risk groups and an improved understanding of intrusions across psychopathologies.

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

PMID: 18234153 [PubMed - indexed for MEDLINE]


Acta Psychol (Amst). 2008 Mar;127(3):645-53. Epub 2008 Feb 14.

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

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

Teacher Training University, Tehran, Iran.

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

PMID: 18178168 [PubMed - indexed for MEDLINE]


Acta Psychol (Amst). 2008 Mar;127(3):532-41. Epub 2007 Dec 19.

The role of the noradrenergic system in emotional memory.

van Stegeren AH.

University of Amsterdam, Department of Clinical Psychology and Cognitive Science  Center, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.

This contribution is an overview on the role of noradrenaline as neurotransmitter and stress hormone in emotional memory processing. The role of stress hormones in memory formation of healthy subjects can bear significance for the derailment of  memory processes, for example, in post traumatic stress disorder (PTSD). Increased noradrenaline levels lead to better memory performance, whereas blocking the noradrenergic receptors with a betablocker attenuates this enhanced  memory for emotional information. Noradrenaline appears to interact with cortisol in emotional memory processes, varying from encoding to consolidation and retrieval. Imaging studies show that confronting human subjects with emotional stimuli results in increased amygdala activation and that this activation is noradrenergic dependent. The role of noradrenaline in other brain areas, such as  hippocampus and prefrontal cortex, is shortly summarized. Finally, the pros and cons of a therapeutic application of betablockers in the (secondary) prevention of PTSD will be discussed.

Publication Types:      Review

PMID: 18070612 [PubMed - indexed for MEDLINE]


Acta Psychol (Amst). 2008 Mar;127(3):513-31. Epub 2007 Sep 27.

The influence of stress hormones on emotional memory: relevance for psychopathology.

Wolf OT.

Department of Psychology, University of Bielefeld, Postfach 10 01 31, D-33501 Bielefeld, Germany.

Substantial progress within recent years has led to a better understanding of the impact of stress on emotional memory. These effects are of relevance for understanding and treating psychopathology. The present selective review describes how emotional memory is modulated through stress hormones. Acute as well as chronic effects are discussed and information from rodent models is compared to human experimental studies and clinical observations. Finally, the relevance of these findings for emotional memory disturbances in psychiatric disorders is exemplified by discussions on neuroendocrine alterations in depression, post traumatic stress disorder and phobias.

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

PMID: 17900515 [PubMed - indexed for MEDLINE]


Addict Biol. 2008 Mar;13(1):95-104. Epub 2008 Jan 14.

Adrenocorticotropic hormone and cortisol plasma levels directly correlate with childhood neglect and depression measures in addicted patients.

Gerra G, Leonardi C, Cortese E, Zaimovic A, Dell'Agnello G, Manfredini M, Somaini L, Petracca F, Caretti V, Baroni C, Donnini C.

Servizio Tossicodipendenze, AUSL Italy.

Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has been reported to be involved in vulnerability to alcohol and drug dependence in humans, possibly underlying both addictive behaviour and depression susceptibility. The aim of the present study was to investigate the possible interactions between childhood adverse experiences, depressive symptoms and HPA axis function in addicted patients, in comparison with healthy control. Eighty-two abstinent heroin or cocaine dependent patients and 44 normal controls, matched for age and sex, completed the symptoms Check List-90 (SCL-90), measuring depressive symptoms, and the Childhood Experience of Care and Abuse Questionnaire. Blood samples were collected to determine adrenocorticotropic hormone (ACTH) and cortisol basal plasma levels at 8:00 and 8:30 a.m. Addicted individuals showed significantly higher neglect and depression scores and ACTH-cortisol plasma levels respect to control subjects. Depression scores at SCL-90 in addicted patients positively correlated with plasma ACTH and cortisol values. In turn, plasma ACTH levels were directly associated with childhood neglect measures, reaching statistical significance with 'mother-neglect' scores. Plasma cortisol levels were related to 'father antipathy' among cocaine addicts. These findings suggest the possibility  that childhood experience of neglect and poor parent-child attachment may have a  persistent effect on HPA axis function as an adult, partially contributing, together with genetic factors and other environmental conditions, to both depressive traits and substance abuse neurobiological vulnerability.

PMID: 18201294 [PubMed - indexed for MEDLINE]


Alcohol Clin Exp Res. 2008 Mar;32(3):481-8. Epub 2008 Jan 22.

Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study.

Driessen M, Schulte S, Luedecke C, Schaefer I, Sutmann F, Ohlmeier M, Kemper U, Koesters G, Chodzinski C, Schneider U, Broese T, Dette C, Havemann-Reinicke U; TRAUMAB-Study Group.

Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Bielefeld, Germany.

BACKGROUND: We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment-seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD. METHODS: In this cross-sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol-dependence (A) in 39.7%, drug-dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics. RESULTS: 25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group  A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD  trauma criteria A without PTSD (exposure). After controlling for SUD and gender,  trauma subgroups significantly differed regarding the onset of alcohol-related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects. CONCLUSIONS: The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.

Publication Types:      Comparative Study     Multicenter Study

PMID: 18215214 [PubMed - indexed for MEDLINE]


Am J Community Psychol. 2008 Mar;41(1-2):43-62.

Intervening processes between youths' exposure to community violence and internalizing symptoms over time: the roles of social support and coping.

Rosario M, Salzinger S, Feldman RS, Ng-Mak DS.

Psychology Department, The City University of New York-The City College and Graduate Center, Convent Avenue and 138th Street, New York, NY 10031, USA.

The roles of social support and coping as intervening processes between exposure  to community violence and internalizing symptoms were examined longitudinally among a community sample of 667 middle school students in the inner city. After controlling for potential confounders (e.g., social desirability, victimization and witnessing of family violence, guardian's psychological symptomatology), internalizing symptoms at Year 2 were predicted by hypothesized changes over 1 year, such that increased community violence exposure, decreased guardian and peer support, and increased use of defensive and confrontational behavioral coping were related to more internalizing symptoms of anxiety, depression and PTSD, although some of these relations varied by gender. The relations between internalizing symptoms at Year 3 and increased changes in exposure to community violence over 2 years were moderated by social support and/or coping, such that decreased guardian support and increased use of defensive and confrontational coping were generally associated with more symptoms for boys exposed to community violence. Girls who witnessed increased community violence and who increased their use of defensive or confrontational coping experienced more internalizing symptoms. The findings underscore the importance of developmental and contextual  considerations in the design and implementation of interventions.

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

PMID: 18165895 [PubMed - indexed for MEDLINE]


Am J Emerg Med. 2008 Mar;26(3):326-30.

A pilot study of an exposure-based intervention in the ED designed to prevent posttraumatic stress disorder.

Rothbaum BO, Houry D, Heekin M, Leiner AS, Daugherty J, Smith LS, Gerardi M.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA.

Early interventions to prevent PTSD have been limited in scope and effectiveness. This pilot study examines the feasibility and preliminary effectiveness of a model for brief preventive intervention: 1-session individualized exposure-based  therapy delivered in the emergency department (ED). Eligible patients who experienced exposure to a traumatic event in the previous 24 hours were screened  and assigned to assessment-only (n = 5) or intervention (imaginal exposure, n = 5) conditions. Both groups returned for 1-week follow-up. Results indicate that patients receiving this intervention reported slightly decreased levels of depression at 1-week follow-up and were rated lower on clinician-rated global severity of symptoms than patients in the assessment-only condition. The level of subject participation and ED staff support in this pilot study argues for feasibility of data collection, intervention, and follow-up with this population. Results also offer evidence that the intervention did not appear to harm participants and in fact may be helpful.

PMID: 18358945 [PubMed - indexed for MEDLINE]


Am J Psychoanal. 2008 Mar;68(1):50-65.

Technical considerations in the psychotherapy of traumatized individuals: a psychoanalytic perspective.

Nayar MC.

Psychoanalytic Center of Philadelphia, USA.

This paper addresses two specific aspects of clinical technique in the treatment  of traumatized individuals. The first aspect involves the creation of a safe holding environment as an essential step for the emergence of trauma-related memories and the containment of the affects accompanying them. Such scenarios may appear in the clinical material only through the workings of "procedural memory." It is therefore important to contain and gradually decipher repetitive patterns of behavior and feelings of shame, guilt and rage that go with them. The second aspect examines the challenges such work poses to the analyst's containing capacities, credulousness and even his or her reality testing within a clinical situation. The resulting instability of the analyst's work ego can make it hard for him or her to remain vigilant yet empathic, and emotionally attuned but analytically skeptical. The analyst's flexibility to be utilized as a transference object, developmental object and self-object remains a critical determinant of the treatment outcome under such circumstances. The paper provides clinical material to illustrate these two aspects of clinical technique.

Publication Types:      Case Reports

PMID: 18301375 [PubMed - indexed for MEDLINE]


Am J Psychoanal. 2008 Mar;68(1):24-32.

Childhood and trauma.

Boschan PJ.

Department of Psychoanalysis, University Institute of Mental Health, Asociación Psicoanalítica de Buenos Aires.

In this paper, I follow the evolution of the concept of trauma within psychoanalytic theory, and some of the effects of this evolution. Starting out from the point where Freud gives up the theory of trauma as the cause of neurosis in 1897, and the alleged reasons for such a change, I analyze the theoretical and clinical consequences of this change within psychoanalysis. I proceed to develop  Ferenczi's ideas on trauma, their relevance to present-day psychoanalytic theorizing and practice, as well as for the understanding of the psychic processes in children, tracing the development of some of these ideas in contemporary psychoanalytic thinking.

PMID: 18301372 [PubMed - indexed for MEDLINE]


Attach Hum Dev. 2008 Mar;10(1):59-71.

Attachment styles, traumatic events, and PTSD: a cross-sectional investigation of adult attachment and trauma.

O'Connor M, Elklit A.

Department of Psychology, University of Aarhus, Denmark.

The aim of the present study was to examine the association between post-traumatic stress disorder (PTSD) and adult attachment in a young adult population. A sample of 328 Danish students (mean age 29.2 years) from four different schools of intermediate education level were studied by the Harvard Trauma Questionnaire (HTQ), the Revised Adult Attachment Scale (RAAS), the Trauma Symptom Checklist (TSC), the Crisis Support Scale (CSS), the Coping Style Questionnaire (CSQ), and the World Assumption Scale (WAS). Attachment styles were associated with number of PTSD symptoms, negative affectivity, somatization, emotional coping, attributions, and social support. The distribution of attachment styles in relation to PTSD symptoms could be conceived as uni-dimensional.

PMID: 18351494 [PubMed - indexed for MEDLINE]


Attach Hum Dev. 2008 Mar;10(1):41-57.

Attachment organization in Vietnam combat veterans with posttraumatic stress disorder.

Nye EC, Katzman J, Bell JB, Kilpatrick J, Brainard M, Haaland KY.

Behavioral Health Care Line, New Mexico VA Health Care System, Albuquerque, USA.

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.

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

PMID: 18351493 [PubMed - indexed for MEDLINE]


Aust N Z J Psychiatry. 2008 Mar;42(3):206-13.

Trauma and post-traumatic stress disorder among homeless adults in Sydney.

Taylor KM, Sharpe L.

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

OBJECTIVE: International studies indicate high prevalence rates of post-traumatic stress disorder within homeless populations. In Australia, studies indicate high  rates of trauma among homeless adults, yet post-traumatic stress disorder has not been investigated in homeless Australian adults. The primary aim of this project  was to determine the prevalence of post-traumatic stress disorder among homeless  adults in Sydney. Further, another aim of the study was to determine whether the  onset of post-traumatic stress disorder preceded the first episode of homelessness or was a consequence of homelessness. METHOD: The sample consisted of 70 homeless men and women aged 18-73 years, who were randomly sampled through  eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted with each participant. Lifetime prevalence of post-traumatic stress disorder was determined via the Composite International Diagnostic Interview. RESULTS: The majority of the sample had experienced at least one traumatic event in their lifetime (98%). Indeed, the mean number of traumas per person was six. The 12 month prevalence of post-traumatic stress disorder was higher among homeless adults in Sydney in comparison to the Australian general population (41% vs 1.5%). But 79% of the sample had a lifetime prevalence of post-traumatic stress. In 59% of cases, the onset of post-traumatic stress disorder preceded the age of the first reported homeless episode. CONCLUSIONS: Homeless adults in Sydney frequently experience trauma and post-traumatic stress disorder. The study found that trauma and post-traumatic stress disorder more often precede homelessness, but re-victimization is common.  These findings highlight the high mental health needs among homeless people and have implications for services for homeless people.

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

PMID: 18247195 [PubMed - indexed for MEDLINE]


Behav Ther. 2008 Mar;39(1):72-8. Epub 2007 Oct 22.

Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims.

Clarke SB, Rizvi SL, Resick PA.

National Center for PTSD and VA Boston Healthcare System, USA.

