Clin Psychol Rev. 2009 Feb;29(1):87-100. Epub 2008 Oct 20.

Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model.

Elwood LS, Hahn KS, Olatunji BO, Williams NL.

Center for Trauma Recovery, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 63121, USA. elwoodls@umsl.edu

While some individuals develop PTSD subsequent to traumatic experiences, many individuals resume prior functioning naturally. Diathesis-stress models suggest that stable individual differences present in individuals prior to trauma may serve as vulnerability factors to symptom development. The high levels of comorbidity and symptom similarity suggest that established vulnerability factors for anxiety and depression may also serve as vulnerability factors for PTSD. The  examination of multiple vulnerability factors simultaneously may increase understanding of the etiology of PTSD and comorbid post-trauma symptomatology and account for a greater percentage of variance in PTSD symptoms. In addition, the vulnerability factors may be related to distinct sets of symptoms, with vulnerabilities predicting the PTSD symptoms most similar to their associated disorders. Research examining the relations between attributional style, rumination, anxiety sensitivity, and the looming cognitive style and the development of PTSD after trauma exposure is reviewed and suggestions for future  research are provided.

PMID: 19008028 [PubMed - in process]

 

Clin Psychol Rev. 2009 Feb;29(1):24-33. Epub 2008 Sep 30.

Posttraumatic growth in cancer: reality or illusion?

Sumalla EC, Ochoa C, Blanco I.

Fundación Privada de Gastroenterología, Dr. Francisco Vilardell, Barcelona, Spain.

Research in posttraumatic growth (PTG) among cancer patients has been triggered primarily by the inclusion of serious illnesses among the events that can lead to posttraumatic stress disorder (PTSD); increasing survival rates among cancer patients; and, attempts at encouraging a positive psychology that focuses on a patient's ability to fight adversity. The difficulties encountered in clearly defining the processes associated with this subjective feeling of growth following recovery raise doubts concerning the real or illusory nature of the phenomenon and its adaptative value. This paper explains why cancer may be different than other traumas and why PTG may interact with this ecology of circumstances in different ways. Difficulty in identifying a single stressor, the internal source of the event, cancer as a future, ongoing and chronic integration threat, and greater perceived control differences between cancer and others traumas. This review brings together the latest studies of PTG in cancer, and focuses in the debate of the real or illusory nature of the PTG and his adaptative value. The ongoing threat, uncertainty and vulnerability associated with cancer are the variables that have been related most consistently with PTG and tend to confuse the relationship between PTG and emotional well-being, too.

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

PMID: 18996633 [PubMed - in process]

 

Int J Neuropsychopharmacol. 2009 Feb;12(1):23-31. Epub 2008 Jun 11.

Onset of activity and time to response on individual CAPS-SX17 items in patients  treated for post-traumatic stress disorder with venlafaxine ER: a pooled analysis.

Stein DJ, Pedersen R, Rothbaum BO, Baldwin DS, Ahmed S, Musgnung J, Davidson J.

University of Cape Town, Cape Town, South Africa.

This pooled analysis of data from two randomized, placebo-controlled trials of venlafaxine extended release (ER) assessed onset of activity and time to response on the 17 symptoms of post-traumatic stress disorder (PTSD) listed in DSM-IV and  measured by the 17-item Clinician-Administered PTSD Scale (CAPS-SX17). The intent-to-treat (ITT) population comprised 687 patients (placebo, n=347; venlafaxine ER, n=340). Significant (p<0.05) separation between venlafaxine ER and placebo was observed on most CAPS-SX17 items, with earliest onset of activity and response (week 2) on items 5 (physiological reactivity on exposure to cues) and 14 (irritability or anger outbursts), and (week 4) items 1 (intrusive recollections) and 4 (psychological distress at exposure to cues). Onset of activity and response occurred later (generally, weeks 6-8) on items 9 (diminished interest/participation in activities), 10 (detachment or estrangement), 11 (restricted range of affect), 12 (sense of foreshortened future), all associated with numbing, 15 (difficulty concentrating), 16 (hypervigilance), 17 (exaggerated startle response), associated with hyperarousal, and 6 (avoidance of thoughts/feelings or conversations). Significant differences between venlafaxine ER and placebo were largely absent throughout the treatment period and at the primary week-12 end-point for items 2  (distressing dreams), 7 (avoidance of activities, places or people), 8 (inability to recall important aspect of trauma) and 13 (difficulty falling/staying asleep). These results indicate that symptoms of physiological reactivity and psychological distress in response to cues, and irritability/anger outbursts show early and robust improvement with venlafaxine ER treatment, while symptoms of numbing and hyperarousal take longer. The early and persistent effect of venlafaxine ER over placebo on anger/irritability is noteworthy in view of the clinical significance of these symptoms in PTSD.

PMID: 18544181 [PubMed - in process]

 

J Interpers Violence. 2009 Feb;24(2):231-58. Epub 2008 May 8.

Deployment stressors of the iraq war: insights from the mainstream media.

La Bash HA, Vogt DS, King LA, King DW.

National Center for PTSD and VA Boston Healthcare System. hlabash@unr.edu.

A comprehensive understanding of the stressors of the Iraq War is needed to ensure appropriate postdeployment assessments and to inform empirical inquiries.  Yet we are unaware of any published studies that address the range of stressors experienced by this cohort. Thus, in the present study, we report the results of  an interpretive literature review of mainstream media reports published from the  beginning of the Iraq War in March 2003 to March 2005. This literature revealed a combination of stressors associated with traditional combat, insurgency warfare,  and peacekeeping operations. The increasing deployment of National Guard/Reservist personnel, older soldiers, and women highlights additional stressors associated with sexual harassment and assault, preparedness and training, and life and family disruptions. This is a cause for concern as war-zone stressors have been implicated in postdeployment health outcomes, including intimate partner violence and child maltreatment, immediate physical and mental health, and long-term adjustment.

PMID: 18467690 [PubMed - in process]

 

J Interpers Violence. 2009 Feb;24(2):349-60. Epub 2008 Apr 1.

MMPI-2 Profiles in Civilian PTSD: An Examination of Differential Responses Between Victims of Crime and Industrial Accidents.

Shercliffe RJ, Colotla V.

Luther College. regan.shercliffe@uregina.ca.

The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with  chronic pain (N = 40). Significant differences were seen in profiles between the  PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different kinds of traumatic incidents: industrial accidents or criminal events. They found differences in profile elevations based  on the type of event: The level of distress and fear is greater in PTSD victims of crime, and the results also suggest that victims of crime are more suspicious  and guarded compared with accident victims. Theoretically based reasons for the differences in profile elevations between the two PTSD groups are discussed.

PMID: 18381973 [PubMed - in process]

 

Psychiatry Res. 2009 Jan 30;171(1):44-53. Epub 2008 Dec 11.

Increased activation of the left hippocampus region in Complex PTSD during encoding and recognition of emotional words: A pilot study.

Thomaes K, Dorrepaal E, Draijer NP, de Ruiter MB, Elzinga BM, van Balkom AJ, Smoor PL, Smit J, Veltman DJ.

GGZ Buitenamstel, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.

To gain insight into memory disturbances in Complex Posttraumatic Stress Disorder (Complex PTSD), we investigated declarative memory function and medial temporal lobe activity in patients and healthy non-traumatized controls. A case-control study was performed in nine patients with Complex PTSD and nine controls. All respondents performed a declarative memory task with neutral and emotional, negative words during functional magnetic resonance imaging. Memory performance of neutral words was impaired in Complex PTSD with a relative conservation of recall of negative words. Deep encoding of later remembered negative words, as well as correct recognition of negative words and false alarms, was associated with an enhanced Blood Oxygenation Level Dependent (BOLD) response in the left hippocampus extending into the parahippocampal gyrus of Complex PTSD patients compared with controls. Post-hoc volumetric comparisons did not reveal significant anatomical differences in the medial temporal lobe between Complex PTSD patients and controls. We conclude that in Complex PTSD preferential recall  of negative words is associated with increased activation in the left hippocampus and parahippocampal gyrus during both successful and false recall. These findings support a model of an abnormally functioning hippocampus in Complex PTSD.

PMID: 19081708 [PubMed - in process]

 

Psychiatry Res. 2009 Jan 30;165(1-2):68-77. Epub 2008 Dec 5.

Verbal learning and memory impairments in posttraumatic stress disorder: The role of encoding strategies.

Johnsen GE, Asbjørnsen AE.

University of Bergen, Bergen, Norway.

The present study examined mechanisms underlying verbal memory impairments in patients with posttraumatic stress disorder (PTSD). Earlier studies have reported that the verbal learning and memory alterations in PTSD are related to impaired encoding, but the use of encoding and organizational strategies in patients with  PTSD has not been fully explored. This study examined organizational strategies in 21 refugees/immigrants exposed to war and political violence who fulfilled DSM-IV criteria for chronic PTSD compared with a control sample of 21 refugees/immigrants with similar exposure, but without PTSD. The California Verbal Learning Test was administered to examine differences in organizational strategies and memory. The semantic clustering score was slightly reduced in both groups, but the serial cluster score was significantly impaired in the PTSD group and they also reported more items from the recency region of the list. In addition, intrusive errors were significantly increased in the PTSD group. The data support an assumption of changed memory strategies in patients with PTSD associated with a specific impairment in executive control. However, memory impairment and the use of ineffective learning strategies may not be related to PTSD symptomatology only, but also to self-reported symptoms of depression and general distress.

PMID: 19058857 [PubMed - in process]

 

J Clin Psychiatry. 2009 Jan 17. pii: ej07m03828. [Epub ahead of print]

Treatment of Posttraumatic Stress Disorder in Postwar Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial.

Gordon JS, Staples JK, Blyta A, Bytyqi M, Wilson AT.

From The Center for Mind-Body Medicine, Washington, D.C., USA. jgordon@cmbm.org.

OBJECTIVE: To determine whether participation in a mind-body skills group program based on psychological self-care, mind-body techniques, and self-expression decreases symptoms of posttraumatic stress disorder (PTSD). METHOD: Eighty-two adolescents meeting criteria for PTSD according to the Harvard Trauma Questionnaire (which corresponds with 16 of the 17 diagnostic criteria for PTSD in DSM-IV) were randomly assigned to a 12-session mind-body group program or a wait-list control group. The program was conducted by high school teachers in consultation with psychiatrists and psychologists and included meditation, guided imagery, and breathing techniques; self-expression through words, drawings, and movement; autogenic training and biofeedback; and genograms. Changes in PTSD symptoms were measured using the Harvard Trauma Questionnaire. The study was conducted from September 2004 to May 2005 by The Center for Mind-Body Medicine at a high school in the Suhareka region of Kosovo. RESULTS: Students in the immediate intervention group had significantly lower PTSD symptom scores following the intervention than those in the wait-list control group (F = 29.8, df = 1,76; p < .001). Preintervention and postintervention scores (mean [SD]) for the intervention group were 2.5 (0.3) and 2.0 (0.3), respectively, and for the control group, 2.5 (0.3) and 2.4 (0.4), respectively. The decreased PTSD symptom  scores were maintained in the initial intervention group at 3-month follow-up. After the wait-list control group received the intervention, there was a significant decrease (p < .001) in PTSD symptom scores compared to the preintervention scores. CONCLUSIONS: Mind-body skills groups can reduce PTSD symptoms in war-traumatized high school students and can be effectively led by trained and supervised schoolteachers. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00136357.

PMID: 18945398 [PubMed - as supplied by publisher]

 

Acta Paediatr. 2009 Jan;98(1):17-22. Epub 2008 Sep 14.

Children and adolescents injured in traffic--associated psychological consequences: a literature review.

Olofsson E, Bunketorp O, Andersson AL.

Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden. eva.m.olofsson@vgregion.se

AIM: To identify the prevalence of post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS) among children and adolescents injured in traffic, and to assess  predictors of such post-traumatic stress. METHODS: Studies identified from electronic databases were reviewed. RESULTS: Based on a review of 12 studies, fulfilling specified criteria, the prevalence of PTSS was estimated at 30% within 1 month and 13% at 3-6 months. The prevalence of PTSD was almost 30% at 1-2 months and decreased to the same level as PTSS at 3-6 months. Perceived threat and high levels of distress, anxiety symptoms and being female were significantly associated with PTSD and PTSS. Injury severity was positively related to the number of PTSD symptoms in one of eight studies. Types of accident, age and socioeconomic status were not related to the development of PTSD/PTSS. CONCLUSION: Any child will be at risk of PTSD/PTSS, not just those with severe injuries. Trauma care should include procedures that could identify and prevent stress reactions in order to minimize the risk of associated psychological consequences.

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

PMID: 18795910 [PubMed - in process]

 

Am J Prev Med. 2009 Jan;36(1):1-8. Epub 2008 Oct 31.

Posttraumatic stress disorder and obesity: evidence for a risk association.

Perkonigg A, Owashi T, Stein MB, Kirschbaum C, Wittchen HU.

Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany. axelp11@gmx.net

BACKGROUND: There is evidence from cross-sectional studies that posttraumatic stress disorder (PTSD) may be associated with obesity. The aim of this study was  to examine prospective longitudinal associations between PTSD and obesity in a community sample. METHODS: A prospective, longitudinal, epidemiologic study with  a representative community sample of adolescents and young adults (N=3021, aged 14-24 years at baseline) was conducted in Munich, Germany. Participants were assessed four times between 1995 and 2005 with the Munich-Composite International Diagnostic Interview. Associations between obesity (BMI > or =30) and DSM-IV PTSD were evaluated in 2007, using cross-sectional and prospective data during young adulthood. RESULTS: The cumulative lifetime incidence of obesity in the sample at 10-year follow-up during young adulthood was 4.3% (women, 4.6%; men, 4.0%). Among women but not among men, obesity was associated with a lifetime history of PTSD (OR=3.8; 95% CI=1.4, 10.7) in the cross-sectional analyses. Prospective longitudinal analyses from 4-year follow-up to 10-year follow-up confirmed that obesity was predicted by antecedent subthreshold and full PTSD (OR=3.0; 95% CI=1.3, 7.0) among women but not among men. There were no associations between other mental disorders and obesity in the prospective analyses. CONCLUSIONS: The  findings indicate a possible causal pathway for the onset of obesity in females with PTSD symptoms. These findings need replication with regard to the pathophysiologic and behavioral mechanisms underlying this relationship.

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

PMID: 18976880 [PubMed - in process]

 

Anxiety Stress Coping. 2009 Jan;22(1):27-37.

The Experience of Intrusions Scale: a preliminary examination.

Salters-Pedneault K, Vine V, Mills MA, Park C, Litz BT.

National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. kristalyn.salters@ va.gov

Intrusive thoughts (i.e., unwelcome, distressing, involuntary thoughts) are prevalent in a variety of clinical conditions and are increasingly a focus of translational research. The goal of this study was to develop and preliminarily examine a brief self-report measure designed to assess clinically relevant aspects of the experience of intrusive thoughts related to a particular target. The Experience of Intrusions Scale (EIS) is a five-item measure that assesses the frequency, unpredictability, and unwantedness of intrusive thoughts, as well as the interference and distress caused by the intrusions, each on a five-point Likert-type scale. Five times over a four-] period, female undergraduates (N=160) completed the EIS in response to intrusive thoughts regarding a film clip depicting a sexual assault. On the first and last days, participants completed the EIS five minutes after watching the clip. In between film clip viewings, participants completed the EIS once per day. The EIS demonstrated good internal consistency, good to excellent test-retest reliability using both immediate post-stimulus and 24-hour time intervals, and convergent validity with two existing measures of intrusive phenomena: the White Bear Suppression Inventory (Wegner & Zanakos, 1994) and the Post-traumatic Stress Disorder Checklist-Civilian Version (Weathers, Litz, Herman, Huska, & Keane, 1993).

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

PMID: 18937103 [PubMed - in process]

 

Anxiety Stress Coping. 2009 Jan;22(1):117-27.

Proactive coping, gratitude, and posttraumatic stress disorder in college women.

Vernon LL, Dillon JM, Steiner AR.

Florida Atlantic University, Jupiter, FL, USA. lvernon@fau.edu

This study investigated relationships among proactive coping, positive emotions,  and posttraumatic stress disorder (PTSD) symptom severity for 182 undergraduate women with trauma histories. Participants were administered the Life Events Checklist (LEC), PTSD Checklist, Proactive Coping Inventory, Proactive Attitude Scale, General Perceived Self-Efficacy Scale, and measures of posttrauma gratitude and emotional growth. An Exploratory Factor Analysis (EFA) with proactive coping, proactive attitude, and self-efficacy items indicated a one-factor solution. The proactive coping style factor and posttrauma gratitude were independently negatively associated with current PTSD symptom level, above and beyond the effects of trauma severity, trauma history, and time elapsed since the trauma. The implications of these results for future research and understanding of the development of PTSD and its treatment are discussed.

PMID: 18791902 [PubMed - in process]

 

Aust N Z J Psychiatry. 2009 Jan;43(1):80-6.