Many studies report that comorbid borderline personality pathology is associated  with poorer outcomes in the treatment of Axis I disorders. Given the high rates of comorbidity between borderline personality pathology and posttraumatic stress  disorder (PTSD), it is essential to determine whether borderline symptomatology affects PTSD treatment outcome. This study examined the effects of borderline personality characteristics (BPC) on 131 female rape victims receiving cognitive-behavioral treatment for PTSD. Higher BPC scores were associated with greater pretreatment PTSD severity; however, individuals with higher levels of BPC were just as likely to complete treatment and also as likely to show significant treatment response on several outcome measures. There were no significant interactions between type of treatment and BPC on the outcome variables. Findings suggest that women with borderline pathology may be able to benefit significantly from cognitive-behavioral treatment for PTSD.

Publication Types:      Comparative Study     Randomized Controlled Trial

PMID: 18328872 [PubMed - indexed for MEDLINE]


Behav Ther. 2008 Mar;39(1):13-21. Epub 2007 Oct 18.

"I need to talk about it": a qualitative analysis of trauma-exposed women's reasons for treatment choice.

Angelo FN, Miller HE, Zoellner LA, Feeny NC.

University of Washington, Seattle, WA 98195-1525, USA.

A significant proportion of individuals suffering from posttraumatic stress disorder do not seek or receive effective treatment. Understanding the reasons why an individual chooses to seek treatment or prefers one treatment to another is a critical step to improve treatment seeking. To begin to understand these reasons, we conducted a qualitative analysis of the reasons women gave for choosing a cognitive-behavioral treatment, prolonged exposure (PE), or a pharmacological treatment, sertraline (SER). A community sample of women with trauma histories were asked to view standardized rationales, to choose among PE,  SER, or no treatment, and to give 5 reasons for their choice. Women indicated that they were more likely to prefer the psychotherapy to the medication. Across  reasons given, the most commonly cited reason for treatment preference highlighted why or how the treatment worked (e.g., I need to talk about it); and  this reason emerged as the strongest predictor of preference for PE. Understanding this role of perceived treatment mechanism may aid clinicians and public health policy officials to identify and address help-seeking barriers regarding treatment.

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

PMID: 18328866 [PubMed - indexed for MEDLINE]


Bipolar Disord. 2008 Mar;10(2):293-302.

Effects of trauma on bipolar disorder: the mediational role of interpersonal difficulties and alcohol dependence.

Maguire C, McCusker CG, Meenagh C, Mulholland C, Shannon C.

Department of Psychology, Queens University of Belfast, Belfast, Northern Ireland, UK.

OBJECTIVES: This study examined: (i) the prevalence of trauma in a bipolar disorder (BD) sample, and (ii) how trauma histories mediated by interpersonal difficulties and alcohol dependence impact on the severity of BD. The prevalence  of posttraumatic stress disorder (PTSD) and its relationship to outcomes in BD were also examined. METHODS: Sixty participants were recruited from a geographically well-defined mental health service in Northern Ireland. Self-reported trauma histories, PTSD, interpersonal difficulties and alcohol dependence and were examined in relation to illness severity. RESULTS: A high prevalence of trauma was found. Trauma predicted the frequency of hospital admissions (R(2) = 0.08), quality of life (R(2) = 0.23) and inter-episode depressive symptoms (R(2) = 0.13). Interpersonal difficulties, but not alcohol dependence, appeared to play an important role in mediating these adverse effects. While only 8% of the sample met criteria for active PTSD, this comorbid  disorder was associated with BD severity. CONCLUSIONS: This study indicates that  awareness of trauma is important in understanding individual differences in bipolar presentations. The theoretical and clinical implications of evidence that trauma is related to more adverse outcomes in BD are discussed. The finding that  interpersonal difficulties mediate the relationship between trauma and BD severity is novel. The need for adjunctive evidence-based treatments targeting interpersonal difficulties is considered.

PMID: 18271909 [PubMed - indexed for MEDLINE]


Bipolar Disord. 2008 Mar;10(2):285-92.

Predictors of trait aggression in bipolar disorder.

Garno JL, Gunawardane N, Goldberg JF.

Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, NY 11004, USA.

OBJECTIVES: Although aggressive behavior has been associated with bipolar disorder (BD), it has also been linked with developmental factors and disorders frequently found to be comorbid with BD, making it unclear whether or not it represents an underlying biological disturbance intrinsic to bipolar illness. We  therefore sought to identify predictors of trait aggression in a sample of adults with BD. METHODS: Subjects were 100 bipolar I (n = 73) or II (n = 27) patients consecutively evaluated in the Bipolar Disorders Research Program of the New York Presbyterian Hospital-Payne Whitney Clinic. Diagnoses were established using the  Structured Clinical Interview for the DSM-IV (SCID-I) and Cluster B sections of the SCID-II. Mood severity was rated by the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Histories of childhood maltreatment were assessed via the Childhood Trauma Questionnaire (CTQ), while trait aggression was measured by the Brown-Goodwin Aggression Scale (BGA). RESULTS: In  univariate analyses, significant relationships were observed between total BGA scores and CTQ total (r = 0.326, p = 0.001), childhood emotional abuse (r = 0.417, p < 0.001), childhood physical abuse (r = 0.231, p = 0.024), childhood emotional neglect (r = 0.293, p = 0.004), post-traumatic stress disorder (t = -2.843, p = 0.005), substance abuse/dependence (t = -2.914, p = 0.004), antisocial personality disorder (t = -2.722, p = 0.008) and borderline personality disorder (t = -5.680, p < 0.001) as well as current HDRS (r = 0.397,  p < 0.001) and YMRS scores (r = 0.371, p < 0.001). Stepwise multiple regression revealed that trait aggression was significantly associated with: (i) diagnoses of comorbid borderline personality disorder (p < 0.001); (ii) depressive symptoms (p = 0.001); and (iii) manic symptoms (p < 0.001). CONCLUSIONS: Comorbid borderline personality disorder and current manic and depressive symptoms each significantly predicted trait aggression in BD, while controlling for confounding factors. The findings have implications for nosologic distinctions between bipolar and borderline personality disorders, and the developmental pathogenesis  of comorbid personality disorders as predisposing to aggression in patients with  BD.

PMID: 18271908 [PubMed - indexed for MEDLINE]


Br J Clin Psychol. 2008 Mar;47(Pt 1):95-109.

Cultural differences in personal identity in post-traumatic stress disorder.

Jobson L, O'Kearney R.

School of Psychology, Australian National University, Canberra, Australia.

OBJECTIVES: This study investigated cultural differences in goals, self-defining  memories, and self-cognitions in those with and without post-traumatic stress disorder (PTSD). METHOD: Trauma survivors with and without PTSD, from independent and interdependent cultures (N=106) provided major personal goals, self-defining  memories, and self-cognitions. RESULTS: Trauma survivors with PTSD from independent cultures reported more goals, self-defining memories, and self-cognitions that were trauma-related than non-PTSD trauma survivors from independent cultures. In contrast, for those from interdependent cultures, there  was no difference between trauma survivors with and without PTSD in terms of trauma-centred goals, self-defining memories, and self-cognitions. CONCLUSIONS: The results suggest cultural variability in the impact of trauma on memory and identity, and highlight the need for contemporary models of PTSD to more explicitly consider culture in their accounts of PTSD. Clinical implications of these findings, such as cultural considerations in assessment and treating trauma relevant self-schema in cognitive therapy for PTSD, are discussed.

Publication Types:      Comparative Study

PMID: 17708833 [PubMed - indexed for MEDLINE]


Br J Psychiatry. 2008 Mar;192(3):212-6.

Psychosocial intervention for war-affected children in Sierra Leone.

Gupta L, Zimmer C.

Plan International Consultant, West Africa Regional Bureau, Freetown, Sierra Leone.

BACKGROUND: There are no psychosocial interventions to address both educational needs and psychological distress among displaced children in post-conflict settings. AIMS: To assess the psychosocial status of displaced children enrolled  in the Rapid-Ed intervention; and to determine whether the Rapid-Ed intervention  alleviated traumatic stress symptoms that interfere with learning among war-affected children in Sierra Leone. METHOD: A randomly selected sample of 315  children aged 8-18 years who were displaced by war were interviewed about their war experiences and reactions to the violence before and after participating in the 4-week Rapid-Ed intervention combining basic education with trauma healing activities. RESULTS: High levels of intrusion, arousal and avoidance symptoms were reported at the pre-test interviews conducted 9-12 months after the war. Post-test findings showed statistically significant decreases in intrusion and arousal symptoms (P<0.0001), a slight increase in avoidance reactions (P<0.0001)  and greater optimism about the future. CONCLUSIONS: The findings suggest potential for combining basic education with trauma healing activities for children in post-conflict settings, but confirmatory studies using a control group are needed. Conducting research in post-conflict settings presents unique challenges.

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

PMID: 18310582 [PubMed - indexed for MEDLINE]


Brain Inj. 2008 Mar;22(3):255-63.

Cognitive and functional outcomes of terror victims who suffered from traumatic brain injury.

Schwartz I, Tuchner M, Tsenter J, Shochina M, Shoshan Y, Katz-Leurer M, Meiner Z.

Department of Physical Medicine and Rehabilitation, Hadassah University Hospital, Jerusalem, Israel.

PRIMARY OBJECTIVE: To describe the outcomes of terror victims suffered from traumatic brain injury (TBI). RESEARCH DESIGN: Retrospective chart review of 17 terror and 39 non-terror TBI patients treated in a rehabilitation department during the same period. METHODS AND PROCEDURE: Variables include demographic data, Injury Severity Scale (ISS), length of stay (LOS) and imaging results. ADL  was measured using the Functional Independence Measurement (FIM), cognitive and memory functions were measured using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery and the Rivermead Battery Memory Test (RBMT), respectively. MAIN OUTCOME AND RESULTS: Terror TBI patients were significantly younger, had higher ISS score and higher rates of intracerebral haemorrhage (ICH), brain surgery and penetrating brain injuries than the non-terror TBI group. There was no difference in mean LOS, mean FIM values, mean  FIM gain and mean cognitive and memory improvement between groups. Terror victims suffered from a higher percentage of post-traumatic epilepsy (35% vs. 10%, p=0.05), whereas the rate of PTSD and the rate of return to previous occupation were similar between groups. CONCLUSIONS: Although TBI terror victims had more severe injury, they gained most of ADL functions and their rehabilitation outcomes were similar to non-terror TBI patients. These favourable results were achieved due to a comprehensive interdisciplinary approach to terror victims and  also by national support which allowed an adequate period of treatment and sufficient resources as needed.

PMID: 18297597 [PubMed - indexed for MEDLINE]


Can J Psychiatry. 2008 Mar;53(3):160-8.

Disclosure and social acknowledgement as predictors of recovery from posttraumatic stress: a longitudinal study in crime victims.

Mueller J, Moergeli H, Maercker A.

Department of Psychology, Dresden University of Technology, Germany.

OBJECTIVE: To address posttraumatic stress disorder (PTSD) predictors with research focused on the coping styles of traumatized individuals. METHOD: A total of 86 crime victims (mean age 46.1, standard deviation 17.6) were assessed at 5 and 11 months post-crime. Disclosure of trauma, social acknowledgement, dysfunctional posttraumatic cognitions, and PTSD symptom severity were assessed by self-reports. RESULTS: Dysfunctional posttraumatic cognitions, disclosure attitudes, and social disapproval correlated positively with PTSD severity. Hierarchical regression analyses revealed the particular value of disclosure attitudes and perceived social disapproval in predicting PTSD symptom severity at 11 months post-crime. CONCLUSIONS: In addition to known predictors of PTSD, disclosure attitudes and social acknowledgement should also be considered. Future research should focus on broader concepts such as the victim's perception of, and interaction with, their social environment, and on the objective factors of social interaction, in addition to intrapersonal processes of posttraumatic recovery.

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

PMID: 18441662 [PubMed - indexed for MEDLINE]


Clin Neuropsychol. 2008 Mar;22(2):350-62.

Comparison of the Morel Emotional Numbing Test for Posttraumatic Stress Disorder  to the Word Memory Test in neuropsychological evaluations.

Morel KR.

Psychology Service, VA Tennessee Valley Healthcare System, Nashville, TN 37212-2637, USA.

The most commonly feigned cognitive and psychiatric disorders for survivors of traumatic injury are memory dysfunction and posttraumatic stress disorder (PTSD). The position of the National Academy of Neuropsychology is that symptom validity  tests (SVTs) should be part of any comprehensive neuropsychological evaluation. In this article the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT), a SVT for PTSD, was compared to a SVT for memory, the Word Memory Test (WMT). Available archival data on 216 consecutive referrals for neuropsychological evaluations at the Veterans Affairs Tennessee Valley Healthcare System were reviewed. Of the total records reviewed 37 patients had been administered both the MENT and the WMT. The clinically recommended cutoff on the WMT was used as the main criterion to classify patients into two groups: simulating impairment or credible. The results indicated that the simulating impairment group had significantly more errors on the MENT than the credible group did (p <.0001). The criterion-related characteristics of the MENT in assessing response bias in relation to the WMT were confirmed Clinical and research implications of the utilization of the MENT are discussed in this study.

Publication Types:      Comparative Study

PMID: 17853136 [PubMed - indexed for MEDLINE]


Clin Psychol Rev. 2008 Mar;28(3):387-406. Epub 2007 Jul 18.