Complex post-traumatic stress disorder in patients with somatization disorder.

Spitzer C, Barnow S, Wingenfeld K, Rose M, Löwe B, Grabe HJ.

University Department of Psychosomatic Medicine and Psychotherapy, University Clinic Hamburg-Eppendorf and Klinikum Eilbek (Schön Kliniken), Hamburg, Germany.  c.spitzer@uke.uni-hamburg.de

OBJECTIVE: Given the association between severe childhood trauma, adult somatization and complex post-traumatic stress disorder (cPTSD), the purpose of the present paper was to assess this syndrome and its clinical correlates in patients with somatization disorder (SD). METHODS: A total of 28 patients (82% women, mean age = 41.7+/-10.1 years) meeting DSM-IV criteria for SD as confirmed  by the Structured Clinical Interview for DSM-IV, Axis I were compared to 28 age-  and gender-matched patients with major depression, but without a lifetime diagnosis of SD. They completed the Structured Interview for Disorders of Extreme Stress, the Brief Symptom Inventory, the Inventory of Interpersonal Problems-Circumplex Scales, and the SF-36 Health Survey. RESULTS: Compared to the control group, SD patients had higher risks for current and lifetime diagnoses of cPTSD (odds ratio (OR) = 15.0, 95% confidence interval (CI) = 1.76-127.54; and OR = 8.33, 95%CI = 2.04-34.07, respectively). SD subjects with cPTSD had more psychological distress, more interpersonal problems and worse psychosocial functioning than those without the syndrome. CONCLUSION: The concept of complex PTSD may hold clinical utility when applied to SD patients because it identifies  a distinct subgroup characterized by severe psychosocial impairment. The diagnostic and therapeutic implications of the present findings are discussed.

PMID: 19085532 [PubMed - in process]

 

Behav Med. 2009 Winter;34(4):125-32.

Hypertension in relation to posttraumatic stress disorder and depression in the US National Comorbidity Survey.

Kibler JL, Joshi K, Ma M.

Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale,  FL.

The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

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

PMID: 19064371 [PubMed - in process]

 

Behav Modif. 2009 Jan;33(1):66-81. Epub 2008 Aug 22.

Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies.

Frueh BC, Grubaugh AL, Cusack KJ, Elhai JD.

The Menninger Clinic and Baylor College of Medicine, Houston, TX 77080, USA.

Posttraumatic stress disorder (PTSD) remains largely untreated among adults with  severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes  precedence in the care of adults with SMI. Such oversight is problematic in that  PTSD in SMI populations is common (19%-43%), contributes a significant illness burden, and hinders mental health care. Yet few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the article is to describe strategies and efforts to disseminate trauma-focused empirically based practices in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are to set clear goals, nurture broad-based organizational commitment and key stakeholder involvement, implement specialty training efforts to provide information and change attitudes, provide ongoing supervision, conduct fidelity monitoring, and ensure accountability to the extent possible.

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

PMID: 18723837 [PubMed - in process]

 

Behav Res Ther. 2009 Jan;47(1):60-5. Epub 2008 Oct 17.

Psychosocial predictors of chronic Post-Traumatic Stress Disorder in Sri Lankan tsunami survivors.

Lommen MJ, Sanders AJ, Buck N, Arntz A.

Department of Clinical Psychological Science, Maastricht University, Maastricht,  The Netherlands.

This study aimed to determine whether psychological factors associated with Post-Traumatic Stress Disorder (PTSD) identified in Western samples generalize to low Social-Economical-Status (SES) populations in an underdeveloped Asian country. The study included 113 survivors of the 2004-tsunami on the south coast  of Sri Lanka, recruited from 4 preschools and 10 villages for displaced persons.  With logistic regressions the relations between interview-based PTSD diagnosis and psychological factors were assessed, controlling for putative confounders. Fifteen months post-trauma the prevalence of PTSD was 52.2%. Multivariate analyses indicated that negative interpretation of tsunami-memories was significantly (P<0.005) related to PTSD. Of the putative confounders, gender and  (non-replaced) lost work equipment were related to current PTSD (P<0.05). The results indicate that the relation between negative interpretation of trauma memories and PTSD is quite universal, suggesting that interventions focusing on this factor may be important in treatment of tsunami survivors who are suffering  from chronic PTSD.

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

PMID: 19013551 [PubMed - in process]

 

Behav Res Ther. 2009 Jan;47(1):6-12. Epub 2008 Oct 17.

A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder.

Bugg A, Turpin G, Mason S, Scholes C.

Stratford Locality, Mental Health Services, Building 2, 2nd Floor Arden Street, Stratford-upon-Avon, United Kingdom. ali_bugg@hotmail.com

The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A & E), were screened for Acute Stress Disorder and randomised to an information control group (n=36) or a writing and information group (n=31). Participants in both groups received an information booklet one-month post-injury. Participants in the writing group also wrote about emotional aspects of their trauma during three 20-min sessions, five to six weeks post-injury. Psychological assessments were completed within one month and at three and six months post-injury. There were significant improvements on measures of anxiety, depression and PTSD over time. Differences between groups on these measures were  not statistically significant. However, subjective ratings of the usefulness of writing were high. In conclusion, the results do not currently support the use of writing as a targeted early intervention technique for traumatic injury patients  at risk of developing PTSD.

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

PMID: 19012880 [PubMed - in process]

 

Brain Dev. 2009 Jan;31(1):15-9. Epub 2008 Jun 16.

Psychiatric disorders and behavioral problems in children and adolescents with Tourette syndrome.

Ghanizadeh A, Mosallaei S.

Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran. ghanizad@sina.tums.ac.ir

OBJECTIVE: Many previous studies have surveyed associations between Tourette syndrome (TS) and co-morbid psychiatric disorders, but they usually did not include oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). METHOD: The subjects were children and adolescents with TS who visited a child and adolescent psychiatric clinic, and who were interviewed using DSM-IV diagnostic criteria. Characteristics of their tics were examined by the Yale-Global Tic Severity Scale (Y-GTSS). Behavioral problems were surveyed by the Child Behavior Checklist (CBCL) filled in by the parents. RESULTS: About 87.9% of the subjects were boys.  The mean age of the subjects was 11.8 years. The most common psychiatric disorders were attention deficit hyperactivity disorder (ADHD), ODD, nail biting, and obsessive compulsive disorder (OCD). Only one subject was affected by TS without co-morbidities. Among TS patients with co-morbidities, those with disruptive behavioral disorders (DBD) have significantly higher mean scores than  patients without DBD on the Externalizing scale, Social problems, Attention problems, Delinquent and Aggression scales. Co-morbidity of anxiety disorders was not related to the CBCL scores. CONCLUSION: Many of our results were similar to those reported in studies conducted in other parts of the world. TS is more common in boys and nearly all of them had at least one co-morbid disorder. The most common co-morbidity was ADHD. Behavioral problems in TS are related to the co-morbidity with the DBD, and possibly not to the anxiety disorders.

PMID: 18558469 [PubMed - in process]

 

Clin Child Psychol Psychiatry. 2009 Jan;14(1):71-83.

Guilt and posttraumatic stress symptoms in child victims of interpersonal violence.

Kletter H, Weems CF, Carrion VG.

Stanford University School of Medicine, California, USA.

Our objective was to examine the relationship between guilt and posttraumatic stress disorder (PTSD) symptoms in children with a history of interpersonal violence. Eighty-seven children between the ages of 5 and 16 years (mean age = 11.70 years) were administered the Clinician-Administered PTSD Scale for Children and Adolescents to assess for PTSD symptoms and associated features. Multiple regression analysis found that guilt over acts of commission or omission (behaviors the child performed or failed to perform during the event or to prevent it) was highly associated with PTSD severity. Derealization and changes in attachment were also significantly related to PTSD symptoms. Findings suggest  that it may be important for clinicians to assess for associated features in traumatized children as these are associated with greater PTSD severity. Posttraumatic interventions may benefit from targeting these symptoms.

PMID: 19103706 [PubMed - in process]

 

Drug Alcohol Depend. 2009 Jan 1;99(1-3):169-75. Epub 2008 Oct 8.

Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans.

Dickerson DL, O'Malley SS, Canive J, Thuras P, Westermeyer J.

Yale University, 1 Long Wharf Drive, Box 18, New Haven, CT 06511, USA; University of California, Los Angeles (UCLA), Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, USA.

BACKGROUND: American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. METHODS: This study analyzes the co-occurrence of current and  lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans. RESULTS: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder. CONCLUSIONS: Substantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.

PMID: 18845405 [PubMed - in process]

 

Int Clin Psychopharmacol. 2009 Jan;24(1):29-33.

Pregabalin augmentation of antidepressants in patients with accident-related posttraumatic stress disorder: an open label pilot study.

Pae CU, Marks DM, Han C, Masand PS, Patkar AA.

aDepartment of Psychiatry, The Catholic University of Korea College of Medicine bDepartment of Psychiatry, The Korea University, Seoul, South Korea cDepartment of Psychiatry and Behavioral Medicines, Duke University Medical Center, Durham, North Carolina dDepartment of Psychiatry and Behavioral Sciences, SUNY Upstate Medical Center at Syracuse, New York, USA.

This study evaluated the efficacy of pregabalin augmentation of antidepressant treatment in patients with posttraumatic stress disorder (PTSD). Nine patients meeting Diagnostic and Statistical Manual, fourth edition criteria for PTSD who were on stable doses of antidepressants were treated open label with flexibly dosed pregabalin for 6 weeks. All patients were assessed with the Short PTSD Rating Interview, Montgomery-Asberg Depression Rating Scale, Patient Global Impression-severity, Visual Analog Scale-pain, and Sheehan Disability Scale at baseline and weeks 2, 4, and 6. Significant reductions were observed in all effectiveness measures from week 4 to the end of the study. In particular, the numerical improvement of the Visual Analog Scale-pain score was most robust (-53.4%, P=0.007). Pregabalin augmentation was effective and well tolerated during the study. Our findings warrant adequately powered, placebo-controlled clinical trials to confirm the usefulness of pregabalin augmentation of antidepressants in patients with PTSD.

PMID: 19060720 [PubMed - as supplied by publisher]

 

J Affect Disord. 2009 Jan;112(1-3):81-4. Epub 2008 Jun 10.

Depression and PTSD symptoms among bereaved adolescents 6(1/2) years after the 1988 spitak earthquake.

Goenjian AK, Walling D, Steinberg AM, Roussos A, Goenjian HA, Pynoos RS.

UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Collaborative Neuroscience Network, Garden Grove, CA 92845.

OBJECTIVE: To compare depression and PTSD symptoms of parentally bereaved adolescents and a comparison group after a catastrophic natural disaster. METHOD: Six and a half years after the Spitak earthquake, 48 parentally bereaved adolescents and a comparison group of 44 subjects with no parental loss were evaluated using the Depression Self - Rating Scale (DSRS) and Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI). RESULTS: Orphans scored significantly  higher on depression than those who lost a father (Mean DSRS scores: 20.2+/-3.3 vs. 16.6+/-5.2; p<0.001), who in turn scored significantly higher than those who  lost a mother (Mean DSRS scores: 16.6+/-5.2 vs. 12.7+/-4.1; p<0.002). Depression  scores for orphans fell above the cut-off for clinical depression, while those who lost a father scored slightly below. PTSD scores within each group fell in the moderate range of severity, with girls scoring higher than boys (Mean CPTSD-RI scores: 35.9+/-11.3 vs. 29.3+/-10.1; p<0.04). LIMITATION: As self-report instruments were used, responses may have been over- or under- reported. Participants belonged to the same ethnic group and therefore the results may not  be generalizable to other populations. CONCLUSION: Loss of both parents and, to a lesser degree, loss of a father is a significant risk factor for depression, but  not for PTSD. This study extends prior findings documenting post-disaster chronicity of depression and PTSD among bereaved adolescents, and underscores the need for post-disaster mental health and social programs, especially for those who suffer the loss of both parents.

PMID: 18547646 [PubMed - in process]

 

J Affect Disord. 2009 Jan;112(1-3):144-50. Epub 2008 Jun 6.

Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder.

Romero S, Birmaher B, Axelson D, Goldstein T, Goldstein BI, Gill MK, Iosif AM, Strober MA, Hunt J, Esposito-Smythers C, Ryan ND, Leonard H, Keller M.

University of Pittsburgh Medical Center. Western Psychiatric Institute Clinic, United States; Institute Clinic of Neuroscience, Hospital Clinic Universitari of  Barcelona, Spain.

OBJECTIVE: Adult bipolar disorder (BP) has been associated with lifetime history  of physical and sexual abuse. However, there are no reports of the prevalence of  abuse in BP youth. The objective of this study was to examine the prevalence and  correlates of physical and/or sexual abuse among youth with BP spectrum disorders. METHODS: Four hundred forty-six youths, ages 7 to 17 years (12.7+/-3.2), meeting DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized definition of BP-NOS (n=154) were assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime version (K-SADS-PL). Abuse was ascertained using the K-SADS. RESULTS: Twenty percent of the sample experienced physical and/or sexual abuse. The most robust correlates of any abuse history were living with a non-intact family (OR=2.6), lifetime history of posttraumatic stress disorder (PTSD) (OR=8.8), psychosis (OR=2.1), conduct disorder (CD) (OR=2.3), and first-degree family history of mood disorder (OR=2.2). After adjusting for confounding demographic factors, physical abuse was associated with longer duration of BP illness, non-intact family, PTSD, psychosis, and first-degree family history of mood disorder. Sexual abuse was associated with PTSD. Subjects with both types of abuse were older, with longer illness duration, non-intact family, and greater prevalence of PTSD and CD as compared with the non-abused group. LIMITATIONS: Retrospective data. Also, since this is a cross-sectional study, no inferences regarding causality can be made. CONCLUSION: Sexual and/or physical abuse is common in youth with BP particularly in subjects with comorbid PTSD, psychosis, or CD. Prompt identification and treatment of these youth is warranted.

PMID: 18538857 [PubMed - in process]

 

J Affect Disord. 2009 Jan;112(1-3):71-80. Epub 2008 Jun 3.

Complex PTSD, interpersonal trauma and relational consequences: Findings from a treatment-receiving Northern Irish sample.

Dorahy MJ, Corry M, Shannon M, Macsherry A, Hamilton G, McRobert G, Elder R, Hanna D.

Trauma Resource Centre, North & West Belfast Area, The Belfast Health & Social Care Trust, Belfast, Northern Ireland, United Kingdom; School of Psychology, The  Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom.

BACKGROUND: The relationship between PTSD and complex PTSD remains unclear. As well as further addressing this issue, the current study aimed to assess the degree to which DESNOS (complex PTSD) was related to interpersonal trauma and had relational consequences. METHODS: Eighty one treatment-receiving participants with a history of exposure to the 'Troubles' in Northern Ireland, were assessed on various forms of interpersonal trauma, including exposure to the Troubles, and measures of interpersonal and community connectedness. RESULTS: DESNOS symptom severity was related to childhood sexual abuse and perceived psychological impact of Troubles-related exposure. A lifetime diagnosis of DESNOS was related to childhood Troubles-related experiences, while a current diagnosis of DESNOS was associated with childhood emotional neglect. PTSD avoidance predicted current DESNOS diagnosis and severity. Feeling emotionally disconnected from family and friends (i.e., interpersonal disconnectedness) was related to all three indices of DESNOS (i.e., lifetime diagnosis, current diagnosis and current symptom severity). LIMITATIONS: Sample characteristics (i.e., treatment-receiving) and size may limit the generalizability of findings. CONCLUSIONS: Complex PTSD is associated with PTSD but when present should be considered a superordinate diagnosis.

PMID: 18511130 [PubMed - in process]

 

J Anxiety Disord. 2009 Jan;23(1):77-86. Epub 2008 Apr 18.

The stressor Criterion-A1 and PTSD: A matter of opinion?

Van Hooff M, McFarlane AC, Baur J, Abraham M, Barnes DJ.

University of Adelaide, The Centre for Military and Veterans' Health, Level 2/122 Frome Street, Adelaide, South Australia 5000, Australia.

Considerable controversy exists with regard to the interpretation and definition  of the stressor "A1" criterion for Post Traumatic Stress Disorder (PTSD). At present, classifying an event as either traumatic (satisfying DSM-IV Criterion-A1 for PTSD), or non-traumatic (life event) is determined by the rater's subjective  interpretation of the diagnostic criteria. This has implications in research and  clinical practice. Utilizing a sample of 860 Australian adults, this study is the first to provide a detailed examination of the impact of event categorization on  the prevalence of trauma and PTSD. Overall, events classified as non-traumatic were associated with higher rates of PTSD. Unanimous agreement between raters occurred for 683 (79.4%) events. As predicted, the categorization method employed (single rater, multiple rater-majority, multiple rater-unanimous) substantially altered the prevalence of Criterion-A1 events and PTSD, raising doubts about the  functionality of PTSD diagnostic criteria. Factors impacting on the categorization process and suggestions for minimizing discrepancies in future research are discussed.

PMID: 18511232 [PubMed - in process]

 

J Anxiety Disord. 2009 Jan;23(1):54-9. Epub 2008 Mar 28.

Repetitive TMS combined with exposure therapy for PTSD: A preliminary study.

Osuch EA, Benson BE, Luckenbaugh DA, Geraci M, Post RM, McCann U.

Biological Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MA, United States.

Treatment for anxiety and post-traumatic stress disorder (PTSD) includes exposure therapy and medications, but some patients are refractory. Few studies of repetitive transcranial magnetic stimulation (rTMS) for anxiety or PTSD exist. In this preliminary report, rTMS was combined with exposure therapy for PTSD. Nine subjects with chronic, treatment-refractory PTSD were studied in a placebo-controlled, crossover design of imaginal exposure therapy with rTMS (1Hz) versus sham. PTSD symptoms, serum and 24h urine were obtained and analyzed. Effect sizes for PTSD symptoms were determined using Cohen's d. Active rTMS showed a larger effect size of improvement for hyperarousal symptoms compared to  sham; 24-h urinary norepinephrine and serum T4 increased; serum prolactin decreased. Active rTMS with exposure may have symptomatic and physiological effects. Larger studies are needed to confirm these preliminary findings and verify whether rTMS plus exposure therapy has a role in the treatment of PTSD.

PMID: 18455908 [PubMed - in process]

 

J Anxiety Disord. 2009 Jan;23(1):27-37. Epub 2008 Mar 20.

Evaluating symptom expression as a function of a posttraumatic stress disorder severity.

Palm KM, Strong DR, Macpherson L.

Brown Medical School, Butler Hospital, United States.

Little is known about the relative severity or typical sequence of Diagnostic and Statistical Manual (DSM-IV) symptoms of posttraumatic stress disorder (PTSD). Using data from the National Comorbidity Study-Replication (NCS-R) [Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., & Hiripi, E., et al. (2004). The US National Comorbidity Survey-Replication (NCS-R): design and field  procedures. International Journal of Methods in Psychiatric Research, 13(2), 69-92], the current study used a logistic item response model to assess the degree to which DSM-IV symptoms combine to define a primary construct underlying  PTSD, to identify which symptoms are associated with greater severity of PTSD, and to determine whether the symptoms and symptom patterns are influenced by gender. Results suggested that PTSD symptoms can be combined to assess a single dimension of PTSD severity, providing support for a continuum of symptom severity. However, several DSM-IV symptoms provided overlapping information, potentially reducing the effectiveness of these symptoms in describing a broad range of PTSD. More precise assessment of PTSD severity may help improve the descriptive value of PTSD measures relationship to continuous measures of treatment outcomes, and ultimately inform more effective treatments.

PMID: 18434083 [PubMed - in process]

 

J Psychiatr Res. 2009 Jan;43(3):309-18. Epub 2008 May 19.

Hippocampal function during associative learning in patients with posttraumatic stress disorder.

Werner NS, Meindl T, Engel RR, Rosner R, Riedel M, Reiser M, Fast K.

Clinic of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich,  Germany; Department of Psychology, Ludwig-Maximilians-University of Munich, Germany.

In the last decade several studies have shown memory deficits in patients with posttraumatic stress disorder (PTSD) which have been associated with a reduced hippocampus volume. However, until now we do not know how or whether these structural abnormalities turn into functional abnormalities. Thus, the primary purpose of the present study was the investigation of the hippocampal function using functional magnet resonance imaging (fMRI). We compared PTSD patients and healthy control participants using an associative learning paradigm consisting of two encoding and one retrieval condition. During fMRI scanning participants had to learn face-profession pairs. Afterwards only faces were presented as cue stimuli for associating the category of the prior learned target profession and the participants had to decide whether this face belonged to a scientific or an artistic profession. Additionally, cognitive functioning, i.e. memory and attention, was examined using neuropsychological standard tests. During encoding  PTSD patients showed stronger hippocampal and weaker prefrontal activation compared to healthy control participants. During retrieval the two groups did not differ neither in hippocampus activation nor in accuracy of retrieval. PTSD patients however showed a reduced activation in the left parahippocampal gyrus and other memory-related brain regions. We did not find any significant memory differences between PTSD patients and healthy control participants. The results suggest that PTSD has an effect on memory-related brain function despite intact memory functioning. In particular the hippocampal/parahippocampal regions and the prefrontal cortex show functional alterations during associative learning and memory.

PMID: 18490028 [PubMed - in process]

 

Mol Psychiatry. 2009 Jan;14(1):86-94. Epub 2007 Oct 30.

WFS1 gene as a putative biomarker for development of post-traumatic syndrome in an animal model.

Kesner Y, Zohar J, Merenlender A, Gispan I, Shalit F, Yadid G.

Neuropharmacology Laboratory, Mina and Everard Goodman Faculty of Life Sciences and the Leslie and Susan Gonda (Goldshmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after the experiencing or witnessing of a life-threatening event. PTSD is defined by the coexistence of three clusters of symptoms: re-experiencing, avoidance and  hyperarousal, which persist for at least 1 month in survivors of the event (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Using an established model of PTSD, we addressed the well-accepted clinical finding that only a minority (about 20%) of the individuals exposed to a traumatic event develop PTSD. Moreover, we followed individual rat behavior for up to a month, and then treated the PTSD-like animals with citalopram. Our data demonstrate high face (20% of rats exposed to a reminder of the stressor develop symptoms characteristic of PTSD) and predictive (response to citalopram) validities. Based on these validities we identified alterations in the Wolframin gene in the CA1 and amygdala regions, specifically in exposed PTSD-like rats, which were normalized after treatment with citalopram. We suggest the Wolframin gene as a putative biomarker for PTSD. Since Wolframin gene undergoes alternative splicing  and has polymorphism in the population, it may serve a future marker for identification of the vulnerable population exposed to a traumatic event.

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

PMID: 17968352 [PubMed - in process]

 

Neuropsychol Rehabil. 2009 Jan;19(1):86-97. Epub 2008 May 1.

Cognitive behaviour therapy for post-traumatic stress symptoms in the context of  hydrocephalus: A single case.

Kneebone II, Hull SL.

Surrey NHS Primary Care Trust, UK.

There is limited information about anxiety disorders occurring in the context of  the challenging condition of hydrocephalus. This paper describes the treatment, via trauma-focused cognitive behaviour therapy (TFCBT), of post-traumatic stress  symptoms arising on account of hydrocephalus in a 23-year-old man. Specific components of the intervention included exposure, cognitive disputation, and relaxation training. The 20-session intervention appeared effective with decreases in anxiety (on the Hospital Anxiety and Depression Scale) and event impact (on the Impact of Events Scale) from clinical to sub-clinical levels. The  main contributor to change appeared to be the exposure element of the treatment.  The benefits of the intervention were maintained at one-, three-, and six-month follow-up.

PMID: 18609019 [PubMed - in process]

 

Occup Med (Lond). 2009 Jan;59(1):25-31. Epub 2008 Dec 12.

Alcohol misuse in the Royal Navy.

Henderson A, Langston V, Greenberg N.

King's Centre for Military Health Research, Academic Centre for Defence Mental Health, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. sososanta@aol.com

BACKGROUND: Evidence suggests that military personnel consume considerable amounts of alcohol which may have both medical and occupational implications. AIM: To compare alcohol consumption and misuse within the Royal Navy (RN) to that in the civilian population. METHODS: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire is a short measure of alcohol use disorders. It was administered to 1333 male RN personnel from operational naval units. 'Heavy' drinking was defined as consuming >21 units/week, 'very heavy' as  >42 units/week, binge drinking as >8 units in one session and 'problem' drinkers  as those advised to cut down in the last year. The study also measured psychological health using the General Health Questionnaire (GHQ)-12 and post-traumatic stress disorder checklist for civilians (PCL-C). RESULTS: The response rate was 70%. The majority (92%) scored as hazardous drinkers on the AUDIT-C, 40% met the criteria for heavy drinking, 27% for very heavy drinking, 48% reported binge drinking at least once a week and 15% were classed as problem  drinkers. Heavy drinking was associated with younger age, lower rank and higher scores for both PCL and GHQ. All results were substantially higher than in age-matched civilian samples. CONCLUSIONS: Excessive alcohol consumption, especially binge drinking, is significantly more prevalent in the RN than in the  general population. Such high levels of drinking are likely to impact upon occupational efficiency and have both short-term and long-term health effects. We suggest that more needs to be done to deter excessive levels of consumption in order to avoid long-term health consequences.

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

PMID: 19074746 [PubMed - in process]

 

Psychooncology. 2009 Jan;18(1):30-41.

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing.

Salsman JM, Segerstrom SC, Brechting EH, Carlson CR, Andrykowski MA.

Evanston Northwestern Healthcare, Evanston, Illinois, USA. jsalsman@enh.org

INTRODUCTION: The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. METHODS: Fifty-five post-treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months  post-diagnosis, were recruited from a state cancer registry and completed baseline and 3-month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal),  and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). RESULTS: PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety,  and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3-month PTSD symptomatology and there was a trend  for baseline cognitive rehearsal predicting 3-month PTG. CONCLUSIONS: Additional  research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer. (c) 2008 John Wiley & Sons, Ltd.

PMID: 18481837 [PubMed - in process]

 

Law Hum Behav. 2008 Dec 30. [Epub ahead of print]

Sexual Harassment and Posttraumatic Stress Disorder: Damages Beyond Prior Abuse.

Stockdale MS, Logan TK, Weston R.

Department of Psychology, Southern Illinois University, Carbondale, IL, 62901-6502, USA, pstock@siu.edu.

This study examined the extent to which harassment experiences correlate with posttraumatic stress disorder (PTSD) symptoms, and whether diagnosable PTSD on the basis of sexual harassment occurs after accounting for prior PTSD, prior sexual abuse, and prior psychological dysfunction. The sample consisted of a two-wave panel of 445 women who had received a domestic violence protective order from a Kentucky court. Hierarchical linear and logistic analyses confirmed that sexual harassment experiences were significantly correlated with PTSD symptoms after controlling for an extensive set of trauma variables measured in both the baseline and follow up interviews. Our findings lend further evidence that claims of PTSD from sexual harassment may be credible even if claimants have been victims of other forms of trauma.

PMID: 19115099 [PubMed - as supplied by publisher]

 

J Interpers Violence. 2008 Dec 23. [Epub ahead of print]

Posttraumatic Stress Disorder Among Sri Lankan University Students as a Consequence of Their Exposure to Family Violence.

Haj-Yahia MM, Tishby O, Zoysa PD.

Hebrew University of Jerusalem.

The article presents the results of a study on the association between exposure to family violence (i.e., witnessing interparental violence and experiencing parental violence) during childhood and adolescence and adult posttraumatic stress disorder (PTSD). The study was conducted among a self-selected convenience sample of 476 students from Sri Lanka, using a self-administered questionnaire. The findings indicate that the more participants witnessed interparental violence and the more they experienced parental violence, the more they exhibited PTSD symptoms. Moreover, the findings reveal that participants' exposure to family violence explains a significant amount of the variance in their PTSD over and above the variance that can be attributed to their sociodemographic characteristics (age, gender, number of siblings, and family's socioeconomic status) and to their perceptions of the environment and functioning of their families. The limitations of the study and recommendations for future research are discussed.

PMID: 19106201 [PubMed - as supplied by publisher]

 

J Womens Health (Larchmt). 2008 Dec 23. [Epub ahead of print]

Lifetime Interpersonal Violence and Self-Reported Chlamydia trachomatis Diagnosis among California Women.

Alvarez J, Pavao J, Mack KP, Chow JM, Baumrind N, Kimerling R.

VA Palo Alto Health Care System, Palo Alto, California.

Abstract Objective: To examine the relationship between cumulative exposure to various types of interpersonal violence throughout the life span and self-reported history of Chlamydia trachomatis (CT) diagnosis in a population-based sample of California women. Methods: This was a cross-sectional  analysis of a population-based survey of California women aged 18-44 years (n = 3521). Participants reported their experience of multiple types of interpersonal  violence: physical or sexual abuse in childhood or adulthood and intimate partner violence (IPV) in the past 12 months. Current posttraumatic stress disorder (PTSD) and depressive symptoms were also reported. Separate logistic regression models assessed the association between experiencing each type of interpersonal violence, as well as women's cumulative exposure to violence, and past CT diagnosis, adjusting for age, race/ethnicity, and poverty, as well as mental health problems. Results: Six percent of women reported a past diagnosis of CT, and 40.8% reported experiencing at least one type of interpersonal violence in their lifetime. All types of violence were significantly associated with higher odds of having a past CT diagnosis even after controlling for sociodemographics.  Women who reported experiencing four or more types of violence experiences had over five times the odds of reporting a lifetime CT diagnosis compared with women who never experienced interpersonal violence (adjusted odds ratio = 5.71, 95% CI  3.27-9.58). Current PTSD and depressive symptoms did not significantly affect the relationship between a woman's cumulative experience of violence and her risk of  past CT diagnosis. Conclusions: There is a robust association between experiencing multiple forms of violence and having been diagnosed with CT. Women  who seek treatment for sexually transmitted diseases (STDs), such as CT, should be assessed for their lifetime history of violence, especially violence in their  current intimate relationships. Sexual risk reduction counseling may also be important for women who have a history of risky sexual behaviors and who are likely to be reinfected.

PMID: 19105689 [PubMed - as supplied by publisher]

 

Memory. 2008 Dec 22:1-15. [Epub ahead of print]

The normative and the personal life: Individual differences in life scripts and life story events among USA and Danish undergraduates.

Rubin DC, Berntsen D, Hutson M.

Duke University, Durham, NC, USA.

Life scripts are culturally shared expectations about the order and timing of life events in a prototypical life course. American and Danish undergraduates produced life story events and life scripts by listing the seven most important events in their own lives and in the lives of hypothetical people living ordinary lives. They also rated their events on several scales and completed measures of depression, PTSD symptoms, and centrality of a negative event to their lives. The Danish life script replicated earlier work; the American life script showed minor differences from the Danish life script, apparently reflecting genuine differences in shared events as well as less homogeneity in the American sample.  Both consisted of mostly positive events that came disproportionately from ages 15 to 30. Valence of life story events correlated with life script valence, depression, PTSD symptoms, and identity. In the Danish undergraduates, measures of life story deviation from the life script correlated with measures of depression and PTSD symptoms.

PMID: 19105087 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Dec 16. [Epub ahead of print]

The Role of the Galaninergic System in Modulating Stress-Related Responses in an  Animal Model of Posttraumatic Stress Disorder.

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

State of Israel Ministry of Health, State of Israel Ministry of Health, Chaim Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat Gan, Israel.

BACKGROUND: Converging evidence implicates the regulatory neuropeptide galanin in anxiety- and depression-related behaviors, through modulation of neuroendocrine,  serotonergic, and noradrenergic systems. This study examined the relationship between stress-induced posttraumatic stress disorder (PTSD)-like behavioral response patterns in rats and galanin mRNA levels in key brain areas and the effects of acute phase pharmacologic manipulation using an agonist (galnon) on behavioral, physiologic, and response patterns of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine-1A (5HT-1A). METHOD: Galanin mRNA expression was assessed in the frontal cortex and hippocampus in the short- and long-term (30 min and 7 days) after exposure to predator scent stress. The effects of intraperitoneal galnon .5 mg/kg versus saline 1 hour postexposure on behavioral tests (elevated plus maze and acoustic startle response) were evaluated 7 days later. Trauma-cue response, circulating corticosterone, and localized brain expression of 5HT-1A receptors and BDNF were subsequently assessed. All data were analyzed in relation to individual behavior patterns. RESULTS: Whereas animals with minimal behavioral disruption displayed a lasting upregulation of galanin mRNA in the hippocampal CA1 area, those with extreme behavioral responses displayed downregulation in both CA1 and frontal cortex. Immediate postexposure treatment with galnon significantly reduced prevalence rates of extreme responders, reduced trauma-cue freezing responses, corrected the corticosterone response, and increased CA1 expression of 5HT-1A and BDNF mRNA compared with saline controls. CONCLUSIONS: Galanin is actively involved in the neurobiological response to predator scent stress with resilience/recovery after  stress exposure and thus warrants further study as a potential therapeutic avenue for the treatment of anxiety-related disorders.

PMID: 19095221 [PubMed - as supplied by publisher]

 

J Psychiatr Res. 2008 Dec 15. [Epub ahead of print]

The role of trauma-related distractors on neural systems for working memory and emotion processing in posttraumatic stress disorder.

Morey RA, Dolcos F, Petty CM, Cooper DA, Hayes JP, Labar KS, McCarthy G.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3918, Durham, NC 27710, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA; Mental Illness Research Education and Clinical Center for Post Deployment Mental Health, Durham VA Medical Center, Durham, NC, USA.