Mental health following traumatic injury: toward a health system model of early psychological intervention.

O'Donnell ML, Bryant RA, Creamer M, Carty J.

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

In 2005, over 2 million people in the United States of America were hospitalised  following non-fatal injuries. The frequency with which severe injury occurs renders it a leading cause of posttraumatic stress disorder and other trauma-related psychopathology. In order to develop a health system model of early psychological intervention for this population, we review the literature that pertains to mental health early intervention. The relevant domains include prevalence of psychopathology following traumatic injury, the course of symptoms, screening, and early intervention strategies. On the basis of available evidence, we propose a health system model of early psychological intervention following traumatic injury. The model involves screening for vulnerability within the hospital setting, follow-up screening for persistent symptoms at one month posttrauma, and early psychological intervention for those who are experiencing clinical impairment. Recommendations are made to facilitate tailoring early intervention psychological therapies to the special needs of the injury population.

Publication Types:      Review

PMID: 17707563 [PubMed - indexed for MEDLINE]


Compr Psychiatry. 2008 Mar-Apr;49(2):195-201. Epub 2007 Dec 21.

Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth.

Bruwer B, Emsley R, Kidd M, Lochner C, Seedat S.

Department of Psychiatry, University of Stellenbosch, Cape Town 7505, South Africa.

INTRODUCTION: There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, although its reproducibility in the South African youth has not yet been investigated. METHODS: This study aimed to investigate the psychometric properties of the MSPSS in the South African youth using confirmatory factor analysis. The relationship of PSS to depressive and anxiety symptoms, as well as the effects of sex and ethnicity, was investigated.  Participants completed a battery of self-report measures, including the MSPSS, Beck Depression Inventory, and the Child Posttraumatic Stress Disorder Checklist  on a single occasion. Confirmatory factor analysis was performed to validate the  a priori factor structure of the MSPSS. In addition, Cronbach alpha coefficients  and intercorrelations (for clinical variables) were calculated. A missing value analysis was performed to assess the influence of missing data on our findings. RESULTS: Data are reported for 502 youth (11.3-23.5 years). The 3-factor structure of the MSPSS (significant other, family, and friends) fitted the data well. The MSPSS showed good internal consistency. Perceived social support was also positively correlated with resilience and negatively correlated with depression, exposure to community violence, and other potentially life-threatening traumas. Females and youth of white or mixed race reported significantly higher levels of PSS than males and black youth, respectively. CONCLUSIONS: The MSPSS is a psychometrically sound instrument that can be applied to South African youth.

Publication Types:      Validation Studies

PMID: 18243894 [PubMed - indexed for MEDLINE]


Compr Psychiatry. 2008 Mar-Apr;49(2):163-9. Epub 2007 Oct 24.

Childhood trauma, trauma in adulthood, and psychiatric diagnoses: results from a  community sample.

Zlotnick C, Johnson J, Kohn R, Vicente B, Rioseco P, Saldivia S.

Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.

This study compared the prevalence rates of various psychiatric disorders in persons with first onset of a potentially traumatic event (PTE) in childhood, persons with first onset of a PTE in adulthood, and those with no history of a PTE in a representative sample of Chileans. The Diagnostic of Statistical Manual  of Mental Disorders, Revised Third Edition (DSM-III-R), posttraumatic stress disorder, and antisocial personality disorder modules from the Diagnostic Interview Schedule and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview were administered to 2390 Chileans.  The study found that exposure to a lifetime PTE was associated with a higher probability of psychiatric morbidity than no PTE exposure. A PTE with childhood onset relative to adult onset was related to lifetime panic disorder, independent of the number of lifetime and demographic differences between the 2 groups. Childhood interpersonal trauma compared with interpersonal trauma in adulthood was significantly associated with lifetime panic disorder, agoraphobia, and posttraumatic stress disorder. Our findings suggest that specific disorders are linked to interpersonal trauma and PTEs that occur in childhood rather than later in life.

PMID: 18243889 [PubMed - indexed for MEDLINE]


Compr Psychiatry. 2008 Mar-Apr;49(2):113-20. Epub 2007 Dec 21.

Adjustment disorders, posttraumatic stress disorder, and depressive disorders in  old age: findings from a community survey.

Maercker A, Forstmeier S, Enzler A, Krüsi G, Hörler E, Maier C, Ehlert U.

Department of Psychopathology and Clinical Intervention, University of Zurich, CH-8050 Zurich, Switzerland.

Based on a new psychopathological model of adjustment disorders (AJD), we propose that AJDs are particular forms of stress response syndromes, in which intrusions, avoidance of reminders, and failure to adapt are core symptoms. We aim to demonstrate that these AJD symptom groups constitute a disorder that is distinct  from posttraumatic stress disorder (PTSD), complicated grief disorder, major depressive disorder, and subsyndromal depression, by estimating their prevalence  and comorbidities. A representative sample of elderly persons from Zurich, aged 65 to 96 years, was assessed by standardized interviews or self-report questionnaires. Index events for AJD were indicated by 52% of the sample set, with a 2.3% current prevalence of AJD. Prevalence rates for other disorders were  0.7% PTSD, 4.2% subsyndromal PTSD, 4.2% complicated grief disorder, 2.3% major depressive disorder, and 9.3% subsyndromal depression. The comorbidity rate for AJD and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders is 46%, and that between AJD and subsyndromal disorders is 38%. Use of mental health care for AJD is low. This article concludes that the new concept of AJD constitutes a meaningful psychopathological model and thus warrants a place in standardized psychiatric taxonomies. Although this study was  restricted to a sample of the elderly, it provides evidence regarding AJD prevalence, comorbidity, and associated health care use, all of which indicate its utility.

PMID: 18243882 [PubMed - indexed for MEDLINE]


Crit Care Nurs Clin North Am. 2008 Mar;20(1):73-81, vii.

PTSD: therapeutic interventions post-Katrina.

Rhoads J, Pearman T, Rick S.

LSUHSC School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA.

August 29, 2006, brought the largest, most deadly hurricane ever to strike the Gulf Coast. According to reports, the storm killed more than 2000 people and destroyed billions of dollars of property, with winds clocked at 160 to 175 mph.  More than a million residents were displaced, many requiring care for chronic conditions who suddenly also needed care for acute stress symptoms. Today, many individuals still struggle to cope with major psychiatric posttraumatic stress disorders (PTSD). Using a case study approach, this article discusses PTSD, including what it is, how it is manifested, how to diagnose it, patient education, and how it can be managed with therapeutic interventions. Special circumstances related to children are briefly presented.

Publication Types:      Case Reports     Review

PMID: 18206587 [PubMed - indexed for MEDLINE]


Crit Care Nurs Clin North Am. 2008 Mar;20(1):13-22, v.

Skill set requirements for nurses deployed with an expeditionary medical unit based on lessons learned.

Whitcomb JJ, Newell KJ.

Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.

Based in Kuwait 3 years apart, the authors recount how nurses and corps staff, along with their physician counterparts, came together to form well-run medical facilities under adverse circumstances. Their respective hospitals became competent organizations because of specific formulas for success, along with preparation, identification of required skill sets, and making improvements based on experience. This article describes the training of medical, nursing, and corps staff, the facilities and resources required for managing casualties, and some of the more commonly encountered combat injuries and conditions.

PMID: 18206580 [PubMed - indexed for MEDLINE]


Cult Med Psychiatry. 2008 Mar;32(1):102-21.

Cultural formulation with attention to language and cultural dynamics in a mexican psychiatric patient treated in San Diego, California.

Bucardo JA, Patterson TL, Jeste DV.

Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive  (MS 0680), San Diego, CA 92093, USA.

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

PMID: 18188683 [PubMed - indexed for MEDLINE]


Epilepsy Res. 2008 Mar;79(1):84-9. Epub 2008 Feb 20.

Adult attachment style and childhood interpersonal trauma in non-epileptic attack disorder.

Holman N, Kirkby A, Duncan S, Brown RJ.

Division of Clinical Psychology, University of Manchester, UK.

Non-epileptic attack disorder (NEAD) poses a significant clinical problem but is  poorly understood. Attachment theory provides a framework for understanding the development and maintenance of NEAD and the contribution of childhood abuse and neglect to these processes. A cross-sectional design was used to study attachment style and early traumatic experiences in individuals with NEAD (N=17) compared to those with epilepsy (N=26). A significant difference in predominant attachment style between the two groups was found, with fearful attachment occurring more frequently in the NEAD group. Abuse and neglect were also significantly more common in the NEAD patients. Both early traumatic experiences and fearful attachment added significantly to the predictive power of a logistic regression equation after controlling for anxiety and dysthymia. The findings suggest a link between disturbed attachment and NEAD and have clinical implications for therapeutic intervention with this group.

PMID: 18281196 [PubMed - indexed for MEDLINE]


Eur Arch Psychiatry Clin Neurosci. 2008 Mar;258(2):82-96.

Gene-environment interaction in posttraumatic stress disorder: review, strategy and new directions for future research.

Koenen KC, Nugent NR, Amstadter AB.

Department of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.

The purpose of this article is to encourage research investigating the role of measured gene-environment interaction (G x E) in the etiology of posttraumatic stress disorder (PTSD). PTSD is uniquely suited to the study of G x E as the diagnosis requires exposure to a potentially-traumatic life event. PTSD is also moderately heritable; however, the role of genetic factors in PTSD etiology has been largely neglected both by trauma researchers and psychiatric geneticists. First, we summarize evidence for genetic influences on PTSD from family, twin, and molecular genetic studies. Second, we discuss the key challenges in G x E studies of PTSD and offer practical strategies for addressing these challenges and for discovering replicable G x E for PTSD. Finally, we propose some promising new directions for PTSD G x E research. We suggest that G x E research in PTSD is essential to understanding vulnerability and resilience following exposure to a traumatic event.

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

PMID: 18297420 [PubMed - indexed for MEDLINE]


Eur Child Adolesc Psychiatry. 2008 Mar;17(2):93-8. Epub 2007 Sep 17.

Risk indicators and psychopathology in traumatised children and adolescents with  a history of sexual abuse.

Carey PD, Walker JL, Rossouw W, Seedat S, Stein DJ.

MRC Research Unit for Anxiety and Stress, Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town 7505, South Africa.

PURPOSE: Childhood sexual abuse (CSA) is widespread amongst South African (SA) children, yet data on risk factors and psychiatric consequences are limited and mixed. METHODS: Traumatised children and adolescents referred to our Youth Stress Clinic were interviewed to obtain demographic, sexual abuse, lifetime trauma and  psychiatric histories. RESULTS: Data for 94 participants (59 female, 35 male; mean age 14.25 [8.25-19] years) exposed to at least one lifetime trauma were analysed. Sexual abuse was reported in 53% of participants (42.56% females, 10.63% males) with 64% of violations committed by perpetrators known to them. Multinomial logistic regression analysis revealed female gender (P=0.002) and single-parent families (P=0.01) to be significant predictors of CSA (62.5%). CSA  did not predict exposure to other traumas. Sexually abused children had significantly higher physical and emotional abuse subscale scores and total CTQ scores than non-abused children. Depression (33%, X(2)=10.89, P=0.001) and PTSD (63.8%, X(2)=4.79, P=0.034) were the most prevalent psychological consequences of trauma and both were significantly associated with CSA. CONCLUSIONS: High rates of CSA predicted high rates of PTSD in this traumatised sample. Associations we found appear consistent with international studies of CSA and, should be used to  focus future social awareness, prevention and treatment strategies in developing  countries.

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

PMID: 17876504 [PubMed - indexed for MEDLINE]


Gen Hosp Psychiatry. 2008 Mar-Apr;30(2):162-70.

The role of cumulative sexual trauma and difficulties identifying feelings in understanding female veterans' physical health outcomes.

Polusny MA, Dickinson KA, Murdoch M, Thuras P.

Collaborators: Polusny MA, Murdoch M.

Department of Veterans Affairs Medical Center, Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA.

OBJECTIVE: To examine the role of alexithymia (difficulties identifying one's emotions) in understanding the link between PTSD symptoms and negative health outcomes in sexually victimized female veterans. We hypothesized that having experienced multiple types of sexual trauma across the lifespan, experiencing greater severity of PTSD symptoms, and reporting difficulties in identifying emotions would be associated with increased negative health outcomes. METHOD: Anonymous cross-sectional survey of a convenience sample of 456 female veterans enrolled in a VA clinic within the prior year. Data collected included demographics, lifetime trauma exposure, psychological and medical symptoms, emotion recognition problems (alexithymia), health-risk behaviors, and health care utilization. RESULTS: A total of 57.5% of participants reported a lifetime history of sexual trauma. After controlling for sexual trauma history, PTSD symptoms, and other well-established predictors of health care utilization in the VA medical system such as pre-disposing, enabling and need-based factors, hierarchical regression analyses showed that alexithymia independently explained  unique variance in participants' physical health complaints and in their odds of  reporting at least one outpatient urgent care visit in the past year. CONCLUSIONS: These data suggest that emotion recognition problems may contribute  to poorer health outcomes in sexually traumatized women veterans beyond what is explained by sexual trauma exposure, health risk behaviors and PTSD. Psychological interventions that enhance emotion identification skills for women  who have experienced sexual trauma could improve health perceptions and reduce need for acute health care.

PMID: 18291298 [PubMed - indexed for MEDLINE]


Gen Hosp Psychiatry. 2008 Mar-Apr;30(2):100-3.

Veterans' disclosure of trauma to healthcare providers.

Leibowitz RQ, Jeffreys MD, Copeland LA, Noël PH.

Research and Development Service, Portland VA Medical Center, Portland, OR 97239, USA.

OBJECTIVE: The purpose of this study is to gain a better understanding of patients' trauma disclosure to health professionals. METHOD: A convenience sample of 173 veterans in outpatient treatment for posttraumatic stress disorder (PTSD)  in the Veterans Health Administration completed surveys querying trauma history,  reasons for trauma disclosure and perceived provider responses. RESULTS: For half of the participants, a healthcare provider was the first person to whom they disclosed. Reasons were primarily external, such as pressure from others. Although 72% were glad to disclose, 45% perceived at least one negative provider  response. CONCLUSION: Patients disclose to a wide range of provider types and perceive varied responses. Providers' awareness of the need to be sensitive to trauma disclosure could facilitate treatment for PTSD.

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

PMID: 18291291 [PubMed - indexed for MEDLINE]


Heart Lung. 2008 Mar-Apr;37(2):113-21.

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction.

Wiedemar L, Schmid JP, Müller J, Wittmann L, Schnyder U, Saner H, von Känel R.

Department of General Internal Medicine, University Hospital Berne, Switzerland.

OBJECTIVE: We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS: We recruited 400 patients (mean age 60 +/- 12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS: Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS: Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.

PMID: 18371504 [PubMed - indexed for MEDLINE]


Int J Prison Health. 2008 Mar;4(1):54-63.

Child sexual abuse, coping strategies and lifetime posttraumatic stress disorder  among female inmates.

Huang G, Zhang Y, Momartin S, Huang X, Zhao L.

The Mental Health Center of Sichuan Province, China.

The purpose of the study was to assess the relationship between child sexual abuse (CSA) and posttraumatic stress disorder (PTSD) in female inmates in China.  A total of 471 participants were assessed for CSA, personality traits, coping strategies, and frequency of lifetime PTSD. Results demonstrated that CSA and negative coping were predictive factors for lifetime PTSD among female inmates after personality traits were controlled. The findings suggest that CSA is one potential factor contributing to lifetime PTSD among female inmates. The importance of screening for CSA among female inmates was highly emphasized. Early intervention and prevention programmes based on coping skills may be useful to forestall the development of chronic PTSD in female inmates.

PMID: 18382850 [PubMed - indexed for MEDLINE]


Issues Ment Health Nurs. 2008 Mar;29(3):299-314.

Impact of physical abuse on adulthood depressive symptoms among women.

Al-Modallal H, Peden A, Anderson D.

College of Nursing, University of Kentucky, Lexington, Kentucky 40503-0232, USA.

This manuscript provides a systematic review of the literature to examine the relationship between childhood physical abuse and intimate partner physical abuse with adulthood depressive symptoms among women. Thirty-five studies that targeted women, measured depressive symptoms, childhood physical abuse, and intimate partner physical abuse were reviewed. Findings indicated an association between physical abuse experiences and depressive symptoms. However, the association of other risk factors, including other types of abuse, with depressive symptoms confounded this relationship. Recommendations, including control for other types  of abuse, use of valid and reliable measures, and provision of a clear definition of physical abuse, are provided.

Publication Types:      Review

PMID: 18340614 [PubMed - indexed for MEDLINE]


J Behav Ther Exp Psychiatry. 2008 Mar;39(1):42-56. Epub 2006 Dec 29.

A randomised controlled trial of group debriefing.

Devilly GJ, Annab R.

Brain Sciences Institute, Swinburne University, PO Box 218, Hawthorn, Vic. 3122,  Australia.

There has never been published a randomised controlled trial of group debriefing. In this study we employed an analogue study with students to conduct the first such trial. Sixty-four participants were shown a stressful video of paramedics attending to injured and dead victims of a road traffic accident. Half the participants were subsequently debriefed and half were provided with tea and biscuits and allowed to talk amongst themselves. A 1 month follow-up was administered. It was found that, while the video was rated as distressing, there  were no significant differences between the debriefed and non-debriefed groups on measures of affective distress and trauma symptoms. Those who were debriefed later recalled having wanted to talk more to someone about the video than those who were not debriefed. It is suggested that cognitive dissonance may explain this result.

Publication Types:      Comparative Study     Randomized Controlled Trial

PMID: 17196547 [PubMed - indexed for MEDLINE]


J Clin Nurs. 2008 Mar;17(5):677-87.

Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors.

Oflaz F, Hatipoğlu S, Aydin H.

Gülhane Military Medical Academy, School of Nursing, Etlik, Ankara, Turkey.

AIMS AND OBJECTIVES: The aim of the study was to examine the effectiveness of a psychoeducation intervention based on Peplau's approach, including problem-solving compared with intervention with medication on post-traumatic stress disorder (PTSD) symptoms and coping of earthquake survivors. BACKGROUND: Post-traumatic reactions and recovery are the result of complex interactions among biological, personal, cultural and environmental factors. Both psychosocial and psychopharmacological methods have been advised to treat PTSD. The general goal of treatment is to decrease the anxiety and to support these patients in regaining normal daily functions. DESIGN: The study used a pretest to posttest quasi-experimental design with three comparison groups. METHODS: The sample of the study included 51 survivors of the Marmara Earthquake who met diagnostic criteria for PTSD. Comparison groups were made up as psychoeducation only, medication only and psychoeducation with medication (PEM). Six semi-structured psychoeducation sessions were conducted individually. Patients in the 'medication only' group did not participate in these sessions. The Clinician Administered PTSD Scale, Hamilton Depression Scale and Coping Strategies Scale were used for the measurements. RESULTS: There was a significant difference between the 'PEM' group and the 'medication only' group with the first group showing greater relief of symptoms. Generally, there were no differences between the 'medication only' and 'psychoeducation only' groups. Avoidance as a coping strategy had significant positive correlations with PTSD and depression outcomes. CONCLUSIONS: Patients with PTSD seem to take more advantage from the combined treatment model. Nurses can help the patients with PTSD by teaching them to cope with the symptoms. RELEVANCE TO CLINICAL PRACTICE: The number and variety of catastrophic events in  the world are increasing. Psychiatric nurses should therefore take responsibility regarding the effects of trauma and investigate the ways of working with people who experienced trauma in more detail and develop interventions based on scientific evidence.

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

PMID: 18279300 [PubMed - indexed for MEDLINE]


J Clin Psychiatry. 2008 Mar;69(3):400-5.

Paroxetine CR augmentation for posttraumatic stress disorder refractory to prolonged exposure therapy.

Simon NM, Connor KM, Lang AJ, Rauch S, Krulewicz S, LeBeau RT, Davidson JR, Stein MB, Otto MW, Foa EB, Pollack MH.

Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA 02114, USA.

OBJECTIVE: Little is known about the efficacy of "next step" strategies for patients with post-traumatic stress disorder (PTSD) who remain symptomatic despite treatment. This study prospectively examines the relative efficacy of augmentation of continued prolonged exposure therapy (PE) with paroxetine CR versus placebo for individuals remaining symptomatic despite a course of PE. METHOD: Adult outpatients meeting DSM-IV criteria for PTSD were recruited from February 2003 to September 2005 at 4 academic centers. Phase I consisted of 8 sessions of individual PE over a 4- to 6-week period. Participants who remained symptomatic, defined as a score of >or= 6 on the Short PTSD Rating Interview (SPRINT) and a Clinical Global Impressions-Severity of Illness scale (CGI-S) score >or= 3, were randomly assigned to the addition of paroxetine CR or matched  placebo to an additional 5 sessions of PE (Phase II). RESULTS: Consistent with prior studies, the 44 Phase I completers improved significantly with initial PE (SPRINT: paired t = 7.6, df = 41, p < .0001; CGI-S: paired t = 6.37, df = 41, p < .0001). Counter to our hypothesis, however, we found no additive benefit of augmentation of continued PE with paroxetine CR compared to pill placebo for the  23 randomly assigned patients, with relatively minimal further gains overall in Phase II. CONCLUSION: Although replication with larger samples is needed before definitive conclusions can be drawn, our data do not support the addition of paroxetine CR compared with placebo to continued PE for individuals with PTSD who remain symptomatic after initial PE, suggesting that the development of novel treatment approaches for PTSD refractory to PE is needed. CLINICAL TRIALS REGISTRATION: identifier NCT00215163.

Publication Types:      Clinical Trial, Phase II     Multicenter Study     Randomized Controlled Trial     Research Support, Non-U.S. Gov't

PMID: 18348595 [PubMed - indexed for MEDLINE]


J Clin Psychol. 2008 Mar;64(3):245-63.

Posttraumatic growth in accident survivors: openness and optimism as predictors of its constructive or illusory sides.

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

Roseneck Hospital, Prien am Chiemsee, Germany.

Posttraumatic growth (PTG), the phenomenon of self-reported positive outcomes of  trauma, is assumed to consist of two sides: a constructive and an illusory side.  This study investigates the relationship between PTG and its possible illusory and constructive predictors, as well as the moderating role of posttraumatic stress disorder (PTSD) severity. One-hundred two motor vehicle accident (MVA) survivors with full, subsyndromal, and without PTSD were assessed by multiple psychometric measures targeting PTSD severity, posttraumatic growth, optimism, and openness to experience. Hierarchical regression analysis yielded differential interaction effects between PTSD severity and optimism, as well as openness facets pointing to the moderating role of PTSD severity in the prediction of an illusory and a constructive factor in PTG.

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

PMID: 18302209 [PubMed - indexed for MEDLINE]


J Geriatr Psychiatry Neurol. 2008 Mar;21(1):61-71.

Posttraumatic stress and aggression among veterans in long-term care.

Carlson EB, Lauderdale S, Hawkins J, Sheikh JI.

National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, Menlo Park, California 94025, USA.

Because stresses associated with long-term care settings may exacerbate distress  and aggression related to past trauma, we investigated self-report and staff reports of posttraumatic stress disorder symptoms and staff observations of verbal and physical aggression in 32 elderly males who were patients in a long-term care unit for veterans. Feelings of anger and irritability were reported by 47% of patients; levels of anger and irritability were significantly  correlated with observed aggressive behaviors (r = 0.43, P < .02); and observed aggressive behaviors were significantly more frequent among those reporting past  traumatic stressors (t = 2.84, P < .008). Patient-reported posttraumatic stress disorder symptoms were significantly correlated with the frequency of past traumatic stressors (r = 0.48, P < .006). Observer-reported posttraumatic stress  disorder symptoms and patient reports of anger were strongly correlated (r = 0.73, P < .001). No patient or staff reports were related to level of cognitive function. These findings are consistent with the hypothesis that posttraumatic symptoms can contribute to aggressive behaviors in elderly, medically ill, and cognitively impaired patients.

PMID: 18287172 [PubMed - indexed for MEDLINE]


J Interpers Violence. 2008 Mar;23(3):339-61.

International terrorism and mental health: recent research and future directions.

Fischer P, Ai AL.

Social, Economic, and Organisational Psychology, Exeter University, UK.

International terrorism has become a major global concern. Several studies conducted in North America and Europe in the aftermath of terrorist attacks reveal that international terrorism represents a significant short-term and long-term threat to mental health. In the present article, the authors clarify the concept and categories of terrorism and then present central findings from studies conducted in the United States and Europe, which mainly focus on negative impacts on mental health, such as emotional stress and PTSD. Furthermore, the authors outline experiments that focus on social interaction processes thought to be triggered by international terrorism and which are assumed to be related indirectly to mental health processes. Next, they highlight the potential positive outcomes on the resilience side, in line with the current theory on posttraumatic growth in adversity. Finally, theoretical and practical implications as well as limitations and future directions are discussed.

Publication Types:      Review

PMID: 18245572 [PubMed - indexed for MEDLINE]


J Nerv Ment Dis. 2008 Mar;196(3):252-5.

Difficulty identifying feelings predicts the persistence of trauma symptoms in a  sample of veterans who experienced military sexual trauma.

O'Brien C, Gaher RM, Pope C, Smiley P.

Bay Pines VA Healthcare System, Bay Pines, Florida, USA.

The current study examined the prospective association between alexithymia and the persistence of trauma symptoms in a clinical sample of 175 male and female veterans who experienced sexual trauma during military service (military sexual trauma; MST). Trauma symptoms decreased significantly over the course of a specialized residential treatment program. Difficulty identifying feelings was related to persistence of the following trauma symptoms: overall symptoms, sexual abuse trauma symptoms, dissociative symptoms, and anxiety. Men exhibited more persistent symptoms overall, more persistent sexual problems, and more sexual abuse trauma symptoms compared with women (over and above controlling for symptoms at intake). The results speak to the significant role that difficulty identifying feelings has in the treatment of PTSD. In addition, the results suggest that MST has different implications for men compared with women. Specifically, men who were sexually abused in the military experienced greater persistence of symptoms compared with women, especially in the areas of sexual functioning.