The relevance of emotional stimuli to threat and survival confers a privileged role in their processing. In PTSD, the ability of trauma-related information to divert attention is especially pronounced. Information unrelated to the trauma may also be highly distracting when it shares perceptual features with trauma material. Our goal was to study how trauma-related environmental cues modulate working memory networks in PTSD. We examined neural activity in participants performing a visual working memory task while distracted by task-irrelevant trauma and non-trauma material. Recent post-9/11 veterans were divided into a PTSD group (n=22) and a trauma-exposed control group (n=20) based on the Davidson trauma scale. Using fMRI, we measured hemodynamic change in response to emotional (trauma-related) and neutral distraction presented during the active maintenance  period of a delayed-response working memory task. The goal was to examine differences in functional networks associated with working memory (dorsolateral prefrontal cortex and lateral parietal cortex) and emotion processing (amygdala,  ventrolateral prefrontal cortex, and fusiform gyrus). The PTSD group showed markedly different neural activity compared to the trauma-exposed control group in response to task-irrelevant visual distractors. Enhanced activity in ventral emotion processing regions was associated with trauma distractors in the PTSD group, whereas activity in brain regions associated with working memory and attention regions was disrupted by distractor stimuli independent of trauma content. Neural evidence for the impact of distraction on working memory is consistent with PTSD symptoms of hypervigilance and general distractibility during goal-directed cognitive processing.

PMID: 19091328 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2008 Dec 15;161(3):330-5. Epub 2008 Oct 25.

Basal and suppressed salivary cortisol in female Vietnam nurse veterans with and  without PTSD.

Metzger LJ, Carson MA, Lasko NB, Paulus LA, Orr SP, Pitman RK, Yehuda R.

Research Service, VA Medical Center, Research Service (151), 718 Smyth Rd, Manchester, NH 03104, United States; Departments of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Charlestown, MA 02129,  United States.

It has been suggested that discrepant findings regarding low basal cortisol levels and enhanced suppression of cortisol in response to dexamethasone (DEX) administration in post-traumatic stress disorder (PTSD) may reflect individual differences in gender, trauma type, stage of development at trauma occurrence (e.g., childhood vs. adulthood), early pre-traumatic risk factors, or other individual differences. This study examined salivary cortisol levels at 08.00h and 16.00h as well as cortisol response to 0.50 mg DEX in 40 female Vietnam nurse veterans who had current, chronic PTSD (Current) vs. 43 who never had PTSD (Never). Repeated measures analyses of covariance did not reveal significant group differences in cortisol levels or cortisol suppression. Given that nurses who served in Vietnam had similar exposures, ages at exposure, and duration since exposure to previously studied male Vietnam combat veterans, the present lack of  evidence for low cortisol and cortisol hyper-suppression in nurses with PTSD suggests that previous findings of low cortisol and cortisol hyper-suppression in male Vietnam veterans, females sexually abused as children, and other populations may reflect risk factors beyond simply having PTSD.

PMID: 18951637 [PubMed - in process]

 

AIDS Behav. 2008 Dec 12. [Epub ahead of print]

Lifetime and HIV-Related PTSD Among Persons Recently Diagnosed with HIV.

Martin L, Kagee A.

Department of Psychology, Stellenbosch University, Matieland, Private Bag X1, Stellenbosch, 7602, South Africa.

This cross-sectional study sought to determine the percentage of individuals who  met criteria for lifetime PTSD and HIV-related PTSD among 85 recently diagnosed HIV-positive patients attending public health clinics in the Western Cape, South  Africa. The PTSD module of the Composite International Diagnostic Interview (CIDI) was used to determine the percentage of those who met criteria for lifetime PTSD and HIV-related PTSD. The rate of lifetime PTSD and incidence of HIV-related PTSD was 54.1% (95% CI: 43.6-64.3%) and 40% (95% CI: 30.2-50.6%), respectively. Findings suggest that receiving an HIV-positive diagnosis and/or being HIV-positive may be considered a stressor that frequently results in HIV-related PTSD. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health of HIV-positive individuals is appropriately addressed.

PMID: 19082880 [PubMed - as supplied by publisher]

 

Cogn Process. 2008 Dec 11. [Epub ahead of print]

A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration.

Gruzelier J.

Department of Psychology, Goldsmiths, University of London, Lewisham Way, New Cross, London, SE14 6NW, UK, j.gruzelier@gold.ac.uk.

Professionally significant enhancement of music and dance performance and mood has followed training with an EEG-neurofeedback protocol which increases the ratio of theta to alpha waves using auditory feedback with eyes closed. While originally the protocol was designed to induce hypnogogia, a state historically associated with creativity, the outcome was psychological integration, while subsequent applications focusing on raising the theta-alpha ratio, reduced depression and anxiety in alcoholism and resolved post traumatic stress syndrome  (PTSD). In optimal performance studies we confirmed associations with creativity  in musical performance, but effects also included technique and communication. We extended efficacy to dance and social anxiety. Diversity of outcome has a counterpart in wide ranging associations between theta oscillations and behaviour in cognitive and affective neuroscience: in animals with sensory-motor activity in exploration, effort, working memory, learning, retention and REM sleep; in man with meditative concentration, reduced anxiety and sympathetic autonomic activation, as well as task demands in virtual spatial navigation, focussed and sustained attention, working and recognition memory, and having implications for  synaptic plasticity and long term potentiation. Neuroanatomical circuitry involves the ascending mescencephalic-cortical arousal system, and limbic circuits subserving cognitive as well as affective/motivational functions. Working memory and meditative bliss, representing cognitive and affective domains, respectively, involve coupling between frontal and posterior cortices, exemplify a role for theta and alpha waves in mediating the interaction between distal and widely distributed connections. It is posited that this mediation in part underpins the integrational attributes of alpha-theta training in optimal performance and psychotherapy, creative associations in hypnogogia, and enhancement of technical, communication and artistic domains of performance in the arts.

PMID: 19082646 [PubMed - as supplied by publisher]

 

Am J Med Genet B Neuropsychiatr Genet. 2008 Dec 5;147B(8):1488-94.

Association of the cannabinoid receptor gene (CNR1) with ADHD and post-traumatic  stress disorder.

Lu AT, Ogdie MN, Järvelin MR, Moilanen IK, Loo SK, McCracken JT, McGough JJ, Yang MH, Peltonen L, Nelson SF, Cantor RM, Smalley SL.

Department of Human Genetics, University of California, Los Angeles, California,  USA.

Attention deficit hyperactivity disorder (ADHD) is a highly heritable disorder affecting some 5-10% of children and 4-5% of adults. The cannabinoid receptor gene (CNR1) is a positional candidate gene due to its location near an identified ADHD linkage peak on chromosome 6, its role in stress and dopamine regulation, its association with other psychiatric disorders that co-occur with ADHD, and its function in learning and memory. We tested SNP variants at the CNR1 gene in two independent samples-an unselected adolescent sample from Northern Finland, and a  family-based sample of trios (an ADHD child and their parents). In addition to using the trios for association study, the parents (with and without ADHD) were used as an additional case/control sample of adults for association tests. ADHD and its co-morbid psychiatric disorders were examined. A significant association  was detected for a SNP haplotype (C-G) with ADHD (P = 0.008). A sex by genotype interaction was observed as well with this haplotype posing a greater risk in males than females. An association of an alternative SNP haplotype in this gene was found for post-traumatic stress disorder (PTSD) (P = 0.04 for C-A, and P = 0.01 for C-G). These observations require replication, however, they suggest that the CNR1 gene may be a risk factor for ADHD and possibly PTSD, and that this gene warrants further investigation for a role in neuropsychiatric disorders. Copyright 2008 Wiley-Liss, Inc.

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

PMID: 18213623 [PubMed - in process]

 

Biol Psychiatry. 2008 Dec 4. [Epub ahead of print]

Amygdala Deactivation as a Neural Correlate of Pain Processing in Patients with Borderline Personality Disorder and Co-Occurrent Posttraumatic Stress Disorder.

Kraus A, Esposito F, Seifritz E, Di Salle F, Ruf M, Valerius G, Ludaescher P, Bohus M, Schmahl C.

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

BACKGROUND: Previous studies have revealed altered affective pain processing in patients with borderline personality disorder (BPD) as well as in patients with posttraumatic stress disorder (PTSD). Reduced levels of activation in the amygdala might be related to antinociceptive mechanisms pertinent to both disorders. This study aimed at clarifying whether central antinoceptive mechanisms discriminate BPD patients with and without co-occurrent PTSD. METHODS: We investigated 29 medication-free female outpatients with BPD, 12 with and 17 without co-occurrent PTSD. Psychophysical characteristics were assessed, and functional magnetic resonance imaging was performed during heat stimulation with  stimuli adjusted for equal subjective painfulness. RESULTS: No difference in pain sensitivity was found between both groups of patients. Amygdala deactivation, however, was more pronounced in BPD patients with co-occurrent PTSD compared with those without PTSD. Amygdala deactivation was independent of BPD symptom severity and dissociation. CONCLUSIONS: Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD. On the basis of these preliminary findings it might be speculated that reduced pain sensitivity or at least the emotional component of it is associated with amygdala deactivation in patients with both disorders, whereas BPD patients without PTSD use different yet unknown antinociceptive mechanisms.

PMID: 19058793 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Dec 4. [Epub ahead of print]

A Study of the Protective Function of Acute Morphine Administration on Subsequent Posttraumatic Stress Disorder.

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

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

BACKGROUND: To index the extent to which acute administration of morphine is protective against development of posttraumatic stress disorder (PTSD). METHODS:  Consecutive patients admitted to hospital after traumatic injury (n = 155) were assessed for current psychiatric disorder, pain, and morphine dose in the initial week after injury and were reassessed for PTSD and other psychiatric disorders 3  months later (n = 120). RESULTS: Seventeen patients (14%) met criteria for PTSD at 3 months. Patients who met criteria for PTSD received significantly less morphine than those who did not develop PTSD; there was no difference in morphine levels in those who did and did not develop major depressive episode or another anxiety disorder. Hierarchical regression analysis indicated that PTSD severity at 3 months was significantly predicted by acute pain, mild traumatic brain injury, and elevated morphine dose in the initial 48 hours after trauma, after controlling for injury severity, gender, age, and type of injury. CONCLUSIONS: Acute administration of morphine may limit fear conditioning in the aftermath of  traumatic injury and may serve as a secondary prevention strategy to reduce PTSD  development.

PMID: 19058787 [PubMed - as supplied by publisher]

 

Drug Alcohol Depend. 2008 Dec 3. [Epub ahead of print]

Posttraumatic stress disorder and other psychopathology in substance abusing patients.

Cacciola JS, Koppenhaver JM, Alterman AI, McKay JR.

The University of Pennsylvania School of Medicine/Philadelphia Veterans Affairs Medical Center, Center for Studies of Addiction, Philadelphia, PA 19104, United States; The Treatment Research Institute, Philadelphia, PA 19106, United States.

Studies demonstrating greater problem severity in substance abuse patients with posttraumatic stress disorder (PTSD) versus those without have rarely considered  other co-occurring psychiatric disorders. This study of 466 male veterans recently admitted to outpatient substance abuse treatment attempts to identify problems associated with PTSD versus those associated with other nonsubstance use Axis I disorders. Problem severity, particularly psychiatric, was examined across four groups of patients with substance use disorders (SUDs). Those with: 1, SUDs  only (SU-Only); 2, PTSD, but no other Axis I disorders (SU+PTSD); 3, PTSD and other Axis I disorders (SU+PTSD+Axis I); and 4, no PTSD, but other Axis I disorders (SU+other Axis I). Results suggested a hierarchy of psychiatric, and to a lesser extent, other life problem severities associated with these diagnostic groupings. The most severe group was SU+PTSD+Axis I, followed in decreasing severity by the SU+other Axis I, SU+PTSD, and SU-Only groups. Additional analyses comparing the SU+PTSD+Axis I patients with a subgroup of Axis I patients with more than one Axis I disorder (SU+multiple Axis I) revealed few group differences except for more lifetime suicide attempts and psychiatric hospitalizations in the SU+PTSD+Axis I group. The findings suggest that it is not PTSD per se, but the frequent co-occurrence of PTSD and other psychopathology that largely accounts for previously reported greater problem severity of SUD patients with PTSD.

PMID: 19062202 [PubMed - as supplied by publisher]

 

J Burn Care Res. 2008 Dec 3. [Epub ahead of print]

The Effect of Propranolol on Posttraumatic Stress Disorder in Burned Service Members.

McGhee LL, Maani CV, Garza TH, Desocio PA, Gaylord KM, Black IH.

From the *Battlefield Pain Control Project Area and daggerCenter for Outcomes Research, United States Army Institute of Surgical Research; and double daggerDepartment of Anesthesiology, Brooke Army Medical Center, Ft. Sam Houston,  Texas.

Posttraumatic stress disorder (PTSD) is reported to affect almost one third of the civilian burn patient population. Predisposing factors for PTSD include experiencing a traumatic event. Of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) soldiers returning home after deployment without injury, 17% reported cognitive symptoms of PTSD. The authors recent study of soldiers burned  in OIF/OEF showed a PTSD prevalence of approximately 30%, which is similar to civilian studies. Burns are characterized by hypermetabolism and increased catecholamine levels. beta-Adrenergic receptor blocking agents, like propranolol, decrease catecholamine levels. Propranolol may reduce consolidation of memory and a prophylaxis for PTSD. This retrospective study examines the relationship between PTSD prevalence and propranolol administration. After institutional review board approval, propranolol received, number of surgeries, anesthetic/analgesic regimen, TBSA burned, and injury severity score were collected from patients charts. The military burn center received 603 soldiers injured in OIF/OEF, of which 226 completed the PTSD Checklist-Military. Thirty-one soldiers received propranolol and 34 matched soldiers did not. In propranolol patients, the prevalence of PTSD was 32.3% vs 26.5% in those not receiving propranolol (P = .785). These data suggest propranolol does not decrease PTSD development in burned soldiers. The prevalence of PTSD in patients  receiving propranolol is the same as those not receiving propranolol. More research is needed to determine the relationship between PTSD and propranolol.

PMID: 19060728 [PubMed - as supplied by publisher]

 

Am J Psychiatry. 2008 Dec 1. [Epub ahead of print]

Toward Validation of the Diagnosis of Posttraumatic Stress Disorder.

North CS, Suris AM, Davis M, Smith RP.

Unlike most psychiatric diagnoses, posttraumatic stress disorder (PTSD) is defined in relation to a potentially etiologic event (the traumatic "stressor criterion") that is fundamental to its conceptualization. The diagnosis of PTSD thus inherently depends on two separate but confounded processes: exposure to trauma and development of a specific pattern of symptoms that appear following the trauma. Attempts to define the range of trauma exposure inherent in the diagnosis of PTSD have generated controversy, as reflected in successive revisions of the criterion from DSM-III onward. It is still not established whether or not there are specific types of traumatic events and levels of exposure to them that are associated with a syndrome that is cohesive in clinical characteristics, biological correlates, familial patterns, and longitudinal diagnostic stability. On the other hand, the symptomatic description of PTSD is becoming more clear. Of three categories of symptoms associated with PTSD-intrusive memories, avoidance and numbing, and hyperarousal-avoidance and numbing appear to be the most specific for identification of PTSD. Research is now poised to answer questions about the relevance of traumatic events based on their relationship to symptomatic outcome. The authors recommend that future research begin with existing diagnostic criteria, testing and further refining them in accordance with the classic Robins and Guze strategy for validation of psychiatric diagnoses. In this process, diligent adherence to the criteria under  examination is paramount to successful PTSD research, and changes in criteria are driven by empirical data rather than theory. Collaborations among trauma research biologists, epidemiologists, and nosologists to map the correspondence between the clinical and biological indicators of psychopathology are necessary to advance validation and further understanding of PTSD.

PMID: 19047323 [PubMed - as supplied by publisher]

 

Am J Psychiatry. 2008 Dec;165(12):1566-75. Epub 2008 Nov 17.

Comment in:     Am J Psychiatry. 2008 Dec;165(12):1505-6.

Trauma, resilience, and recovery in a high-risk African-American population.

Alim TN, Feder A, Graves RE, Wang Y, Weaver J, Westphal M, Alonso A, Aigbogun NU, Smith BW, Doucette JT, Mellman TA, Lawson WB, Charney DS.

Department of Psychiatry, Howard University, Washington, DC, USA.

OBJECTIVE: Despite increased risk for psychiatric disorders after trauma exposure, many people are able to adapt with minimal life disruption, and others  eventually recover after a symptomatic period. This study examined psychosocial factors associated with resilience and recovery from psychiatric disorders in a high-risk sample of African American adults exposed to a range of severe traumas, who participated in structured diagnostic interviews. METHOD: The sample included 259 patients exposed to at least one severe traumatic event, recruited from primary care offices at Howard University and administered the Structured Clinical Interview for DSM-IV Axis I disorders. Multinomial logistic regression was used to identify potential psychosocial factors associated with resilience and recovery, including purpose in life, mastery, and coping strategies. RESULTS: Forty-seven patients had no lifetime psychiatric disorders (resilient), 85 met criteria for at least one past DSM-IV disorder but no current disorders (recovered), and 127 met criteria for at least one current DSM-IV disorder (currently ill). The resilient group was characterized by a significantly lower lifetime trauma load. Female gender was predictive of currently ill status. In the final model, purpose in life emerged as a key factor associated with both resilience and recovery, and mastery was also significantly associated with recovery. CONCLUSIONS: The identification of psychosocial factors associated with resistance to severe trauma can inform future studies of preventive and treatment interventions for high-risk populations. Further study is needed to determine which psychosocial factors are consistently associated with resilience and to what extent they can be modified through clinical intervention.