PMID: 18340263 [PubMed - indexed for MEDLINE]


J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):300-6. Epub 2007 Aug 16.

Comment in:     J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):237.

Mild traumatic brain injury does not predict acute postconcussion syndrome.

Meares S, Shores EA, Taylor AJ, Batchelor J, Bryant RA, Baguley IJ, Chapman J, Gurka J, Dawson K, Capon L, Marosszeky JE.

Department of Psychology, Macquarie University, Sydney, Australia.

BACKGROUND: The aetiology of postconcussion syndrome (PCS) following mild traumatic brain injury (mTBI) remains controversial. Identifying acute PCS (within the first 14 days after injury) may optimise initial recovery and rehabilitation, identify those at risk and increase understanding of PCS. OBJECTIVE: To examine predictors of acute outcome by investigating the relationship between preinjury psychiatric disorder, demographic factors, injury  related characteristics, neuropsychological and psychological variables and acute PCS. METHODS: Prospective study of consecutive trauma admissions to a level 1 trauma hospital. The final sample comprised 90 patients with mTBI and 85 non-brain injured trauma controls. Individuals were administered a PCS checklist, and neuropsychological and psychological measures. Multiple imputation of missing data in multivariable logistic regression and bivariate logistic regressions were used to predict acute PCS at a mean of 4.90 days after injury. RESULTS: Diagnosis of acute PCS was not specific to mTBI (mTBI 43.3%; controls 43.5%). Pain was associated with acute PCS in mTBI. The strongest effect for acute PCS was a previous affective or anxiety disorder (OR 5.76, 95% CI 2.19 to 15.0). Females were 3.33 times more likely than males to have acute PCS (95% CI 1.20 to 9.21). The effect of acute post-traumatic stress and neuropsychological function on acute PCS was relatively small. Higher IQ was associated with acute PCS. CONCLUSIONS: There is a high rate of acute PCS in both mTBI and non-brain injured trauma patients. PCS was not found to be specific to mTBI. The use of the term PCS may be misleading as it incorrectly suggests that the basis of PCS is a brain injury.

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

PMID: 17702772 [PubMed - indexed for MEDLINE]


J Psychiatr Res. 2008 Mar;42(4):268-77. Epub 2007 Apr 2.

Diminished rostral anterior cingulate activity in response to threat-related events in posttraumatic stress disorder.

Kim MJ, Chey J, Chung A, Bae S, Khang H, Ham B, Yoon SJ, Jeong DU, Lyoo IK.

Department of Psychology, Seoul National University, Seoul, South Korea.

BACKGROUND: Previous brain imaging studies have reported hyperactivation of the amygdala and hypoactivation of the anterior cingulate in posttraumatic stress disorder (PTSD) patients, which is believed to be an underlying neural mechanism  of the PTSD symptoms. The current study specifically focuses on the abnormal activity of the rostral anterior cingulate, using a paradigm which elicits an unexpected processing conflict caused by salient emotional stimuli. METHODS: Twelve survivors (seven men and five women) of the Taegu subway fire in 2003, who later developed PTSD, agreed to participate in this study. Twelve healthy volunteers (seven men and five women) were recruited for comparison. Functional brain images of all participants were acquired using functional magnetic resonance imaging while performing a same-different judgment task, which was modified to elicit an unexpected emotional processing conflict. RESULTS: PTSD patients, compared to comparison subjects, showed a decreased rostral anterior cingulate functioning when exposed to situations which induce an unexpected emotional processing conflict. Moreover, PTSD symptom severity was negatively correlated to the level of decrease in the rostral anterior cingulate activity. CONCLUSIONS: The results of this study provide evidence that the rostral anterior cingulate functioning is impaired in PTSD patients during response-conflict situations that involve emotional stimuli.

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

PMID: 17400251 [PubMed - indexed for MEDLINE]


J Psychiatry Neurosci. 2008 Mar;33(2):142-6.

Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder.

Bryant RA, Felmingham K, Whitford TJ, Kemp A, Hughes G, Peduto A, Williams LM.

Brain Dynamics Centre, Westmead Hospital, Sydney, Australia.

OBJECTIVE: To index the extent to which treatment response in posttraumatic stress disorder (PTSD) is predicted by rostral anterior cingulate cortex (rACC) volume. METHOD: We used structural magnetic resonance imaging in a 1.5 T scanner  to examine subjects with PTSD (n = 13), traumatized control subjects (n = 13) and nontraumatized control subjects (n = 13). Subjects with PTSD then participated in 8 sessions of cognitive-behavioural therapy, after which we reassessed them for PTSD. RESULTS: According to voxel-based morphometry, treatment responders had larger rACC volume than nonresponders. Further, symptom reduction was associated  with larger rACC volume. CONCLUSION: Consistent with evidence for the neural bases of extinction learning, PTSD patients with larger rACC volume may be better able to regulate fear during cognitive-behavioural therapy and thus achieve greater treatment gains.

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

PMID: 18330460 [PubMed - indexed for MEDLINE]


J Psychoactive Drugs. 2008 Mar;40(1):67-75.

Victimization among African-American adolescents in substance abuse treatment.

Perron BE, Gotham HJ, Cho D.

University of Michigan School of Social Work, Ann Arbor, MI 48109, USA.

Victimization is regarded as a significant public health issue, especially among  adolescents in urban areas. Although victimization is linked to substance use, the research on victimization among adolescents in treatment is underdeveloped. Given the high rate of victimization among African-American adolescents, further  research on the prevalence and correlates of victimization for this population is needed. This knowledge can guide the development of effective treatment and prevention strategies. This study contributed to the research by examining the rate and different types of victimization among a sample of African-American adolescents in an urban substance abuse treatment program, testing whether victimization is associated with increased levels of psychopathology and high-risk behaviors; and comparing the rates and associations with existing studies of adolescent victimization. It reports on a sample of 259 African-American adolescents receiving substance abuse treatment in an inner-city program. Fifty-four percent of the subjects reported lifetime victimization. Severity of victimization was associated with depression, generalized anxiety disorder, traumatic stress disorder, and conduct disorder, although the effect sizes were relatively small. Lifetime victimization exhibited a relationship of small to moderate strength with high-risk behaviors (i.e., illegal activity, gang membership, multiple sex partners and unprotected sex). Service implications and  recommendations for future research are provided.

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

PMID: 18472666 [PubMed - indexed for MEDLINE]


J Psychosoc Nurs Ment Health Serv. 2008 Mar;46(3):45-51.

Adolescents' attitudes toward schizophrenia, depression and PTSD.

Arbanas G.

Department of Psychiatry, General Hospital Karlovac, Karlovac, Croatia.

The objective of this study was to compare adolescents' attitudes toward schizophrenia, depression, and posttraumatic stress disorder (PTSD). Stigmatizing attitudes toward these three mental disorders were evaluated in 325 senior students from medical, commercial, and grammar high schools in Croatia using a 45-item questionnaire. Results indicated that stigmatizing attitudes toward PTSD  were at the same level as attitudes toward depression and were less stigmatizing  than were attitudes toward schizophrenia. Negative attitudes were the lowest among medical students. Gender differences existed only for attitudes toward depression. Stigmatizing attitudes toward PTSD were not as high as expected. All  of the students believed mental disorders are different from other disorders. Specific knowledge of psychiatry has been shown to reduce stigma. The nonaddictive nature of psychotropic medications should receive greater emphasis when teaching psychiatry.

Publication Types:      Comparative Study

PMID: 18416274 [PubMed - indexed for MEDLINE]


J Psychosom Obstet Gynaecol. 2008 Mar;29(1):61-71.

Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth.

Zaers S, Waschke M, Ehlert U.

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zürich, Switzerland.

This study examined the course of psychological problems in women from late pregnancy to six months postpartum, the rates of psychiatric, especially depressive and post-traumatic stress symptoms and possible related antecedent variables. During late pregnancy, one to three days postpartum, six weeks and six months postpartum, 47 of the 60 participating women completed a battery of questionnaires including the General Health Questionnaire, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the PTSD Symptom Scale. In general, most women recovered from psychiatric and somatic problems over the period of investigation. However, depressive and post-traumatic stress symptoms in particular were not found to decline significantly. Six weeks postpartum, 22% of the women had depressive symptoms, with this figure remaining  at 21.3% six months postpartum. In addition, 6% of the women studied reported clinically significant PTSD symptoms at six weeks postpartum with 14.9% reporting such symptoms at six months postpartum. The most important predictor for depressive and post-traumatic stress symptoms was the block variable "anxiety in  late pregnancy". Other predictors were the variables "psychiatric symptoms in late pregnancy", "critical life events" and the "experience of delivery". The results of our study show a high prevalence rate of psychiatric symptoms in women after childbirth and suggest, besides the experience of the delivery itself, a vulnerability or predisposing history that makes the development of psychiatric symptoms after childbirth more probable.

PMID: 18266166 [PubMed - indexed for MEDLINE]


J Psychosom Obstet Gynaecol. 2008 Mar;29(1):53-60.

Parents' mental health after the birth of an extremely preterm child: a comparison between bereaved and non-bereaved parents.

Jenewein J, Moergeli H, Fauchère JC, Bucher HU, Kraemer B, Wittmann L, Schnyder U, Büchi S.

Department of Psychiatry, University Hospital, Zurich, Switzerland.

OBJECTIVE: To assess the impact of extremely preterm birth (24-26 weeks of gestation) on the mental health of parents two to six years after delivery, and to examine potential differences in post-traumatic growth between parents whose newborn infant died and those whose child survived. METHOD: A total of 54 parents who had lost their newborn and 38 parents whose preterm child survived were assessed by questionnaires with regard to depression and anxiety (HADS) and post-traumatic growth (PTGI). RESULTS: Neither group of parents had clinically relevant levels of depression and anxiety. Mothers showed higher levels of anxiety than fathers. Bereaved parents with no other, living child reported higher levels of depression than bereaved parents with one or more children. Mothers reported higher post-traumatic growth compared to fathers. In particular, bereaved mothers experienced the value and quality of their close social relationships more positively compared to the non-bereaved parents. CONCLUSION: In the long term, bereaved and non-bereaved parents cope reasonably well with an  extremely preterm birth of a child. Post-traumatic growth appears to be positively related to bereavement, particularly in mothers.

Publication Types:      Comparative Study

PMID: 18266165 [PubMed - indexed for MEDLINE]


J Urban Health. 2008 Mar;85(2):268-80. Epub 2008 Jan 24.

Sampling and recruitment in multilevel studies among marginalized urban populations: the IMPACT studies.

Ompad DC, Galea S, Marshall G, Fuller CM, Weiss L, Beard JR, Chan C, Edwards V, Vlahov D.

Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth  Avenue, New York, NY 10029-5283, USA.

Illicit drug use in urban settings is a major public health problem. A range of individual level factors are known to influence drug use and its consequences, and a number of recent studies have suggested that the neighborhood in which an individual lives may also play a role. However, studies seeking to identify neighborhood-level determinants of drug use, particularly among marginalized urban populations, need to overcome significant challenges, particularly in the area of sampling and recruitment. One key issue is defining functional neighborhoods that are relevant to local residents. Another arises from the need  to sample a representative or even a diverse population when studying marginalized groups such as illicit drug users. These are common problems that raise particular challenges when both need to be addressed in the same study. For example, many sampling approaches for neighborhood-level studies have included some form of random sample of households, but this may systematically overlook marginalized populations. On the other hand, the sampling approaches commonly used in studies of hidden populations such as chain referral, snow ball, and more recently, respondent-driven sampling, typically expand beyond a geographic "neighborhood." We describe the organization and rationale for the IMPACT Studies in New York City as a case illustration on how such issues may be addressed.

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

PMID: 18214686 [PubMed - indexed for MEDLINE]


Kans Nurse. 2008 Mar;83(3):6-11.

Scrapbooking and journaling interventions for chronic illness: a triangulated investigation of approaches in the treatment of PTSD.

Davidson JU, Robison B.

Rocky Mountain University of Health Professions, Provo, Utah, USA.

Publication Types:      Evaluation Studies

PMID: 18524339 [PubMed - indexed for MEDLINE]


Lijec Vjesn. 2008 Mar-Apr;130(3-4):101-3.

[Disturbed sleep in war veterans according to overnight polysomnography]

[Article in Croatian]

Buljan R, Hrabrić K, Jukić V, Bisko A.

Psihijatrijska bolnica Vrapce.