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

PMID: 19015233 [PubMed - indexed for MEDLINE]

 

52: Am J Public Health. 2008 Dec;98(12):2191-8. Epub 2008 Oct 15.

Canadian military personnel's population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations.

Sareen J, Belik SL, Afifi TO, Asmundson GJ, Cox BJ, Stein MB.

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. sareen@cc.umanitoba.ca

OBJECTIVES: We investigated mental disorders, suicidal ideation, self-perceived need for treatment, and mental health service utilization attributable to exposure to peacekeeping and combat operations among Canadian military personnel. METHODS: With data from the Canadian Community Health Survey Cycle 1.2 Canadian Forces Supplement, a cross-sectional population-based survey of active Canadian military personnel (N = 8441), we estimated population attributable fractions (PAFs) of adverse mental health outcomes. RESULTS: Exposure to either combat or peacekeeping operations was associated with posttraumatic stress disorder (men: PAF = 46.6%; 95% confidence interval [CI] = 27.3, 62.7; women: PAF = 23.6%; 95% CI = 9.2, 40.1), 1 or more mental disorder assessed in the survey (men: PAF = 9.3%; 95% CI = 0.4, 18.1; women: PAF = 6.1%; 95% CI = 0.0, 13.4), and a perceived need for information (men: PAF = 12.3%; 95% CI = 4.1, 20.6; women: PAF = 7.9%; 95% CI = 1.3, 15.5). CONCLUSIONS: A substantial proportion, but not the majority, of mental health-related outcomes were attributable to combat or peacekeeping deployment. Future studies should assess traumatic events and their association with physical injury during deployment, premilitary factors, and postdeployment psychosocial factors that may influence soldiers' mental health.

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

PMID: 18923111 [PubMed - indexed for MEDLINE]

 

53: Arch Gen Psychiatry. 2008 Dec;65(12):1410-8.

Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age: the Vietnam experience study.

Gale CR, Deary IJ, Boyle SH, Barefoot J, Mortensen LH, Batty GD.

Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, England. crg@mrc.soton.ac.uk

CONTEXT: Lower cognitive ability is a risk factor for some forms of psychopathology, but much of the evidence for risk is based on individuals who required specialist care. It is unclear whether lower ability influences the risk of particular patterns of comorbidity. OBJECTIVE: To examine the relation between premorbid cognitive ability in early adulthood and the risk of major depression,  generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), alcohol and other drug abuse or dependence, and comorbid forms of these conditions in midlife. DESIGN: Prospective cohort study in which cognitive ability was measured on enlistment into military service at a mean age of 20.4 years and psychiatric disorder was assessed by structured diagnostic interview at a mean age of 38.3 years. SETTING: The United States. PARTICIPANTS: A total of 3258 male veterans, participants in the Vietnam Experience Study. MAIN OUTCOME MEASURES: Major depression, GAD, PTSD, and alcohol or other drug abuse or dependence since enlistment and currently, diagnosed according to the DSM-III. RESULTS: Lower cognitive ability was associated with an increased risk of depression, GAD, alcohol abuse or dependence, and PTSD and with some patterns of comorbidity. For  a 1-SD decrease in cognitive ability, unadjusted odds ratios (95% confidence interval) for having these disorders currently were 1.32 (1.12-1.56) for depression, 1.43 (1.27-1.64) for GAD, 1.20 (1.08-1.35) for alcohol abuse or dependence, 1.39 (1.18-1.67) for PTSD, 2.50 (1.41-4.55) for PTSD plus GAD, 2.17 (1.47-3.22) for PTSD plus GAD plus depression, and 2.77 (1.12-6.66) for all 4 disorders. Most associations remained statistically significant after adjustment  for confounders. CONCLUSIONS: Lower cognitive ability is a risk factor for several specific psychiatric disorders, including some forms of comorbidity. Understanding the mechanisms whereby ability is linked to individual patterns of  psychopathology may inform intervention.

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

PMID: 19047528 [PubMed - indexed for MEDLINE]

 

Assessment. 2008 Dec;15(4):404-25. Epub 2008 Jun 20.

Exploratory and confirmatory factor analyses of the structured interview for disorders of extreme stress.

Scoboria A, Ford J, Lin HJ, Frisman L.

Department of Psychology, University of Windsor, Windsor, ON, Canada. scoboria@uwindsor.ca

Two studies were conducted to provide the first empirical examination of the factor structure of a revised version of the clinically derived Structured Interview for Disorders of Extreme Stress, a structured interview designed to assess associated features of posttraumatic stress disorder (PTSD) thought to be  related to early onset, interpersonal, and prolonged traumatic exposure. Five factors representing demoralization, somatic dysregulation, anger dysregulation,  risk/self-harm, and altered sexuality were derived from an exploratory factor analysis conducted with adult trauma survivors in substance abuse treatment. They provided a good fit in a confirmatory factor analysis conducted in a second study with a nonclinical sample of ethnoculturally diverse, socioeconomically disadvantaged, incarcerated adults. Evidence of the derived factors' internal consistency and convergent and discriminant validity is reported. Evidence supported the association of these factors with interpersonal trauma (physical and/or sexual), its repetition, and its earlier onset. Implications for clinical  assessment of complex posttraumatic stress disorder are discussed.

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

PMID: 18567699 [PubMed - in process]

 

Assessment. 2008 Dec;15(4):391-403. Epub 2008 Apr 24.

Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans.

Vogt DS, Proctor SP, King DW, King LA, Vasterling JJ.

Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare  System, Boston, MA 02130, USA. dawne.vogt@va.gov

The Deployment Risk and Resilience Inventory (DRRI) is a suite of scales that can be used to assess deployment-related factors implicated in the health and well-being of military veterans. Although initial evidence for the reliability and validity of DRRI scales based on Gulf War veteran samples is encouraging, evidence with respect to a more contemporary cohort of Operation Iraqi Freedom (OIF) veterans is not available. Therefore, the primary goal of the present study was to validate scales from the DRRI in a large sample of OIF army personnel diversified in occupational and demographic characteristics. In general, results  supported the use of these DRRI scales in this population. Internal consistency reliability estimates were quite strong. Additionally, support was obtained for criterion-related validity, as demonstrated by associations with mental and physical health measures, and discriminative validity, as demonstrated by differences between key military subgroups.

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

PMID: 18436857 [PubMed - in process]

 

Aust N Z J Psychiatry. 2008 Dec;42(12):1051-9.

Naturalistic comparison of models of programmatic interventions for combat-related post-traumatic stress disorder.

Forbes D, Lewis V, Parslow R, Hawthorne G, Creamer M.

Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia. dforbes@unimelb.edu.au

OBJECTIVES: Post-traumatic stress disorder (PTSD) is a difficult-to-treat sequel  of combat. Data on effectiveness of alternate treatment structures are important  for planning veterans' psychiatric services. The present study compared clinical  presentations and treatment outcomes for Australian veterans with PTSD who participated in a range of models of group-based treatment. METHOD: Participants  consisted of 4339 veterans with combat-related PTSD who participated in one of five types of group-based cognitive behavioural programmes of different intensities and settings. Data were gathered at baseline (intake), as well as at  3 and 9 month follow up, on measures of PTSD, anxiety, depression and alcohol misuse. Analyses of variance and effect size analyses were used to investigate differences at intake and over time by programme type. RESULTS: Small baseline differences by programme intensity were identified. Although significant improvements in symptoms were evident over time for each programme type, no significant differences in outcome were evident between programmes. When PTSD severity was considered, veterans with severe PTSD performed less well in the low-intensity programmes than in the moderate- or high-intensity programmes. Veterans with mild PTSD improved less in high-intensity programmes than in moderate- or low-intensity programmes. CONCLUSION: Comparable outcomes are evident across programme types. Outcomes may be maximized when veterans participate in programme intensity types that match their level of PTSD severity. When such matching is not feasible, moderate-intensity programmes appear to offer the most consistent outcomes. For regionally based veterans, delivering treatment in their local environment does not detract from, and may even enhance, outcomes. These findings have implications for the planning and purchasing of mental health services for sufferers of PTSD, particularly for veterans of more recent combat or peacekeeping deployments.

PMID: 19016093 [PubMed - in process]

 

Behav Res Ther. 2008 Dec;46(12):1305-10. Epub 2008 Sep 25.

Anxiety and post-traumatic stress symptoms following wisdom tooth removal.

de Jongh A, Olff M, van Hoolwerff H, Aartman IH, Broekman B, Lindauer R, Boer F.

Academic Centre for Dentistry Amsterdam, Department of Social Dentistry and Behavioural Sciences, University of Amsterdam, Louwesweg 1, 1066 EA Amsterdam, The Netherlands. a.de.jongh@acta.nl

The purpose of the present study was to determine the psychological impact of wisdom teeth removal and to identify the psychological risk factors for the development of dental anxiety and post-traumatic stress symptoms. Participants were 34 consecutive elective patients referred for surgical removal of a wisdom tooth under local anesthesia. Frequency of previous distressing dental events and general traumatic life events were assessed at baseline (t1), and emotional distress (pain, state anxiety and disturbance) immediately after treatment (t2).  Post-traumatic stress responses were determined three days after treatment (t3),  and at four weeks follow-up (t4), while severity of dental trait anxiety was assessed at t1 and at t4. Two patients (8%) met screening criteria for Post-Traumatic Stress Disorder (PTSD) at t4. Multivariate analysis revealed that  previous exposure to distressing dental events and pre-operative anxiety level predicted anxiety level at t4, accounting for 71% of the variance. Severity of pain during treatment was a significant predictor variable of PTSD symptom severity at t4 (25% explained variance). The findings underline the importance of pain-free treatments and awareness of patients' individual predisposition to anxiety or trauma-related symptoms to reduce the risk of iatrogenic psychological harm.

PMID: 18954863 [PubMed - in process]

 

Behav Ther. 2008 Dec;39(4):386-97. Epub 2008 Jun 6.

Risk factors for isolated sleep paralysis in an African American sample: a preliminary study.

Ramsawh HJ, Raffa SD, White KS, Barlow DH.

Boston University, Boston, MA, USA. hramsawh@ucsd.edu

Isolated sleep paralysis (ISP) is a temporary period of involuntary immobility that can occur at sleep onset or offset. It has previously been reported in association with both panic disorder (PD) and posttraumatic stress disorder (PTSD). The current study examined the association between ISP and several possible risk factors--anxiety sensitivity, trauma exposure, life stress, and paranormal beliefs--in a sample of African American participants with and without a history of ISP. Significant between-group differences were found for PD and PTSD diagnoses, anxiety sensitivity, life stress, and certain aspects of paranormal belief, with the ISP group being higher on all of these indices. No differences were found with regard to trauma exposure. Hierarchical regression analyses indicated that PD, anxiety sensitivity, and life stress each contributed unique variance to ISP cognitive symptoms, whereas PTSD and paranormal beliefs did not. These results provide preliminary support for an association between ISP and anxiety sensitivity and corroborate previous reports of ISP's association with PD and life stress. The current trauma/PTSD findings are mixed, however, and warrant future research.

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

PMID: 19027435 [PubMed - in process]

 

Burns. 2008 Dec;34(8):1082-9. Epub 2008 Jun 3.

PTSD in persons with burns: an explorative study examining relationships with attributed responsibility, negative and positive emotional states.

Van Loey NE, van Son MJ, van der Heijden PG, Ellis IM.

Association of Dutch Burn Centres, Beverwijk, The Netherlands. nvanloey@burns.nl

A sample of 90 persons who had been hospitalized for severe burns were interviewed 1-4 years after the incident. Current DSM-IV post-traumatic stress disorder (PTSD) was assessed with the Composite International Diagnostic Interview. Perceived attributed responsibility and related positive and negative  emotional states were examined using a semi-structured interview. Findings showed that PTSD was established in 8% of the participants and partial PTSD in 13%. In a homogeneity analysis (HOMALS), PTSD was associated with the attribution of responsibility for the incident to impersonal relationships and with a negative emotional state. The absence of (partial) PTSD was associated with the attribution of responsibility to close relationships, internal and circumstance-related attribution of responsibility and neutral or forgiving feelings. In logit analyses, both emotional state as well as attributed responsibility are significantly related to (partial) PTSD. However, the model including emotional state showed to have the best fit. Although further research  is needed, these results may indicate that professionals working in burn care should consider the emotional state in relation to perceived attribution of responsibility when considering PTSD. Promoting forgiveness may be a beneficial strategy in dealing with post-traumatic stress reactions.

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

PMID: 18511200 [PubMed - in process]

 

Cyberpsychol Behav. 2008 Dec;11(6):775-7.

BusWorld: an analog pilot test of a virtual environment designed to treat posttraumatic stress disorder originating from a terrorist suicide bomb attack.

Josman N, Reisberg A, Weiss PL, Garcia-Palacios A, Hoffman HG.

Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, Israel. naomij@research.haifa.ac.il

Exposure therapy treatment can lead to large reductions in posttraumatic stress disorder (PTSD) symptoms. Virtual reality exposure (VRE) therapy is designed to facilitate cognitive behavioral therapy for PTSD. During VRE therapy, patients go into an immersive computer-generated environment (go back to the scene of the traumatic event) to help them gain access to their memories of the traumatic event, change unhealthy thought patterns, gradually habituate to their anxiety, and reduce the intensity of associated emotions. The therapist's ability to manipulate the amount of anxiety experienced by the client during therapy is an important element of successful exposure therapy. Using a within-subjects design, 30 asymptomatic volunteers each experienced four levels of a virtual world depicting a terrorist bus bombing, designed to be increasingly distressful. There was a statistically significant difference between the mean subjective units of discomfort scores (SUDS) of the four levels, and several planned paired comparisons showed significantly higher SUDS ratings with higher simulation levels. Results suggest that sound may play an important role in successful elicitation of emotional responses during VRE. The results of this analog study provide initial validation of the potential of BusWorld to provide graded exposure for individuals suffering from PTSD originating from suicide bus bombings. Future research exploring whether VR exposure therapy with BusWorld can reduce PTSD in clinical patients is warranted.

PMID: 18991534 [PubMed - in process]

 

Encephale. 2008 Dec;34(6):577-83. Epub 2008 Apr 2.

[Prevalence of trauma-related disorders in the French WHO study: Santémentale en  population générale (SMPG).]

[Article in French]

Vaiva G, Jehel L, Cottencin O, Ducrocq F, Duchet C, Omnes C, Genest P, Rouillon F, Roelandt JL.

Secteur des urgences psychiatriques, pôle des urgences, CHRU de Lille, rue André-Verhaeghe, 59037 Lille, France; GIS épidémiologie en santé mentale, CHU de  Sainte-Anne, Paris, France.

INTRODUCTION: Trauma-related disorders are disabling affections of which epidemiological data change according to the country, population and measuring instruments. The prevalence of posttraumatic stress disorder (PTSD) appears to have increased over the past 15 years, but one cannot tell whether it has indeed  increased or whether the standardized procedure has improved. Moreover, very few  epidemiologic studies among the general population have been conducted in Europe, notably in France. DESIGN OF THE STUDY: The "Santé mentale en population générale" (SMPG) survey, that took place in France between 1999 and 2003 among more than 36 000 individuals, gives an estimation of the prevalence of psychotraumatic disorders in the general population. Multi-varied analyses were performed on PTSD-related variables and comorbid disorders. The instantaneous prevalence (past month) of PTSD was of 0.7% among the whole SMPG sample, with almost the same proportion of men (45%) and women (55%). There was a high rate of comorbidity among PTSD individuals, notably with mood disorders, anxiety disorders and addictive behaviour. There was an obvious relationship with suicidal behaviour, with 15-fold more suicide attempts during the past month among the PTSD population. RESULTS: This survey analysed the consequences of a psychic traumatism over and above complete PTSD according to DSM-IV criteria, observing for instance the consequences for people exposed both to a trauma and suffering from at least one psychopathological symptom since the trauma. Those who suffered from a psychotraumatic syndrome, according to our enlarged definition, represented 5.3% of the population, half suffered from daily discomfort and a third of them used medication. Then, we compared those psychotraumatic syndromes to complete PTSD from a sociodemographic, functional and type of care point of view. There was little difference in prevalence of PTSD between men and women in the SMPG survey (45% vs 55%), which is clearly distinct  from the other epidemiologic surveys named above. Regarding age, as in the ESEMeD survey, anxiety disorders appeared to be more frequent among younger people. The  originality of the SMPG survey is obviously in the fact that it studied the functional impact of the psychic disorder, the type of care and the satisfaction  level after care. Only 50% of the PTSD population feels sick which is, however, twice as high as for the psychotraumatized population. This doesn't fit either with the fact that 100% of the PTSD population say they feel uncomfortable with other people. The type of care is in the same vein: 50% of psychotherapies and 75% of medication, but also 25% of mild medicines and 25% of traditional medicines. Moreover, among the drugs, antidepressants (that are still the first choice treatment in all international recommendations) represent only 30%, whereas anxiolytics, hypnotics and phytotherapy represent the remaining 70%. DISCUSSION: Regarding the type of care, the differences between the psychotraumatized population and the PTSD population are obvious. They are obvious in that which concerns the type of care, since the medication is similar. From a very global point of view, patients suffering from a subsyndromal PTSD rarely choose medical care (religion, mild or traditional medicine), while full PTSD patients definitely choose classical medical care (drugs, psychotherapy, and 30% of hospitalization). The prevalence of those who ask for care is very close to that observed in the ESEMeD survey, which was four individuals out of 10 suffering from PTSD. CONCLUSION: The SMPG data show that its necessary to maintain the distinction between subsyndromal PTSD and full PTSD since the populations differ, but both need care.