Sleep disorder is an integral part of posttraumatic stress disorder (PTSD) along  with all subsequent psychological disorders. Overnight polysomnography was performed in a group comprising war veterans (1991-1995) who exhibited a permanent change of personality disorder after they were diagnosed with PTSD as a direct result of combat participation. All 18 (men) participants at our Center who were sent to us from the National Center for Psychotrauma in Zagreb during year 2003, had been suffering from sleep disorder for more than 10 years, and who had on average received either individual or group psychotherapy along with psychopharmacological therapy for a period of 4-8 years. Control group were 14 healthy men without psychiatric disorder. Overnight polysomnography and its subsequent analysis clearly showed discord in five of eight somnological variables when compared during night: reduction in NREM sleep stages 3 and 4, prolonged REM latency, reduction of REM, and a noticeable motoric activity during sleep registered with high PLM index in almost all participants, which disturbed  the sleep continuity. There have been no studies dealing with connection between  sleep disorders and PTSP associated with the war in the Republic Croatia. Results of this study indicate significant sleep disorders and changes of sleep quality in patients with diagnosed PTSP.

Publication Types:      English Abstract

PMID: 18592969 [PubMed - indexed for MEDLINE]


Med Health Care Philos. 2008 Mar;11(1):99-110. Epub 2007 Jun 5.

Inscriptions of violence: societal and medical neglect of child abuse--impact on  life and health.

Kirkengen AL.

Department of Community Medicine, University of Tromsø, Tromsø, Norway.

OBJECTIVE: A sickness history from General Practice will be unfolded with regard  to its implicit lived meanings. This experiential matrix will be analyzed with regard to its medico-theoretical aspects. METHOD: The analysis is grounded in a phenomenology of the body. The patient Katherine Kaplan lends a particular portrait to the dynamics that are enacted in the interface between socially silenced domestic violence and the theoretical assumptions of human health as these inform the clinical practice of health care. RESULTS: By applying an understanding of sickness that transcends the mind-body split, a concealed and complex logic emerges. This logic is embedded in a nexus of the impact of childhood abuse experience and the medical disinterest in subjective experiences  and their impact on selfhood and health. Its core is twofold: the violation of embodiment resulting from intra-familial abuse and existential threat, and the embodiment of violation resulting from social rules and the theoretically blinded medical gaze. CONCLUSION: A considerable medical investment, apparently conducted in a correct and consistent manner as to diagnostic and therapeutic measures, results in the complete incapacitation of a young physician.

Publication Types:      Case Reports

PMID: 17549605 [PubMed - indexed for MEDLINE]


Mem Cognit. 2008 Mar;36(2):449-60.

The reappearance hypothesis revisited: recurrent involuntary memories after traumatic events and in everyday life.

Berntsen D, Rubin DC.

Department of Psychology, University of Aarhus, Aarhus, Denmark.

Recurrent involuntary memories are autobiographical memories that come to mind with no preceding retrieval attempt and that are subjectively experienced as being repetitive. Clinically, they are classified as a symptom of posttraumatic stress disorder. The present work is the first to systematically examine recurrent involuntary memories outside clinical settings. Study 1 examines recurrent involuntary memories among survivors of the tsunami catastrophe in Southeast Asia in 2004. Study 2 examines recurrent involuntary memories in a large general population. Study 3 examines whether the contents of recurrent involuntary memories recorded in a diary study are duplicates of, or differ from, one another. We show that recurrent involuntary memories are not limited to clinical populations or to emotionally negative experiences; that they typically  do not come to mind in a fixed and unchangeable form; and that they show the same pattern regarding accessibility as do autobiographical memories in general. We argue that recurrent involuntary memories after traumas and in everyday life can  be explained in terms of general and well-established mechanisms of autobiographical memory.

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

PMID: 18426073 [PubMed - indexed for MEDLINE]


Midwifery. 2008 Mar;24(1):62-73. Epub 2007 Jan 12.

A pilot study of eye movement desensitisation and reprocessing treatment (EMDR) for post-traumatic stress after childbirth.

Sandström M, Wiberg B, Wikman M, Willman AK, Högberg U.

Private Practice, Umeå Utveckling AB, Sweden.

OBJECTIVE: to explore the possibility of using eye movement desensitisation and reprocessing (EMDR) to treat women who have experienced post-traumatic stress after childbirth. DESIGN: the pilot study consisted of a 'before and after' treatment design combined with follow-up measurements 1-3 years after EMDR treatment. Quantitative data from questionnaires (Traumatic Event Scale [TES]) were collected. In addition, qualitative data from individual interviews with the participants were collected as well as data from the psychotherapist's treatment  notes of the EMDR treatment sessions. SETTING: the north of Sweden. PARTICIPANTS: four women with post-traumatic stress disorder (PTSD) after childbirth (one pregnant and three non-pregnant). FINDINGS: all participants reported reduction of post-traumatic stress after treatment. After 1-3 years, the beneficial effects of EMDR treatment remained for three of the four women. Symptoms of intrusive thoughts and avoidance seemed most sensitive for treatment. IMPLICATIONS FOR PRACTICE: EMDR might be a useful tool in the treatment of non-pregnant women severely traumatised by childbirth; however, further research is required.

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

PMID: 17223232 [PubMed - indexed for MEDLINE]


Mt Sinai J Med. 2008 Mar-Apr;75(2):115-27.

Mental health of workers and volunteers responding to events of 9/11: review of the literature.

Bills CB, Levy NA, Sharma V, Charney DS, Herbert R, Moline J, Katz CL.

Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.

BACKGROUND: Disaster workers responding to the events of September 11th were exposed to traumatic events. No study has systematically investigated the diverse mental health status and needs of the heterogeneous population of disaster workers responding to the events of September 11th. METHODS: Using PubMed and Medline and the search terms of "September 11, 2001" or "September 11" or "9/11"or "WTC" or "World Trade Center", the authors reviewed all articles that examined the mental health outcomes of workers at one of the three September 11th crash sites or the Fresh Kills landfill in New York City. RESULTS: In total, 25 articles met study inclusion criteria, often using different methodologies. The articles described varying degrees of mental health symptomatology, risk factors  for adverse mental health outcomes, and utilization of mental health services. CONCLUSIONS: The mental health needs of workers exposed to the events of September 11th ranged from little to no care to pharmacotherapy. A range of risk  factors, including exposures at the WTC site and occupational activities, impacted on these needs but the role of specific mental health interventions was  less clear. These findings suggest the need for a future program for disaster workers consisting of an accessible mental health treatment service supported by  comprehensive postdisaster surveillance and emphasis on pre-disaster mental wellness. A number of areas for further consideration and study were identified,  including the need for a more diverse exploration of involved responder populations as well as investigation of potential mental health outcomes beyond post-traumatic stress disorder (PTSD). Copyright (c) 2008 Mount Sinai School of Medicine

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

PMID: 18500712 [PubMed - indexed for MEDLINE]


Pediatr Crit Care Med. 2008 Mar;9(2):217-23.

Surgery-related posttraumatic stress disorder in parents of children undergoing cardiopulmonary bypass surgery: a prospective cohort study.

Helfricht S, Latal B, Fischer JE, Tomaske M, Landolt MA.

University Children's Hospital Zurich, Child Development Center, Zurich, Switzerland.

OBJECTIVE: We aimed at evaluating surgery-related posttraumatic stress disorder (PTSD) in parents of children undergoing cardiopulmonary bypass surgery. Risk factors for parental PTSD symptoms were explored. DESIGN: A prospective cohort study was performed assessing PTSD symptoms immediately after discharge and 6 months after cardiopulmonary bypass surgery. SETTING: Recruitment took place at a tertiary pediatric medical center in Switzerland. SUBJECTS: German-speaking parents of children with congenital heart defects aged between 0 and 16 yrs undergoing cardiopulmonary bypass surgery were eligible (n = 228). After child discharge, 135 mothers and 98 fathers of 139 children (response rate 61.0%) participated. Six months after surgery, 121 mothers and 92 fathers of 128 children (response rate, 56.1%) took part in the study. INTERVENTIONS: Assessment via a screening instrument and self-rating scale, and extraction of data from charts. MEASUREMENTS AND MAIN RESULTS: The Posttraumatic Diagnostic Scale was applied to estimate self-reported symptoms of PTSD. Following discharge, 16.4% of mothers and 13.3% of fathers met diagnostic criteria for acute PTSD. Another 15.7% of mothers and 13.3% of fathers experienced significant symptoms of posttraumatic stress. Six months after surgery, PTSD rates were 14.9% and 9.5%, respectively. Mothers experienced more severe symptoms of PTSD, but gender differences were not detected with regard to the frequency of PTSD at either time. After controlling for socioeconomic status and child preoperative morbidity, PTSD symptom severity after discharge remained the only significant predictor of PTSD severity at 6 months. Pre-, peri-, and postoperative factors did not predict parental PTSD. CONCLUSIONS: Parents of children undergoing cardiopulmonary bypass surgery are at increased risk for intermediate and long-term psychological malfunctioning. Acute symptoms of PTSD in parents shortly after discharge of their child are a major risk factor for the development of chronic PTSD. Clinicians need to identify parents at risk at an early stage to provide them with systematic support.

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

PMID: 18477936 [PubMed - indexed for MEDLINE]


Pediatr Rev. 2008 Mar;29(3):103-4; discussion 104.

Posttraumatic stress disorder.

Copeland-Linder N.

Johns Hopkins School of Medicine and the Bloomberg School of Public Health Baltimore, Md, USA.

PMID: 18310469 [PubMed - indexed for MEDLINE]


Pharmacol Biochem Behav. 2008 Mar;89(1):11-6. Epub 2007 Nov 6.

Activation of the serotonin 5-HT2C receptor is involved in the enhanced anxiety in rats after single-prolonged stress.

Harada K, Yamaji T, Matsuoka N.

Pharmacology Research Laboratories, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan. <>

We have recently confirmed that exposure of rats to the single-prolonged stress (SPS) paradigm induces enhanced hypothalamic-pituitary-adrenal (HPA) axis negative feedback and enhanced anxiety, and found that these changes develop time-dependently following stress exposure, suggesting that it could model the neuroendocrinological and behavioral abnormalities of the post-traumatic stress disorder (PTSD) patients. In the present study, microarray analysis was performed using RNA from the hippocampus, amygdala and anterior cingulate cortex of SPS rats and unstressed controls to unveil the molecular changes underlying SPS-induced behavioral changes. Thirty-one genes were found whose time course of  expression corresponded to that of behavioral changes. One gene, 5-hydroxytryptamine2C (5-HT2C) receptor, was identified as a putative candidate.  The overexpression of the gene in the amygdala of SPS rats was confirmed using real-time PCR 7 days after the SPS exposure. This molecule was then pharmacologically validated using FR260010 (N-[3-(4-methyl-1H-imidazol-1-yl)phenyl]-5,6-dihydrobenzo[h]quinazolin-4-amine dimethanesulfonate), a selective 5-HT2C receptor antagonist. FR260010 (1-10 mg/kg, s.c.) significantly inhibited the enhancement of anxiety in SPS rats. These results demonstrate for the first time that activation of the brain 5-HT2C  receptor is involved in the development of behavioral abnormality in this model.  This suggests that selective 5-HT2C receptor antagonists might provide novel therapeutic avenues for PTSD treatment.

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

PMID: 18067955 [PubMed - indexed for MEDLINE]


Psychiatr Danub. 2008 Mar;20(1):80-4.

Relationship between combat related posttraumatic stress disorder (PTSD) and multiple sclerosis (MS).

Bras M, Gregurek R, Milunović V, Busić I, Brajković L.

Clinic for Psychological Medicine, University Hospital Center Zagreb, Croatia.

The interrelation between chronic stress and multiple sclerosis (MS) has always been known, but the biological foundation for this phenomenon has not yet been proven. Our case-study of 5 patients, both diagnosed with multiple sclerosis and  PTSD, attempts to demonstrate various dimensions of interrelation between these two diseases. We have also tried to point out the problems and possible complications doctors might encounter during the treatment of an MS patient who is suffering from chronic stress. Our findings show the need for a multidisciplinary approach in the treatment of patients with chronic PTSD and co  morbid multiple sclerosis, which will optimize treatment and result in more cost-effective care. Appropriate identification and optimal pharmacological interventions for both disorders might modify further chronicity of these disorders and thus achieve better outcome.

Publication Types:      Case Reports

PMID: 18376335 [PubMed - indexed for MEDLINE]


Psychiatr Danub. 2008 Mar;20(1):75-9.

Case-control study: posttraumatic stress disorder and habits of war veterans.

Zalihić A, Skobić H, Pejanović-Skobić N.

Department of Family medicine, Health Care Center Mostar, Hrvatskih branitelja bb, Faculty of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina.

AIM: To correlate habits (abuse of tobacco, alcohol, psychoactive substances and  drugs) of war veterans and the frequency of symptoms in persons with PTSD and those without it. METHODS: We have carried out a prospective research (case-control study) over the period between September of 2005 and June 2006. The sample consisted of two groups of examinees: 60 males, war veterans with PTSD and 60 males, war veterans without PTSD. The group of war veterans without PTSD was formed using matching criteria (same age, level of education). Both groups included married males. Research was performed using a questionnaire designed for this study. RESULTS: A higher number of war veterans without PTSD were employed compared to war veterans with PTSD (chi2=45.753; df=4; p<0.050). A higher number  of war veterans with PTSD used psychoactive substances during the war period compared to war veterans without PTSD (18.3% vs. 3.3%). We have observed that 85% of examinees with PTSD have used anxiolitic drugs in the period of research, compared to only 5% of those without PTSD (chi2=77.576; df=1; P<0.050). All examinees with PTSD had some form of sleep disorders comparing to 70% of those without PTSD (chi2=50.595; df=3; P<0.050). Analysis of alcohol abuse showed a statisticaly significant difference between the examined groups (chi2=9.654; df=2; P=0.008). CONCLUSION: A higher number of war veterans without PTSD had employment in comparison to the group of war veterans with PTSD. A higher number  of war veterans with PTSD had some form of sleeping disorder, used psychoactive substances and anxiolitic drugs during the war period, and had alcohol abuse in comparison to the group of war veterans without PTSD.