Publication Types:      English Abstract

PMID: 19081454 [PubMed - in process]

 

Eur J Neurosci. 2008 Dec;28(11):2299-309. Epub 2008 Nov 3.

Impaired extinction of learned fear in rats selectively bred for high anxiety--evidence of altered neuronal processing in prefrontal-amygdala pathways.

Muigg P, Hetzenauer A, Hauer G, Hauschild M, Gaburro S, Frank E, Landgraf R, Singewald N.

Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Peter-Mayer-Strasse 1,  A-6020 Innsbruck, Austria.

The impaired extinction of acquired fear is a core symptom of anxiety disorders,  such as post-traumatic stress disorder, phobias or panic disorder, and is known to be particularly resistant to existing pharmacotherapy. We provide here evidence that a similar relationship between trait anxiety and resistance to extinction of fear memory can be mimicked in a psychopathologic animal model. Wistar rat lines selectively bred for high (HAB) or low (LAB) anxiety-related behaviour were tested in a classical cued fear conditioning task utilizing freezing responses as a measure of fear. Fear acquisition was similar in both lines. In the extinction trial, however, HAB rats showed a marked deficit in the  attenuation of freezing responses to repeated auditory conditioned stimulus presentations as compared with LAB rats, which exhibited rapid extinction. To gain information concerning the putatively altered neuronal processing associated with the differential behavioural response between HAB and LAB rats, c-Fos expression was investigated in the main prefrontal-amygdala pathways important for cued fear extinction. HAB compared to LAB rats showed an attenuated c-Fos response to repeated conditioned stimulus presentations in infralimbic and cingulate cortices, as well as in the lateral amygdala, but facilitated the c-Fos response in the medial part of the central amygdala. In conclusion, the present results support the notion that impaired extinction in high anxiety rats is accompanied by an aberrant activation profile in extinction-relevant prefrontal-amygdala circuits. Thus, HAB rats may represent a clinically relevant  model to study the mechanisms and potential targets to accelerate delayed extinction processes in subjects with enhanced trait anxiety.

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

PMID: 19019199 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1523-8. Epub 2008 Mar 13.

The symptom structure of posttraumatic stress disorder in the National Comorbidity Replication Survey.

Cox BJ, Mota N, Clara I, Asmundson GJ.

Department of Psychiatry, University of Manitoba, Canada. coxbj@cc.umanitoba.ca

Previous research has provided mixed findings for the validity of various three-  and four-factor models of posttraumatic stress disorder (PTSD) symptomatology. However, much of this research has been restricted to clinical samples rather than nationally representative community-based samples. The current study employed confirmatory factor analysis to evaluate the validity of three competing models of PTSD symptom structure using the DSM-IV-based National Comorbidity Replication Survey (part II of the NCS-R: N=5692). Individuals with a lifetime diagnosis of PTSD (N=588) were selected and symptom assessment was based on the World Health Organization Composite International Diagnostic Interview. Strong support was found for both the DSM-IV three-factor model and a four-factor model  of PTSD symptoms by King et al. [King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment,10, 90-96], a variation of the DSM-IV model in which avoidance and numbing are viewed as separate factors. There was some evidence, however, that the King et al. [King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment,10, 90-96] model demonstrated a significantly superior fit over the DSM-IV three-factor model. Because this study provided support for both the DSM-IV three-factor model and the King et al., four-factor model of PTSD symptoms, further research is still necessary to provide more definitive conclusions in this area.

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

PMID: 18440773 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1393-402. Epub 2008 Feb 29.

Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure.

Adkins JW, Weathers FW, McDevitt-Murphy M, Daniels JB.

Department of Psychology, Auburn University, Auburn, AL 36849, United States.

In this study psychometric properties of seven self-report measures of posttraumatic stress disorder (PTSD) were compared. The seven scales evaluated were the Davidson Trauma Scale (DTS), the PTSD Checklist (PCL), the Posttraumatic Stress Diagnostic Scale (PDS), the Civilian Mississippi Scale (CMS), the Impact of Event Scale-Revised (IES-R), the Penn Inventory for Posttraumatic Stress Disorder (Penn), and the PK scale of the MMPI-2 (PK). Participants were 239 (79 male and 160 female) trauma-exposed undergraduates. All seven measures exhibited  good test-retest reliability and internal consistency. The PDS, PCL and DTS demonstrated the best convergent validity; the IES-R, PDS, and PCL demonstrated the best discriminant validity; and the PDS, PCL, and IES-R demonstrated the best diagnostic utility. Overall, results most strongly support the use of the PDS and the PCL for the assessment of PTSD in this population.

PMID: 18436427 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1496-509. Epub 2008 Mar 13.

Psychometric properties of the Trauma Relevant Assumptions Scale.

Buck N, Kindt M, Arntz A, van den Hout M, Schouten E.

Maastricht University, Department of Medical, Clinical and Experimental Psychology, P.O. Box 616, 6200 MD Maastricht, The Netherlands. N.Buck@erasmusmc.NL

This article describes the psychometric properties of a novel questionnaire, i.e. the Trauma Relevant Assumptions Scale (TRAS). The added value of the TRAS over previous trauma relevant belief questionnaires is that the TRAS enables measuring valence and rigidity of beliefs simultaneously. Both aspects are thought to be predictive of the development of chronic PTSD symptoms. For the exploratory factor analysis, the TRAS was administered to 309 adult volunteers. Principal components analysis yielded two factors: Assumptions about Self and Assumptions about the World. The two-factor structure was confirmed in a sample of 185 traumatized individuals. The TRAS seems to be a valid and reliable instrument, which is strongly related to post-trauma symptoms and has good discriminative validity. Apart from research settings, the TRAS may also be suitable in therapeutic settings to identify the severity of dysfunctional assumptions, and to assess the progress in change from negative assumptions to more positive assumptions.

PMID: 18424063 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1542-50. Epub 2008 Mar 13.

Critiquing symptom validity tests for posttraumatic stress disorder: a modification of Hartman's criteria.

Morel KR, Marshman KC.

Neuropsychology Laboratory/Psychology Service, Department of Veterans Affairs Tennessee Valley Health Care System, Psychology Service 116B, 1310 24th Avenue South, Nashville, TN 37212-2637, United States. k_morel@yahoo.com

The differential diagnosis of malingering in psychological evaluations for Posttraumatic Stress Disorder (PTSD) is complex and relies upon the integration of clinical knowledge and appropriate psychometric instruments. Over the years, there has been an increase in the use of validity measures, including Symptom Validity Tests (SVTs). In 2005, the National Academy of Neuropsychology published Symptom validity assessment: Practice issues and medical necessity, an official policy statement recognizing the importance of effort on test performance and recommending the utilization of specific SVTs to assess for response bias in neurocognitive and personality evaluations. As new SVTs become available, clinicians need a clear understanding of how to critique these tests and determine the strengths and limitations. This article demonstrates the fundamental principles of critiquing an SVT by applying a modified set of Hartman's [Hartman, D. E. (2002). The unexamined lie is a lie worth fibbing: Neuropsychological malingering and the Word Memory Test. Archives of Clinical Neuropsychology, 17, 709-714] criteria, originally developed for neuropsychological SVTs, to the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT).

PMID: 18423958 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1447-53. Epub 2008 Mar 2.

Predicting children's post-traumatic stress symptoms following hospitalization for accidental injury: combining the Child Trauma Screening Questionnaire and heart rate.

Olsson KA, Kenardy JA, De Young AC, Spence SH.

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

This study investigated the utility of combining the Child Trauma Screening Questionnaire (CTSQ) [Kenardy, J. A., Spence, S. H., & Macleod, A. C. (2006). Screening for post-traumatic stress disorder in children after accidental injury. Pediatrics, 118, 1002-1009] and children's heart rate (HR; emergency department and 24-h post-admission) to identify children likely to develop post-traumatic stress disorder (PTSD) symptoms at 1 and 6 months post-injury. Children completed the CTSQ within 2 weeks of injury. PTSD symptoms were assessed with the Anxiety Disorders Interview Schedule for DSM-IV [Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV, Child Version, Parent Interview Schedule. Orlando, Florida: The Psychological Corporation], for 79 children aged 7-16 years. A combination of the CTSQ plus HR (CTSQ-HR) was better  than the CTSQ alone or HR alone at identifying children likely to develop PTSD symptoms. These findings suggest that the CTSQ-HR screen may increase identification of children who are likely to develop PTSD symptoms, enabling development of targeted prevention programs.

PMID: 18394860 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1377-83. Epub 2008 Feb 7.

The factor structure of Posttraumatic Stress Disorder symptoms among bereaved individuals: a confirmatory factor analysis study.

Boelen PA, van den Hout MA, van den Bout J.

Department of Clinical and Health Psychology, Utrecht University, The Netherlands. P.A.Boelen@uu.nl

Posttraumatic Stress Disorder (PTSD) is defined in DSM-IV as an anxiety disorder  that encompasses symptom-clusters of reexperiencing, avoidance, and hyperarousal. Several studies have examined the factor structure of PTSD symptoms. To our knowledge, no studies have yet examined the factor structure of loss-related PTSD symptoms in samples exclusively comprised of bereaved individuals. Such an examination is important because it can advance our understanding of the stability of the structure of PTSD symptoms across groups confronted with different aversive life-events and of processes underlying the occurrence of PTSD symptoms after loss. In this study, five alternative models of the factor structure of PTSD symptoms were examined in a sample of 347 mourners. Results showed that, in this group, PTSD symptoms are best conceptualized as forming four factors: reexperiencing, avoidance, dysphoria, and hyperarousal. Patterns of correlations with depression and complicated grief supported the validity of the  model.

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

PMID: 18342486 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1355-68. Epub 2008 Feb 7.

The PTSD symptom scale's latent structure: an examination of trauma-exposed medical patients.

Naifeh JA, Elhai JD, Kashdan TB, Grubaugh AL.

Disaster Mental Health Institute, The University of South Dakota, Vermillion, SD  57069-2390, United States.

Several studies have employed confirmatory factor analysis (CFA) to evaluate the  latent structure of posttraumatic stress disorder (PTSD) assessment measures among various trauma-exposed populations. Findings have generally failed to support the current three-factor DSM-IV PTSD conceptualization, demonstrating the need to consider alternative models. The present study used CFA to evaluate seven models, including intercorrelated and hierarchical versions of two models with the most empirical support. Data were utilized from a heterogeneous trauma-exposed sample of general medical patients (n=252). Based on several indices, the three-factor DSM-IV PTSD model was shown to be inferior to alternative models. The strongest support was found for an intercorrelated four-factor model, separating avoidance and numbing symptoms into distinct factors. Validity for this model was partially supported by divergent relations between factors and external variables. Implications of the results are discussed, and a framework is proposed for resolving discrepant findings in the PTSD CFA literature.

PMID: 18337058 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1326-36. Epub 2008 Feb 5.

Chronic thought suppression and posttraumatic symptoms: data from the Madrid March 11, 2004 terrorist attack.

Vázquez C, Hervás G, Pérez-Sales P.

Complutense University, Madrid, School of Psychology, Campus de Somosaguas, 28223 Madrid, Spain. cvazquez@psi.ucm.es

Although a considerable number of people either witnessed directly or in the mass media the traumatic scenes of the terrorist attack that took place on March 11th, 2004 in Madrid, only a fraction of Madrid citizens developed posttraumatic symptoms. In this study, posttraumatic stress-related symptoms, degree of exposure, coping strategies related to the attack, and chronic attempts to avoid  intrusive thoughts (i.e., thought suppression) were assessed in a general population Madrid sample (N=503) 2-3 weeks after the attacks. Our results showed  that participants with higher scores in chronic thought suppression exhibited higher levels of PTSD symptoms. Higher scores in chronic thought suppression also correlated positively with the use of avoidant coping strategies after the attacks. We discuss the possible common roots of avoidance of intrusive thoughts  and avoidant coping strategies and the implications of this relationship for the  emergence of stress-related symptoms as well as for public health policies.

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

PMID: 18329844 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1337-46. Epub 2008 Feb 2.

The effects of direct versus witnessed threat on emergency department healthcare  workers: implications for PTSD criterion A.

Alden LE, Regambal MJ, Laposa JM.

Department of Psychology, University of British Columbia, Vancouver, B.C. V6T 1Z4, Canada. lalden@psych.ubc.ca

We compared post-traumatic stress disorder (PTSD) symptom severity and symptom cluster profiles in hospital emergency department (ED) medical staff (N=100) who  experienced an emotionally distressing work event that presented either a direct  threat to themselves or a witnessed threat to patients. The two groups displayed  similar levels of PTSD symptoms, however, they differed on symptom profiles and work consequences. The direct threat group experienced significantly greater fear during the event, more ongoing arousal symptoms, and more job dissatisfaction than the witnessed threat group. The witnessed threat group was more likely to appraise their PTSD symptoms as reflecting personal weakness. Overall, the results point to the need for further research to identify distinctive features of responses to different types of traumatic stressors.

PMID: 18325730 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1297-302. Epub 2008 Jan 19.

Developing a symptom validity test for posttraumatic stress disorder: application of the binomial distribution.

Morel KR, Shepherd BE.

Neuropsychology Laboratory, Psychology Service 116B, Department of Veterans Affairs Tennessee Valley Health Care System, 1310 24th Avenue South, Nashville, TN 37212-2637, United States. k_morel@yahoo.com

The past decade has witnessed a significant increase in research on the detection of malingered Posttraumatic Stress Disorder (PTSD) in civil litigation, other disability pension contexts, and in forensic cases. This article reviews the basic principles and statistical procedures that can be used to design and develop a Symptom Validity Test (SVT) for PTSD. We demonstrate how the practical  application of the binomial distribution can detect response bias in specific psychiatric disorders such as PTSD and can provide empirically grounded probabilistic evidence of malingering. We cite the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT) as an example.

PMID: 18295444 [PubMed - in process]

 

J Behav Ther Exp Psychiatry. 2008 Dec;39(4):546-57. Epub 2008 Jan 25.

The influence of data-driven versus conceptually-driven processing on the development of PTSD-like symptoms.

Kindt M, van den Hout M, Arntz A, Drost J.

Faculty of Social and Behavioural Sciences, Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands. m.kindt@uva.nl

Ehlers and Clark [(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345] propose that a predominance of data-driven processing during the trauma predicts subsequent PTSD. We wondered whether, apart from data-driven encoding, sustained data-driven processing after  the trauma is also crucial for the development of PTSD. Both hypotheses were tested in two analogue experiments. Experiment 1 demonstrated that relative to conceptually-driven processing (n=20), data-driven processing after the film (n=14), resulted in more intrusions. Experiment 2 demonstrated that relative to the neutral condition (n=24) and the data-driven encoding condition (n=24), conceptual encoding (n=25) reduced suppression of intrusions and a trend emerged  for memory fragmentation. The difference between the two encoding styles was due  to the beneficial effect of induced conceptual encoding and not to the detrimental effect of data-driven encoding. The data support the viability of the distinction between data-driven/conceptually-driven processing for the understanding of the development of PTSD.

PMID: 18328462 [PubMed - in process]

 

J Behav Ther Exp Psychiatry. 2008 Dec;39(4):424-35. Epub 2008 Jan 18.

The effect of pre-existing vulnerability factors on a laboratory analogue trauma  experience.

Laposa JM, Alden LE.

University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada. Judith_Laposa@camh.net

This study examined how pre-existing emotional and personality vulnerability factors affect responses to an analogue trauma experience. Sixty-eight undergraduate participants viewed a distressing film and completed measures of trait anxiety, intelligence, depression, trait dissociation, as well as changes in state anxiety, then recorded intrusions over the following week. Results revealed that trait anxiety, depression, trait dissociation, change in anxiety, and post-state anxiety were associated with intrusion frequency. Post-state anxiety mediated the relationship between trait anxiety, depression and trait dissociation, and intrusions. Implications for PTSD theories and laboratory trauma analogue research examining specific elements of cognitive models of PTSD  are discussed.

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

PMID: 18294615 [PubMed - in process]

 

J Consult Clin Psychol. 2008 Dec;76(6):923-32.

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

O'Donnell ML, Creamer MC, Parslow R, Elliott P, Holmes AC, Ellen S, Judson R, McFarlane AC, Silove D, Bryant RA.

Australian Centre for Posttraumatic Mental Health, Heidelberg West, Victoria, Australia. mod@unimelb.edu.au

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during  hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for  PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves  were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.

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

PMID: 19045961 [PubMed - in process]

 

J Fam Psychol. 2008 Dec;22(6):809-18.

Intimate partner abuse and PTSD symptomatology: Examining mediators and moderators of the abuse-trauma link.

Babcock JC, Roseman A, Green CE, Ross JM.

Department of Psychology, University of Houston.

Posttraumatic stress disorder (PTSD) has been linked to intimate partner abuse, physiological reactivity, and social support. The authors used structural equation modeling to test social support as a moderator and psychophysiological reactivity and anger as mediators of the relation between abuse and traumatic symptoms among a sample of women reporting psychological abuse, including women reporting both physical violence and no physical violence. Both physical and psychological abuse were related to PTSD symptoms. Whereas physical and psychological abuse were highly correlated, psychological abuse did not predict PTSD symptomatology over and above the effect due to physical assault. Psychophysiological reactivity and anger and fear displayed during an argument with the partner did not mediate the abuse?trauma link. Social support moderated  the relation between psychological abuse and PTSD symptomatology. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 19102602 [PubMed - in process]

 

J Nerv Ment Dis. 2008 Dec;196(12):912-8.

Trait dissociation predicts posttraumatic stress disorder symptoms in a prospective study of urban police officers.

McCaslin SE, Inslicht SS, Metzler TJ, Henn-Haase C, Maguen S, Neylan TC, Choucroun G, Marmar CR.

Mental Health Service, San Francisco VA Medical Center, San Francisco, California 94121, USA. Shannon.McCaslin@ucsf.edu

The current study prospectively examines the predictive relationship of trait dissociation, assessed during academy training, to PTSD symptoms assessed at 12 months of active police duty in relatively young and healthy police academy recruits (N = 180). The roles of pre-academy trauma exposure, exposure to life-threatening critical incidents during police duty, and peritraumatic dissociation at the time of the officer's worst critical incident were also examined. Utilizing path analytic techniques, greater trait dissociation, assessed during academy training, was predictive of both peritraumatic dissociation, and PTSD symptoms assessed at 12 months of police service. Moreover, after accounting for trait dissociation and peritraumatic dissociation, the relationship of previous trauma to later PTSD symptoms was no longer significant, demonstrating that the effect of previous trauma on later vulnerability to PTSD symptoms in this sample may be mediated by both trait and peritraumatic dissociation.

PMID: 19077859 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Dec;196(12):906-11.

Positive and negative psychological impact after secondary exposure to politically motivated violence among body handlers and rehabilitation workers.

Shiri S, Wexler ID, Alkalay Y, Meiner Z, Kreitler S.

Department of Psychology, Tel Aviv University, Tel Aviv, Israel. shimons3@post.tau.ac.il

The positive and negative psychological impact of secondary exposure to politically motivated violence was examined among body handlers and hospital rehabilitation workers, 2 groups that differed in their proximity and immediacy to violent events. Survivors of politically motivated violence served as a comparison group. Body handlers experienced high levels of positive psychological impact and traumatic stress symptoms. Levels of positive psychological impact among on-scene body handlers were higher than those experienced by rehabilitation workers. Traumatic stress symptoms predicted positive psychological impact among  body handlers. These findings indicate that proximity to stressors is associated  with higher levels of positive and negative psychological impact. Physical proximity is a major contributory factor to both positive and negative psychological effects of secondary exposure to trauma.

Publication Types:      Comparative Study

PMID: 19077858 [PubMed - indexed for MEDLINE]

 

J Neurosurg. 2008 Dec;109(6):1027-33.

Posttraumatic stress disorder in the family and friends of patients who have suffered spontaneous subarachnoid hemorrhage.

Noble AJ, Schenk T.

Department of Psychology, Durham University, Stockton-on-Tees, United Kingdom. a_j_noble@hotmail.com

OBJECT: Significant others (SOs), such as spouses and life partners, of patients  who have survived subarachnoid hemorrhage (SAH) can experience psychiatric symptoms and psychosocial disability. The cause of such symptoms has not been established. Authors of the present study analyzed whether posttraumatic stress disorder (PTSD) subsequent to a loved one's SAH is a plausible explanation for these symptoms. METHODS: The authors examined a large representative sample of 86 patient/SO pairs 3.5 months postictus. All SOs were evaluated using a diagnostic  PTSD measure, and coping skills were assessed. The cognitive, physical, and emotional status of patients was comprehensively examined. RESULTS: Twenty-six percent of SOs met the diagnostic criteria for PTSD, which represents a 3-fold increase in the rate expected within the general population. To establish the cause of PTSD, a logistic regression was performed, and results of this test showed that the use of maladaptive coping strategies was the best predictor of the disorder. A patient's level of disability held no significant association with the development of PTSD in his or her SO. CONCLUSIONS: The elevated incidence of PTSD in SOs helps to explain why these persons report concerning levels of psychiatric symptomatology and psychosocial disability. Greater attention must be given to an SO's adjustment to the experience of having a loved one suffer an SAH. This need is all the more pertinent given that SOs often act as informal caregivers and that PTSD could interfere with their ability to effectively minister. Because bad coping skills seem to be the main cause of PTSD, teaching SOs better strategies might prevent the disorder and any resulting psychosocial disability.

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

PMID: 19035715 [PubMed - in process]

 

J Psychosom Obstet Gynaecol. 2008 Dec;29(4):240-50.

Post-traumatic stress disorder following childbirth: current issues and recommendations for future research.

Ayers S, Joseph S, McKenzie-McHarg K, Slade P, Wijma K.

Department of Psychology, University of Sussex, Brighton, UK.

Background. An increasing body of research shows that a proportion of women experience significant symptoms of Post-Traumatic Stress Disorder (PTSD) following childbirth. Aims and method. An international group of researchers, clinicians, and user-group representatives met in 2006 to discuss the research to date into PTSD following childbirth, issues and debates within the field, and recommendations for future research. This paper reports the content of four discussions on (1) prevalence and comorbidity, (2) screening and treatment, (3) diagnostic and conceptual issues, and (4) theoretical issues. Conclusions. Current knowledge from the perspectives of the researchers is summarized, dilemmas are articulated and recommendations for future research into PTSD following childbirth are made. In addition, methodological and conceptual issues  are considered.

PMID: 18608815 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):521-9.

PTSD symptoms, forgiveness, and revenge among Israeli Palestinian and Jewish adolescents.

Hamama-Raz Y, Solomon Z, Cohen A, Laufer A.

School of Social Work, Ariel University Center of Samaria, Israel.

Exposure to political terror and its psychological toll were assessed in 276 Israeli Palestinian and 1,469 Jewish adolescents using self-report questionnaires. Israeli Palestinians displayed more posttraumatic symptoms, higher levels of objective exposure to terror, more negative life events, lower ability to forgive, and a higher need for vengeance than their Jewish counterparts. Although the two groups did not differ in fear levels, Israeli Palestinians expressed more favorable attitudes toward peace. Ethnicity played a  major role in explaining the variance of posttraumatic symptomatology. Israeli Palestinians displayed increased vulnerability to mental distress when compared to their Jewish counterparts. The unique roles of subjective fear, attitudes towards peace, forgiveness, and revenge among Israeli Palestinians are discussed.

PMID: 19107729 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):556-8.

Self-compassion and PTSD symptom severity.

Thompson BL, Waltz J.

Department of Psychology, University of Montana, Missoula, MT 59812, USA. brian.l.thompson@gmail.com

Neff's (2003a, 2003b) notion of self-compassion emphasizes kindness towards one's self, a feeling of connectedness with others, and mindful awareness of distressing experiences. Because exposure to trauma and subsequent posttraumatic  stress symptoms (PSS) may be associated with self-criticism and avoidance of internal experiences, the authors examined the relationship between self-compassion and PSS. Out of a sample of 210 university students, 100 endorsed experiencing a Criterion A trauma. Avoidance symptoms significantly correlated with self-compassion, but reexperiencing and hyperarousal did not. Individuals high in self-compassion may engage in less avoidance strategies following trauma  exposure, allowing for a natural exposure process.

PMID: 19107727 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):503-6.

Early intervention for trauma: where are we and where do we need to go? A commentary.

Litz BT.

VA Boston Healthcare System, National Center for PTSD, Massachusetts Veterans Epidemiological Research and Information Center, Boston, MA 02130, USA. brett.litz@va.gov

In this commentary, the author underscores the importance of early intervention for trauma and describes the challenges that lie ahead for researchers, decision  makers, and care providers. The author also provides a review of where things stand, briefly reviews psychological first aid strategies, and underscores where  we need to go from here. Although the field has advanced considerably in the last decade or so, and there are compelling trials underway, there is much work that needs to be done, especially in terms of effectiveness and the task of integrating early intervention into various work cultures, such as the military.

PMID: 19107726 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):530-9.

Low cortisol, high DHEA, and high levels of stimulated TNF-alpha, and IL-6 in women with PTSD.

Gill J, Vythilingam M, Page GG.

National Institute of Nursing Research, National Institutes of Health, Bethesda,  MD 20892-1506, USA. jgill@mail.nih.gov

Posttraumatic stress disorder (PTSD) has been associated with hypothalamic-pituitary-adrenal (HPA) axis and immune function alterations; however, few studies have simultaneously investigated these systems in participants with PTSD. In this study, HPA axis and immune function in 26 women with PTSD with and without major depressive disorder was compared to 24 traumatized controls and to 21 nontraumatized controls. Posttraumatic stress disorder was associated with low cortisol and higher levels of DHEA and greater production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) compared to traumatized and healthy controls. Women with PTSD and depression exhibited greater production of IL-6 and higher levels of dehydroepiandrosterone  (DHEA) than those with PTSD, but without depression. These findings suggest dysregulated HPA axis and immune function in women with PTSD, and that comorbid depression may contribute to these abnormalities.

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

PMID: 19107725 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):548-55.

Effects of early nightmares on the development of sleep disturbances in motor vehicle accident victims.

Kobayashi I, Sledjeski EM, Spoonster E, Fallon WF Jr, Delahanty DL.

Department of Psychology, Kent State University, Kent, OH 44242, USA.

The present study prospectively examined the extent to which trauma-related nightmares affected the subsequent development of insomnia symptoms in 314 motor  vehicle accident (MVA) victims. Participants were assessed in-hospital and at 2 weeks, 6 weeks, 3 months, and 1 year post-MVA. Hierarchical linear regression analyses showed that 6-week PTSD symptoms (PTSS) and 3-month nightmares, but not  2-week nightmares were positively associated with sleep onset and maintenance problems reported at 3-month post-MVA. Nightmares reported at 3-months post-MVA were positively associated with 1-year sleep maintenance problems. These findings highlight the dynamic relationship between PTSS and sleep problems as well as the potential importance of early intervention for trauma-related nightmares as a means to prevent sleep problems after a traumatic experience.

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

PMID: 19107721 [PubMed - in process]

 

Minerva Pediatr. 2008 Dec;60(6):1393-9.

The concept of post-traumatic mood disorder and its implications for adolescent suicidal behavior.

Sher L.

Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA LS2003@columbia.edu.

Post-traumatic stress disorder (PTSD) is a common psychiatric disorder which is frequently comorbid with major depressive disorder (MDD). It has been suggested that some or all individuals diagnosed with comorbid PTSD and MDD have a separate psychobiological condition that can be termed ''post-traumatic mood disorder'' (PTMD). The idea was based on the fact that a significant number of studies suggested that patients suffering from comorbid PTSD and MDD differed clinically  and biologically from individuals with PTSD alone or MDD alone. Individuals with  comorbid PTSD and MDD are characterized by greater severity of symptoms and the higher level of impairment in social and occupational functioning compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings from neuroendocrine challenge, cerebrospinal fluid, neuroimaging, sleep and other studies. It has been demonstrated that child abuse increases the risk for PTSD, MDD, and suicidal behavior in adolescents and adults. Many victims of childhood abuse develop comorbid PTSD and depression, i.e., they develop PTMD. PTMD is associated with suicidal behavior. The link between childhood abuse, suicidal behavior in adolescents and PTMD indicates that it is important to develop interventions to prevent PTMD in victims of child abuse; to develop measures to prevent suicidal behavior in adolescents with PTMD; and to study psychobiology of PTMD in order to develop treatments for PTMD. Priorities for intervening to reduce adolescent suicidal behavior lie with interventions focused upon the improved recognition, treatment and management of adolescents with psychiatric disorders including PTMD.

PMID: 18971900 [PubMed - in process]

 

Neurosurgery. 2008 Dec;63(6):1095-104; discussion 1004-5.

Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term.

Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T.

Department of Psychology, Durham University, Stockton-on-Tees, England.

OBJECTIVE: A subarachnoid hemorrhage reduces patients' quality of life (QoL) in both the short and long term. Neurological problems alone cannot explain this reduction. We examined whether posttraumatic stress disorder (PTSD) and fatigue provide an explanation. METHODS: We prospectively studied a representative sample of 105 subarachnoid hemorrhage patients. Patients were examined at approximately  3 and 13 months postictus. Examinations included assessments of PTSD, fatigue, sleep, cognitive and physical outcomes, and QoL. Patients' coping skills were also assessed. Regression analyses identified predictors for QoL and PTSD. RESULTS: Thirty-seven percent met the diagnostic criteria for PTSD at both assessment points. This is a fourfold increase compared with the rate of PTSD in  the general population. Fatigue in patients was also consistently elevated, higher, in fact, than the notoriously high fatigue level reported for cancer patients undergoing chemotherapy. PTSD was the best predictor for mental QoL, the domain most persistently impaired. It also helped predict physical QoL. Moreover, PTSD was linked to increased sleep problems and may, therefore, have led to fatigue in both the acute and later stages of recovery. To establish the cause of PTSD, a logistic regression was performed. This showed that maladaptive coping was the best predictor of PTSD. CONCLUSION: PTSD explains why some subarachnoid hemorrhage patients, despite relatively good clinical outcomes, continue to experience a reduced QoL. Given that maladaptive coping skills seem the main cause of PTSD, teaching patients better coping skills early on might prevent PTSD and QoL reduction.

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

PMID: 19057321 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):546-50.

[Psychosocial consequences of sexual abuse]

[Article in German]

Vyssoki D, Schürmann-Emanuely A.

Arztl. Leiter Ambulanz ESRA Tempelgasse 5, 1020 Wien, Austria. d.vyssoki@esra.at

Violence is what the victims experience as violence. Only they are able to measure what oppression, injury, pain or sexual violence can cause. Violence starts where human beings are constrained, humiliated, abjected and injured in their self-determination by other human beings. The experienced violence causes a trauma in most cases and in many cases also a PTSD. As a lot of epidemiological studies have affirmed, the highest lifetime-prevalence of PTSD appears after one  respectively after a repeated act of sexual violence.It is important to define the circumstances of the action, by defining three fields of violence: domestic sexual violence, sexual violence in civil everyday life respectively violence, that occurs not inside families and sexual violence in wartime.Victims of all fields of violence can be found in Western Europe, the last mentioned form of violence predominant among refugees, but also among survivors of the last world war.

Publication Types:      English Abstract

PMID: 19011596 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):532-45.

[Therapeutic possibilities after traumatic experiences]

[Article in German]

Kapfhammer HP.

Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, Graz, Austria. Hans-peter.kapfhammer@klinikum-graz.at

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following trauma. A major subgroup of patients face a chronic course of illness associated with an increased psychiatric comorbidity and significant impairments in psychosocial adaptation. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. The complex etiopathogenesis of acute and posttraumatic  stress disorder favours multimodal approaches in the treatment. Differential psychotherapeutic and pharmacological strategies are available. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. Positive effects of cognitive-behavioral interventions can be established for ASD. Psychodynamic psychotherapy, cognitive-behavioral therapy and EMDR show promising results in the treatment of  PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care. In an empirical analysis the SSRIs are the most and  best studied medications for ASD and PTSD. In comparison to tricyclic antidepressants SSRIs demonstrate a broader spectrum of therapeutic effects and are better tolerated. The substance classes of SSNRI, DAS, SARI and NaSSA are to  be considered as drugs of second choice. They promise a therapeutic efficacy equivalent to the SSRIs, being investigated so far only in open studies. MAO-inhibitors may dispose of a positive therapeutic potential, their profile of  side effects must be respected, however. Mood stabilizers and atypical neuroleptics may be used first and foremost in add-on strategies. Benzodiazepines should be used only with increased caution for a short time in states of acute crisis. In early interventions, substances blocking the norepinephric hyperactivity seem to be promising alternatives. Stress doses of hydrocortisone may be considered as an experimental pharmacological strategy so far.