PMID: 18376334 [PubMed - indexed for MEDLINE]


Psychiatr Serv. 2008 Mar;59(3):318-21.

Quality and use of trauma histories obtained from psychiatric outpatients: a ten-year follow-up.

Posner J, Eilenberg J, Friedman JH, Fullilove MJ.

Department of Psychiatry, Columbia College of Physicians and Surgeons, USA.

OBJECTIVE: In 1996 Eilenberg and colleagues reviewed 180 charts and reported that trauma histories were poorly documented at a general psychiatric clinic. This study is a ten-year replication of that work. METHODS: A total of 107 randomly selected charts from the same clinic were reviewed for assessment of trauma history. The quality of the assessments was rated. RESULTS: Fifty-six percent of  charts contained a thorough description of trauma severity, compared with 15% in  the initial study. Documentation of posttraumatic symptoms improved significantly in all categories but remained low. Documentation of diagnostic formulations and  treatment plans for patients with a trauma history was thorough in a small proportion of charts (14%), as was found in the initial study (9%). CONCLUSIONS:  Although some improvements were found in recording trauma histories, eliciting such a history did not lead to thorough documentation of posttraumatic symptoms or to inclusion of the history in the diagnostic formulation or treatment plan.

PMID: 18308915 [PubMed - indexed for MEDLINE]


Psychiatr Serv. 2008 Mar;59(3):304-9.

The long road home: rebuilding public inpatient psychiatric services in post-Katrina New Orleans.

Calderon-Abbo J.

Department of Psychiatry, Louisiana State University Health Sciences Center, 210  State St., New Orleans, LA 70118, USA.

In August 2006, a year after Hurricane Katrina, the first acute inpatient public  psychiatric unit for adults was opened in New Orleans to serve patients referred  from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced  workforce. Lessons learned in regard to disaster planning and recovery are also discussed.

PMID: 18308912 [PubMed - indexed for MEDLINE]


Psychiatr Serv. 2008 Mar;59(3):229.

The importance of assessing exposure to trauma.

Ursano RJ, Engel CC.

Publication Types:      Editorial

PMID: 18308899 [PubMed - indexed for MEDLINE]


Psychol Health Med. 2008 Mar;13(2):162-7.

Anxiety in recovery from severe burn injury: an experimental comparison.

Hulbert-Williams NJ, Hulbert-Williams SL, McIlroy D, Bunting B.

Department of Primary Care and Public Health, North Wales Clinical School, Cardiff University, Wrexham, UK.

Adjustment to burn injury is a slow process that often results in high distress and anxiety. This study aimed to investigate the impact on anxiety of viewing various types of photographic stimuli (including burn injuries), comparing a burn-injured and control sample. An experimental design was used comparing those  recovering from a burn injury with age- and gender-matched controls. Thirty participants from a burns support group and their matched controls were asked to  complete a trait anxiety measure (STAI Y-2). Participants then completed the state anxiety measure (STAI Y-1) after viewing different types of photographic stimuli (burn injuries, uninjured body parts, neutral) under controlled experimental conditions. Results demonstrated significant differences in anxiety  levels between groups with respect to trait anxiety and state anxiety after each  experimental condition. Age of injury was also found to be a significant influence over trait anxiety. A significant effect of experimental condition was  found, as was a significant interaction between group and condition. Those with burn injuries were more anxious than controls - a difference that was further exaggerated when participants viewed photographs of burned or uninjured body parts in an experimental setting.

PMID: 18350460 [PubMed - indexed for MEDLINE]


Psychopharmacology (Berl). 2008 Mar;197(1):13-23. Epub 2007 Nov 23.

Noradrenergic-glucocorticoid mechanisms in emotion-induced amnesia: from adaptation to disease.

Hurlemann R.

Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.

DISCUSSIONS: The interaction of emotion and episodic encoding has costs and benefits. These costs and benefits have been characterized in oddball experiments, where a violation of prevailing neutral context through aversive oddballs is associated with subsequent hypermnesia for the aversive oddball and peri-emotional amnesia for the neutral context. Both hypermnesia and peri-emotional amnesia are amygdala-dependent and vary as a function of noradrenergic-glucocorticoid input to the amygdala during emotional episodic encoding. Pharmacological enhancement of this input allows to model the maladaptive effects of emotion on episodic encoding. Extrapolation of these findings to conditions of emotional trauma suggests that disinhibited noradrenergic-glucocorticoid signaling could serve as a crucial etiological contributor to the pathogenesis of peri-traumatic amnesia (PTA) and post-traumatic stress disorder (PTSD). CONCLUSIONS: Immediate pharmacological blockade of noradrenergic-glucocorticoid signaling might prove effective in the secondary prevention of PTA and PTSD.

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

PMID: 18038126 [PubMed - indexed for MEDLINE]


Psychother Psychosom Med Psychol. 2008 Mar-Apr;58(3-4):169-75.

[Psychotherapy with traumatised migrants from Turkey: taking into account cultural factors]

[Article in German]

Schouler-Ocak M, Rapp MA, Reiske SL, Heinz A.

Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Grosse Hamburger Strasse 5 - 11, 10115 Berlin, Germany.

Culture-specific concepts of health and disease, cultural values, and other culture-specific factors can influence the outcome of psychotherapeutic interventions in migrant patients. In this article, culture-specific factors, and specifically, their role in sexually traumatized migrant patients from Turkey, are reviewed and illustrated with two case reports. The influence of culture-specific factors on trauma-focussed psychotherapy is being discussed.

Publication Types:      Case Reports     English Abstract

PMID: 18421657 [PubMed - indexed for MEDLINE]


Psychother Psychosom Med Psychol. 2008 Mar-Apr;58(3-4):155-61.

[Traumatic events and posttraumatic stress disorder in Turkish-speaking patients  in primary care]

[Article in German]

Tagay S, Zararsiz R, Erim Y, Düllmann S, Schlegl S, Brähler E, Senf W.

Klinik für Psychosomatische Medizin und Psychotherapie, Rheinische Kliniken Essen/Universitätsklinik Duisburg-Essen, Universität Duisburg-Essen, Virchowstrasse 174, 45147 Essen.

In a consecutive cross-sectional study 195 Turkish/Kurdish patients from seven general practices (40.5 +/- 13.3 years, 63.6 % female) were examined with regard  to traumatisation and psychological distress with the Essen Trauma Inventory (ETI) and Hospital Anxiety and Depression Scale (HADS). In mean the average duration of living in Germany was 25,3 years (SD = 8.9). 53.3 % reported at least one traumatic event in their life. Of those who experienced a traumatic event, 19.6 % met testpsychometric a positive diagnosis of PTSD. In general, patients with PTSD were more likely to report more about doctor visits (p <or= 0.03), psychotherapy (p <or= 0.01), and use of psychotropics (p <or= 0.01) compared to non traumatized patients. In addition, psychological distress was observed more in PTSD patients on depression (p <or= 0.03) and anxiety (p <or= 0.03) than non traumatized patients. The study demonstrates that PTSD on Turkish/Kurdish migrants is highly prevalent in the primary care. Therefore, the aspect of traumatisation should be increasingly taken into consideration in the diagnostic  process.

Publication Types:      English Abstract

PMID: 18421655 [PubMed - indexed for MEDLINE]


Psychother Psychosom Med Psychol. 2008 Mar-Apr;58(3-4):109-22.

[Depression, anxiety and posttraumatic stress disorders in labor migrants, asylum seekers and refugees. A systematic overview]

[Article in German]

Lindert J, Brähler E, Wittig U, Mielck A, Priebe S.

Evangelische Fachhochschule Ludwigsburg, Abteilung für Public Health, Auf der Karlshöhe 2, 76138 Ludwigsburg.

BACKGROUND: In 2006 there were about 200 millions of transnational "voluntary" migrants like labor migrants and "involuntary migrants" like refugees and asylum  seekers worldwide. Depression, anxiety and posttraumatic stress disorder (PTSD) is the most prevalent psychiatric disorders in general populations and is reported to be highly prevalent among migrants. AIMS: We aimed to assess and compare syndromes and symptoms of depression and anxiety in labor migrants and refugees; and to examine whether the prevalence rates are associated with study methods' and study quality. METHODS: We systematically searched in the databases  MEDLINE and EMBASE for studies published from 1994 - 2007. Studies fulfilling the inclusion criteria are 1) systematically described: 2) and evaluated with 15 quality criteria. RESULTS: The literature search generated 348 results; and 37 fulfilled our inclusion criteria (35 populations) with n = 24 681 migrants (labor migrants: n = 16 971; refugees: n = 7710). Size of studies varies from a minimum  of n = 55 participants to a maximum of n = 4558 participants (Median: n = 338). Prevalence rates for depression vary between 3 % and 47 % (labor migrants) and between 3 % and 81 % (refugees); for anxiety between 6 % and 44 % (labor migrants) and between 5 % and 90 % (refugees) and for PTSD between 4 % and 86 %.  No study fulfilled all 15 quality criteria. CONCLUSION AND OUTLOOK: Migrants are  a heterogeneous group and prevalence rates vary widely between studies. There is  a need of high-quality representative studies on migrants' mental health to adequately plan health and social care.

Publication Types:      English Abstract     Review

PMID: 18421650 [PubMed - indexed for MEDLINE]


Scand J Public Health. 2008 Mar;36(2):161-8.

Partner violence and health: results from the first national study on violence against women in Norway.

Nerøien AI, Schei B.

Department of Public Health and General Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

BACKGROUND: Violence against women has long been considered a hidden health burden. Questions about violence have not been included in health surveys; hence, little is known about prevalence and the consequences for health in the general population. No national study has been conducted in Norway. AIMS: To estimate the prevalence of partner violence in Norway and the relationship between victimization and somatic health and depression and anxiety and post-traumatic stress symptoms. METHODS: Data collection was performed by Statistics Norway. Among a random sample of women aged 20-55 years, 2,407 women returned the questionnaire (63.3%), of whom 2,143 were ever-partnered. Selected demographic characteristics were obtained from registers. RESULTS: In total, 26.8% of 2,143 ever-partnered women had experienced any violence by their partner during their lifetime, and 5.5% in the year before the study. Low educational level, being unmarried, separated or divorced, currently being unemployed, receiving social security benefits and having no children were significantly associated with reporting partner violence. Exposure to partner violence was associated with poor health, depressive and post-traumatic stress symptoms, gynaecological complaints, injuries, and disability, and remained so after controlling for age, education, unemployment, relationship break-up and low economic status. CONCLUSIONS: Partner violence is common and was associated with a range of somatic and mental health problems. Thus, violence against women by their partners is an important public health concern.

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

PMID: 18519280 [PubMed - indexed for MEDLINE]


Soc Psychiatry Psychiatr Epidemiol. 2008 Mar;43(3):184-91. Epub 2007 Nov 16.

Prevalence and risk factors of threshold and sub-threshold psychiatric disorders  in primary care.

Cwikel J, Zilber N, Feinson M, Lerner Y.

Center for Women's Health Studies and Promotion, Ben Gurion University of the Negev, POB 653, Beer Sheva, Israel 84105.

OBJECTIVE: Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care. METHOD: Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages  of 25-75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two "other mental health disorders" (somatization and disordered eating) and five sub-threshold conditions. RESULTS:  The most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had 'other mental disorders' and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45-64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and  Jewish Israelis or between secular or religious sectors of the population. CONCLUSIONS: This study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.

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

PMID: 18026679 [PubMed - indexed for MEDLINE]


Versicherungsmedizin. 2008 Mar 1;60(1):14-20.

[Coping with crisis as an important factor in the rehabilitation process]

[Article in German]

Clemens K, Hack E, Sülzer A, Schottmann J.

Human Protect Consulting GmbH, Köln.

Accidents and serious illnesses are inevitably associated with an emotional crisis, based on the fact that they are followed by significant consequences. Coping with this crisis requires enormous mental adaptation. This active coping process is typically characterised by three phases: the shock phase, the coping phase in the narrow sense and the phase of successful coping versus chronification. In order to ensure a positive rehabilitation process, successful  coping with the illness is necessary. It is therefore absolutely crucial to analyse individual coping styles and possible obstacles thoroughly from a psychological point of view. In order to prevent a process of chronification, relevant psychosocial factors should be considered along with the medical and occupational aspects early in the rehabilitation process. Ultimately, psychological stability is the prerequisite for successful rehabilitation.

Publication Types:      English Abstract

PMID: 18405230 [PubMed - indexed for MEDLINE]


Versicherungsmedizin. 2008 Mar 1;60(1):8-13.

[Malingering of post-traumatic stress disorder]

[Article in German]

Dressing H, Meyer-Lindenberg A.

Zentralinstitut für Seelische Gesundheit, Mannheim.

Post-traumatic stress disorder is a frequently diagnosed disorder. Expert assessments of claimants with PTSD symptoms have become a common challenge for physicians in civil lawsuits. Since diagnosis of PTSD relies primarily on the patient's subjective report, this syndrome is particularly vulnerable to malingering. For this reason, it is important for physicians to try to identify individuals with true PTSD and differentiate them from those who malinger the disorder. This paper outlines the general problems and assessment strategies involved in the detection of malingering. A special focus is placed on the typical presentation of malingered PTSD symptoms.

Publication Types:      English Abstract

PMID: 18405229 [PubMed - indexed for MEDLINE]


Voen Med Zh. 2008 Mar;329(3):56-62, 112.

[Neuro-physiological and morphological manifestations of posttraumatic stress disorder (review of literature)]

[Article in Russian]

Reshetnikov VA, Reznik AM.

The article presents the review of neurophysiological and neuro-morphological researches of combat posttraumatic stress disorder. Also in the article presented data about the existence by the veterans, suffered by combat posttraumatic stress disorder, a regular dysfunction of hypothalamus-pituitary-paranephric system, approving by excessive allowance ruffling ofcortisol, tending the activation neuro-trasmitteric systems. These changes conjoin with predominance of sympaticotony and of increased psycho and physiological inflammability in response to cues, associated with real or imaginable danger. Methods of neurovisulisation show the existence of changes in visceral brain, prefrontal and sense-motorical zone of cerebrum, corresponded to stress signals. The article presents the discuss of cause-and-effects conditions between the morphological changes in central nervous system, influence of stress-factors and advance of disease.

Publication Types:      English Abstract     Review

PMID: 18488491 [PubMed - indexed for MEDLINE]


Vojnosanit Pregl. 2008 Mar;65(3):199-204.

[Assessment of clinical depression comorbid with posttraumatic stress disorder]

[Article in Serbian]

Simonović M, Grbesa G, Milenković T, Radisavljević M.

Klinicki centar, Nis, Srbija.

BACKGROUND/AIM: Comorbidity of the posttraumatic stress disorder (PTSD) and depression is often recognized in the clinical practice. The aim of the paper was to determine the severity of depression and the group of symptoms which are the most prominent in clinical depression comorbid with PTSD. METHODS: Totally 60 patients were assessed and divided into the experimental and control group using  the Structured Clinical Interview for DSM-IV Axis I Disorders, Investigator Version (SCID-I, modified) (SCID for DSM-IV) and ICD-10 diagnostic criteria. The  presence and the severity of the disorders were assessed by means of the following intruments: Clinician-Administrated PTSD Scale for DSM-IV (CAPS-DX), Montgomery-Asberg Depression Rating Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HAMD). The differences between groups were evaluated using  Student t test and by means of the correlational analysis of the data with p < 0.05. RESULTS: The obtained results showed that depression which was comorbid with PTSD was of significant clinical severity with 31.20 score on HAMD and 30.43 score on MADRS in PTSD-D group. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression on MADRS. The group of the symptoms: suicide and somatic symptoms, gastrointestinal, guilt, hypochondriasis, work and  activity, anxiety psychic, agitation, and weight loss, genital symptoms and anxiety somatic contributed mostly to the global severity of comorbid clinical depression on HAMD. The average score was 16.03 and 16.97 on HAMD and MADRS, respectively in PTSD group. CONCLUSION: Depression which is comorbid with posttraumatic stress disorder represents significant clinical entity with domination of the different groups of symptoms between the groups PTSD and PTSD-D on HAMD. Identification of aforementioned severity of illness and delineated group of symptoms lead the clinician to establish the diagnosis of depression, reduce the risk of diagnostic ommition of the depression and enable the clinician to chose the optimal treatment method for the delineated disorders.

Publication Types:      English Abstract

PMID: 18494267 [PubMed - indexed for MEDLINE]


Rev Prat. 2008 Feb 29;58(4):366-72.

[Adult depressive disorder: clinical aspects, nosography and psychiatrics comorbidity]

[Article in French]

Albou A, Allilaire JF.

Service de psychiatrie adulte, groupe hospitalier La Pitié-Salpêtrière, 75651 Paris Cedex 13.

Depressed mood and anhedonia are the main symptoms of depressive disorder. With other symptoms, it is responsible for a real break with premorbid patient's way of life. Several clinicals forms, caracterised by melancholia intensity, psychotic symptoms and cognitive troubles, must be identified to adapt treatment  and to prevent patients from particular risks. The short and middle term prognosis is linked to the suicidal risk and the socioprofessionnal and familial  consequences. Long term risk is the disease chronicisation, recurrence and bipolarity. The existence of other psychiatric comorbidity, such as alcoholism, personality disorder, anxiety disorder, is frequent and must be envisaged, despite the difficulty linked with symptoms intrication.

Publication Types:      Comparative Study     English Abstract

PMID: 18506974 [PubMed - indexed for MEDLINE]


Psychiatry Res. 2008 Feb 28;162(2):147-57. Epub 2008 Jan 16.

Abnormal N-acetylaspartate in hippocampus and anterior cingulate in posttraumatic stress disorder.

Schuff N, Neylan TC, Fox-Bosetti S, Lenoci M, Samuelson KW, Studholme C, Kornak J, Marmar CR, Weiner MW.

Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA 94121, USA.

Magnetic resonance spectroscopic imaging (MRSI) studies suggest hippocampal abnormalities in posttraumatic stress disorder (PTSD), whereas findings of volume deficits in the hippocampus, as revealed with magnetic resonance imaging (MRI), have been inconsistent. Co-morbidities of PTSD, notably alcohol abuse, may have contributed to the inconsistency. The objective was to determine whether volumetric and metabolic abnormalities in the hippocampus and other brain regions are present in PTSD, independent of alcohol abuse. Four groups of subjects, PTSD  patients with (n=28) and without (n=27) alcohol abuse and subjects negative for PTSD with (n=23) and without (n=26) alcohol abuse, were enrolled in this observational MRI and MRSI study of structural and metabolic brain abnormalities  in PTSD. PTSD was associated with reduced N-acetylaspartate (NAA) in both the left and right hippocampus, though only when normalized to creatine levels in the absence of significant hippocampal volume reduction. Furthermore, PTSD was associated with reduced NAA in the right anterior cingulate cortex regardless of  creatine. NAA appears to be a more sensitive marker for neuronal abnormality in PTSD than brain volume. The alteration in the anterior cingulate cortex in PTSD has implications for fear conditioning and extinction.

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

PMID: 18201876 [PubMed - indexed for MEDLINE]


J Clin Oncol. 2008 Feb 20;26(6):934-41.

Post-traumatic stress outcomes in non-Hodgkin's lymphoma survivors.

Smith SK, Zimmerman S, Williams CS, Preisser JS, Clipp EC.

University of North Carolina at Chapel Hill, Chapel Hill; Duke University, Durham, NC, USA.

PURPOSE: A large body of evidence suggests that being diagnosed with and treated  for cancer adversely affects functioning and quality of life, yet less is known about longer term outcomes. Therefore, this study aims to estimate the prevalence of post-traumatic stress disorder (PTSD) symptoms in survivors of adult non-Hodgkin's lymphoma (NHL) who are at least 2 years postdiagnosis and identify  the risk factors associated with PTSD symptoms, with a focus on those that are amenable for screening and modifiable. PATIENTS AND METHODS: A total of 886 NHL survivors identified from the cancer registries of two hospitals in North Carolina participated, ranging in age from 25 to 92 years old and ranging from 2  to 44 years postdiagnosis. Survivors were mailed a survey that assessed PTSD symptoms and quality of life. RESULTS: Participants averaged 10.2 years postdiagnosis, and most (61%) reported no PTSD symptoms. The adjusted prevalence  for full PTSD was 7.9%, with an additional 9.1% meeting criteria for partial PTSD. Modifiable risk factors that were independently associated with PTSD in multiple linear regression included less social support, negative appraisals of life threat and treatment intensity, and more employment and insurance issues. Additionally, several demographic characteristics (nonwhite race, less education, and younger age) and clinical or health-related factors (active disease, more recent diagnosis, and more comorbidity) were independently associated with PTSD.  CONCLUSION: Although only 8% of survivors met PTSD diagnostic criteria, the impact of a cancer diagnosis and treatment persists for many survivors, as evidenced in 39% of this sample. Early identification of those at risk could enable treatment to minimize PTSD symptomatology.

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

PMID: 18281667 [PubMed - indexed for MEDLINE]


BMJ. 2008 Feb 16;336(7640):366-71. Epub 2008 Jan 15.

Comment in:     Evid Based Ment Health. 2008 Nov;11(4):126.

New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study.

Smith TC, Ryan MA, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D; Millennium Cohort Study Team.

Department of Defense Center for Deployment Health Research at the Naval Health Research Center, San Diego, CA 92106, USA.

OBJECTIVE: To describe new onset and persistence of self reported post-traumatic  stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan. DESIGN: Prospective cohort analysis. SETTING AND PARTICIPANTS: Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants. MAIN OUTCOME MEASURES: Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist-civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. RESULTS: More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for  the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress  disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms. CONCLUSIONS: After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.

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

PMID: 18198395 [PubMed - indexed for MEDLINE]


Biol Psychiatry. 2008 Feb 15;63(4):398-405. Epub 2007 Sep 7.

The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma.

Heim C, Mletzko T, Purselle D, Musselman DL, Nemeroff CB.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA.

BACKGROUND: The dexamethasone/corticotropin-releasing factor (CRF) test is considered to be the most sensitive measure of hypothalamic-pituitary-adrenal (HPA) axis hyperactivity and has been demonstrated to be altered in patients with major depression (MDD). Although childhood trauma is a demonstrated risk factor for MDD and patients with a history of childhood abuse and MDD demonstrate HPA axis hyperactivity, the dexamethasone/CRF test remains unstudied in this population. We determined the impact of childhood trauma on dexamethasone/CRF test results in patients with MDD. METHODS: Forty-nine healthy men, ages 18-60 years, without mania or psychosis, active substance abuse, or eating disorder and medication-free were recruited into four study groups, including: 1) normal subjects with no childhood abuse history or psychiatric disorder (n = 14); 2) men with childhood abuse histories without current MDD (n = 14); 3) men with childhood abuse histories with current MDD (n = 15); and 4) men with current MDD  and no childhood abuse history (n = 6). Plasma adrenocorticotropin (ACTH) and cortisol concentrations were measured in response to dexamethasone/CRF administration. RESULTS: Men with childhood trauma histories exhibited increases  in ACTH and cortisol responses to dexamethasone/CRF compared with non-abused men. In particular, abused men with current MDD showed increased responsiveness compared with control subjects and depressed men without childhood abuse experience. Increased response was associated with the severity, duration, and earlier onset of the abuse. The effects were not explained by concurrent posttraumatic stress disorder. CONCLUSIONS: Childhood trauma increases HPA axis activity as measured with the dexamethasone/CRF test in adult men with MDD, potentially reflecting environmental risk for developing depression.

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

PMID: 17825799 [PubMed - indexed for MEDLINE]


Biol Psychiatry. 2008 Feb 15;63(4):406-14. Epub 2007 Aug 14.

The interplay of familial depression liability and adverse events in predicting the first onset of depression during a 10-year follow-up.

Zimmermann P, Brückl T, Lieb R, Nocon A, Ising M, Beesdo K, Wittchen HU.

Molecular Psychology Unit, Max Planck Institute of Psychiatry, Munich, Germany.

BACKGROUND: The aim of the present article is to explore interaction and correlation effects between familial depression liability and selected adverse (separation and traumatic) events in predicting the first onset of a major depressive episode (MDE) in a 10-year prospective longitudinal community survey.  METHODS: Analyses are based on 1982 subjects (14 to 24 years at baseline) without baseline MDE who participated during the whole study period and for whom diagnostic information about psychopathology in both parents was available. The offspring's familial depression liability was determined by aggregating information on parental depressive symptoms obtained from family history data and direct interviews with parents. Data were assessed with the Munich-Composite International Diagnostic Interview according to its DSM-IV algorithms. RESULTS: Adverse events predicted a substantially increased incidence of MDE among respondents with familial liability but not in those without familial liability.  There was a significant interaction between familial liability and traumatic events with the strongest effect for the number of severe traumatic events (risk  difference = 11.3%; 95% confidence interval = 3.55-19.15). Associations with familial liability were most pronounced for separation events. CONCLUSIONS: Adverse events are particularly pathogenic in individuals with familial liability. The involvement of interactions and correlations between familial liability and adversity might depend on type, severity, and number of events. Both processes are suggested to be concomitant rather than exclusive.

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

PMID: 17698041 [PubMed - indexed for MEDLINE]


Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15;32(2):544-51. Epub 2007 Oct 30.

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

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

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

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

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