Publication Types:      English Abstract

PMID: 19011595 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):474-84.

Mental health care of psychotraumatized persons in post-war Bosnia and Herzegovina--experiences from Tuzla Canton.

Avdibegović E, Hasanović M, Selimbasić Z, Pajević I, Sinanović O.

University Clinical Centre Tuzla, Trnovac b.b, 75000 Tuzla, Bosna and Herzegovina.

BACKGROUND: Majority of Bosnia-Herzegovina (BH) residents were exposed to cumulative traumatic events during and after the (1992-1995) war, which demanded  emergency organizing of psychosocial support as well as psychiatric-psychological treatment of psychotraumatized individuals. OBJECTIVES: To describe organizing of psychosocial help during and after the BH war, institutional treatment of psychotraumatized in the frame of mental health service reform program with an overview on the model of psychosocial support and psychiatry-psychological treatment of psychotraumatized persons of Tuzla Canton region. SUBJECTS AND METHODS: The retrospective analysis of functioning in the Department for traumatic stress disorders on the Psychiatry Clinic in Tuzla for the 1999-2003 period has been described in regard of number, gender, age and trauma related mental disorders of referred patients. RESULTS: In the observed period, 8.329 of  patients in the outpatient care program were included, 617 of inpatients were treated in the Clinic, while 301 of patients in the Partial hospitalization program were included. Mean +/- standard deviation of patients' age was 45+/-8.06 years. More psychotraumatized women (60.8%) were encompassed in the partial hospitalization program than in inpatients (23.9%) or outpatients (18.3%) care programs. In regard of trauma related mental disorders, majority outpatients had  Posttraumatic stress disorder (PTSD) in co morbidity with other mental disorders  (72.5%), PTSD was presented amongst the majority of inpatients (64.5%) and in partial hospitalization program there were (47.5%) patients with PTSD. CONCLUSIONS: In the treatment of psychotraumatized persons, in the organizing of  health care system schema in postwar Bosnia and Herzegovina, meaningful obstacles are presented still today on the both, social and political level, despite mental health service reform performed in Bosnia-Herzegovina. The stigmatization of mental health issues is an important problem in treatment of traumatized individuals especially among war veterans. The lack a single Center for psychotrauma in postwar BH shows absence of political will in BH to resolve the problem of war veterans with trauma related psychological disorders.

PMID: 19011588 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):466-73.

Social support and PTSD symptoms in war-traumatized women in Bosnia and Herzegovina.

Klarić M, Francisković T, Klarić B, Kresić M, Grković J, Lisica ID, Stevanović A.

Department of Psychiatry, Mostar University School of Medicine, Mostar, Bosnia and Herzegovina. klaricmiro@net.hr

OBJECTIVE: To determine the correlation between social support and PTSD symptoms  in women traumatized by the war and postwar social insecurity in Herzegovina. SUBJECTS AND METHODS: The experimental group consisted of 187 randomly selected women living in Mostar, who were exposed to a wide spectrum of traumatic events during the war. The control group included 180 women living in the area surrounding Mostar who were not directly exposed to war destruction. Demographic  data were obtained and a battery of psychological tests was used to measure the level of war traumatization and PTSD symptoms, along with the perception of social support. RESULTS: Women in the experimental group had significantly lower  levels of perceived social support from friends (t=2.91; p<0.05) and coworkers (t=2.30; p<0.05). However, its protective significance for all levels of posttraumatic symptoms was strong, even stronger than social support from the family. Of all the sources of emotional social support, low level of perceived support from friends is the only significant predictor of PTSD. CONCLUSION: The sources of social support which the traumatized women drew from family, friends and coworkers change their significance depending on their availability. These sources are a strong predictive factor of PTSD development.

PMID: 19011587 [PubMed - in process]

 

Psychiatr Genet. 2008 Dec;18(6):261-6.

Heritabilities of symptoms of posttraumatic stress disorder, anxiety, and depression in earthquake exposed Armenian families.

Goenjian AK, Noble EP, Walling DP, Goenjian HA, Karayan IS, Ritchie T, Bailey JN.

UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, USA. armengoenjian@cnstrial.com

OBJECTIVE: To examine the heritabilities of symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, and the shared genetic component of these symptoms among family members exposed to the 1988 Spitak earthquake in Armenia. METHODS: Two hundred members of 12 multigenerational families exposed to the Spitak earthquake were studied using a battery that assessed earthquake exposure  and symptoms of PTSD, anxiety, and depression. Heritabilities of these phenotypes were determined using variance component analyses and shared genetic vulnerabilities between these phenotypes were determined using bivariate analyses. RESULTS: Heritabilities were as follows: PTSD symptoms 41% (P<0.001), anxiety symptoms 61% (P<0.001), and depressive symptoms 66% (P<0.001). The genetic correlation (rhog>0) of PTSD symptoms with anxiety symptoms was 0.75 (P<0.001) and with depressive symptoms it was 0.71 (P<0.001). The genetic correlation of anxiety with depressive symptoms was 0.54 (P<0.001). CONCLUSION: The heritabilities found in this multigenerational family study indicate that the genetic make-up of some individuals renders them substantially more vulnerable than others to develop symptoms of PTSD, anxiety, and depression. A large proportion of the genetic liability for PTSD, anxiety, and depression are shared. The findings offer promise for identifying susceptibility genes for these phenotypes.

PMID: 19018230 [PubMed - in process]

 

Psychiatry Clin Neurosci. 2008 Dec;62(6):713-20.

Relationship between post-traumatic stress disorder-like behavior and reduction of hippocampal 5-bromo-2'-deoxyuridine-positive cells after inescapable shock in  rats.

Kikuchi A, Shimizu K, Nibuya M, Hiramoto T, Kanda Y, Tanaka T, Watanabe Y, Takahashi Y, Nomura S.

Division of Behavioral Sciences, National Defense Medical College Research Institute, Tokyo, Japan.

AIM: Inescapable shocks (IS) have been reported to reduce the number of 5-bromo-2'-deoxyuridine (BrdU)-positive cells in hippocampus. Antidepressants prevent this reduction, and the role of neurogenesis in depression is now suggested. It has been reported, however, that the number of BrdU-positive cells  was not different between the rats that developed learned helplessness and those  that did not. This suggests that reduction of neurogenesis does not constitute a  primary etiology of depression. It has been previously shown that IS can cause various post-traumatic stress disorder (PTSD)-like behavioral changes in rats. The aim of the present was therefore to examined whether the reduction of BrdU-positive cells relates to any PTSD-like behavioral changes in this paradigm. METHODS: Rats were given either inescapable foot-shocks (IS) or not shocked (non-S) treatment in a shuttle box on day 1 and received BrdU injections once daily during the first week after IS/non-S treatment. On day 14, rats treated with IS and non-S were given an avoidance/escape test in the shuttle box and dorsal hippocampal SGZ were analyzed by BrdU immunohistochemistry. RESULTS: In accordance with previously reported results, IS loading resulted in fewer BrdU-positive cells in the hippocampal subgranular zone (SGZ). Furthermore, in the IS-treated group, the number of BrdU-positive cells in the hippocampal SGZ was negatively correlated at a significant level with several hyperactive behavioral parameters but not with hypoactive behavioral parameters. Earlier findings had indicated that chronic selective serotonin re-uptake inhibitor administration, which is known to increase hippocampal neurogenesis, restored the increase in hypervigilant/hyperarousal behavior but did not attenuate the increase in numbing/avoidance behavior. CONCLUSION: The regulatory mechanism responsible for the decreased proliferation and survival of cells in the hippocampus may be related to the pathogenic processes of hypervigilance/hyperarousal behaviors.

PMID: 19068009 [PubMed - in process]

 

Psychiatry Clin Neurosci. 2008 Dec;62(6):646-52.

Clinical evaluation of paroxetine in post-traumatic stress disorder (PTSD): 52-week, non-comparative open-label study for clinical use experience.

Kim Y, Asukai N, Konishi T, Kato H, Hirotsune H, Maeda M, Inoue H, Narita H, Iwasaki M.

National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

AIM: The present study was a 52-week, non-comparative, open-label study of flexible dose paroxetine (20-40 mg) in 52 Japanese post-traumatic stress disorder (PTSD) patients in order to obtain clinical experience regarding efficacy and safety in regular clinical practice. METHODS: Efficacy was measured using the Clinician-Administered PTSD Scale One Week Symptom Status Version (CAPS-SX). RESULTS: The mean change from baseline in CAPS-SX total score was -19.1, -22.8 and -32.3 at weeks 4, 12 and 52, respectively, and that in the Clinical Global Impression (CGI) Severity of Illness score was -1.1 at week 12 and -1.7 at week 52. A total of 46.9% were CGI responders at week 12, while 67.3% were improved on the CGI at week 52. Of 52 subjects who entered into the drug treatment, 25 completed the study. Only one patient withdrew from the study due to lack of efficacy. In patients who were rated as 'moderately ill' or less at baseline, the proportion of CGI responders at end-point was higher at a dose of 20 mg/day than  at higher doses, whereas in patients rated as 'markedly ill' or more, it was higher at 30 and 40 mg/day, suggesting that severely ill patients could benefit from higher doses. CONCLUSION: Paroxetine appeared generally tolerated in short-  and long-term use, and the safety profile in this study was consistent with international trials and other Japanese populations (i.e. patients suffering from depression, panic disorder or obsessive-compulsive disorder). Although the study  was not conducted in double-blind fashion, the current findings suggest that paroxetine may contribute to clinically meaningful improvement that is maintained during long-term use and is generally well tolerated.

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

PMID: 19068000 [PubMed - in process]

 

Psychol Assess. 2008 Dec;20(4):327-40.

The MMPI-2 Restructured Clinical Scales in the assessment of posttraumatic stress disorder and comorbid disorders.

Wolf EJ, Miller MW, Orazem RJ, Weierich MR, Castillo DT, Milford J, Kaloupek DG,  Keane TM.

National Center for PTSD, VA Boston Healthcare System.

This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared with that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties and patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of  the RCSs compared with the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 19086756 [PubMed - in process]

 

Psychol Assess. 2008 Dec;20(4):317-26.

The utility and comparative incremental validity of the MMPI-2 and Trauma symptom Inventory validity scales in the detection of feigned PTSD.

Efendov AA, Sellbom M, Bagby RM.

Centre for Addiction and Mental Health.

The authors examined the comparative predictive capacity of the Trauma Symptom Inventory (TSI) Atypical Response Scale (ATR) and the standard set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) fake-bad validity scales (i.e., F, F-sub(B), F-sub(p), FBS) to detect feigned posttraumatic stress disorder (PTSD).  Remitted trauma victims (n = 60) completed the TSI and MMPI-2 under standard (honest) instructions and then were randomly assigned to 1 of 2 experimental conditions (noncoached/validity scale coached) in which they were administered these instruments again with instruction to fake PTSD. These test protocols were  compared with TSI and MMPI-2 results from workplace injury claimants with PTSD (n = 84). The ATR and FBS were able to distinguish only the noncoached participants  instructed to fake from the PTSD claimants; in contrast, the F, F-sub(B), and F-sub(p) scales were able to distinguish both the noncoached and the validity-scale-coached participants from the PTSD claimants. F, F-sub(B), and F-sub(p) always outperformed the ATR and FBS; neither the ATR nor the FBS was able to add incremental predictive variance to that of F, F-sub(B), or F-sub(p).  (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 19086755 [PubMed - in process]

 

Psychol Med. 2008 Dec;38(12):1771-80. Epub 2008 Feb 25.

Dissociative responses to conscious and non-conscious fear impact underlying brain function in post-traumatic stress disorder.

Felmingham K, Kemp AH, Williams L, Falconer E, Olivieri G, Peduto A, Bryant R.

Brain Dynamics Centre, Westmead Millennium Institute, Westmead Hospital, Australia. kim_felmingham@wmi.usyd.edu.au

BACKGROUND: Dissociative reactions in post-traumatic stress disorder (PTSD) have  been regarded as strategic responses that limit arousal. Neuroimaging studies suggest distinct prefrontal responses in individuals displaying dissociative and  hyperarousal responses to threat in PTSD. Increased prefrontal activity may reflect enhanced regulation of limbic arousal networks in dissociation. If dissociation is a higher-order regulatory response to threat, there may be differential responses to conscious and automatic processing of threat stimuli. This study addresses this question by examining the impact of dissociation on fear processing at different levels of awareness. METHOD: Functional magnetic resonance imaging (fMRI) with a 1.5-T scanner was used to examine activation to fearful (versus neutral) facial expressions during consciously attended and non-conscious (using backward masking) conditions in 23 individuals with PTSD. Activation in 11 individuals displaying non-dissociative reactions was compared to activation in 12 displaying dissociative reactions to consciously and non-consciously perceived fear stimuli. RESULTS: Dissociative PTSD was associated with enhanced activation in the ventral prefrontal cortex for conscious fear, and in the bilateral amygdala, insula and left thalamus for non-conscious fear compared to non-dissociative PTSD. Comparatively reduced activation in the dissociative group was apparent in dorsomedial prefrontal regions for conscious fear faces. CONCLUSIONS: These findings confirm our hypotheses of enhanced prefrontal activity to conscious fear and enhanced activity in limbic networks to non-conscious fear in dissociative PTSD. This supports the theory that dissociation is a regulatory strategy invoked to cope with extreme arousal in PTSD, but this strategy appears to function only during conscious processing of threat.

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

PMID: 18294420 [PubMed - in process]

 

Psychoneuroendocrinology. 2008 Dec 1. [Epub ahead of print]

No PTSD-related differences in diurnal cortisol profiles of genocide survivors.

Eckart C, Engler H, Riether C, Kolassa S, Elbert T, Kolassa IT.

Clinical Psychology & Neuropsychology, Department of Psychology, University of Konstanz, Germany.

Posttraumatic stress disorder (PTSD) has been associated with reduced cortisol levels. Opposing results have been interpreted as resulting from methodological differences between studies. We investigated the diurnal profile of salivary cortisol in a population of highly traumatized adult males from Rwanda with and without PTSD, who spent the whole day of examination together under a maximally standardized schedule. Besides the detection of PTSD-related alterations in cortisol release we aimed at determining physiologically relevant effects of cumulative trauma exposure on HPA functioning in interaction with or independent  of diagnosis. There were no differences in the diurnal pattern of cortisol release between subjects with and without PTSD. We observed an increasing prevalence of PTSD with increasing number of different traumatic event types experienced, replicating earlier results on a "building-block effect" of multiple traumatization. However, size of cumulative exposure was not related to any of the cortisol measures. The results suggest that besides methodological constraints also confounding factors not previously controlled for, e.g., sex differences or current life stress, might contribute to the diverging results of  lowered, unchanged or enhanced cortisol secretion in PTSD. Future research should therefore closely monitor these possible confounds to optimize models for cortisol in research on stress-dependent illnesses.

PMID: 19054622 [PubMed - as supplied by publisher]

 

Psychooncology. 2008 Dec;17(12):1172-9.

Discrimination between worry and anxiety among cancer patients: development of a  Brief Cancer-Related Worry Inventory.

Hirai K, Shiozaki M, Motooka H, Arai H, Koyama A, Inui H, Uchitomi Y.

Center for the Study of Communication Design, Department of Psychology and Behavioral Sciences, Graduate School of Human Sciences, Osaka University, Osaka,  Japan. khirai@grappo.jp

OBJECTIVES: A psychometric scale for assessing cancer-related worry among cancer  patients, called the Brief Cancer-Related Worry Inventory (BCWI), was developed.  METHODS: A cross-sectional questionnaire survey for item development was conducted of 112 Japanese patients diagnosed with breast cancer, and test-retest  validation analysis was conducted using the data from another prospective study of 20 lung cancer patients. The questionnaire contained 15 newly developed items  for cancer-related worry, the Hospital Anxiety and Depression Scale, The Impact of Event Scale Revised, and the Medical Outcomes Study Short Form-8. RESULTS: Exploratory factor analysis of the 15 items yielded a 3-factor structure including (1) future prospects, (2) physical and symptomatic problems and (3) social and interpersonal problems. A second-order confirmatory factor analysis identified a second-order factor called cancer-related worry and confirmed the factor structure with an acceptable fit (chi-square (df=87)=160.16, P=0.001; GFI=0.83; CFI=0.92; RMSEA=0.09). The internal consistency and test-retest reliability were confirmed with the lung cancer sample. Multidimensional scaling  found that cancer-related worry is separate from anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms. CONCLUSION: Our study succeeded in developing and confirming the validity and reliability of a BCWI. The study also  confirmed the discriminable aspects of cancer-related worry from anxiety, depression, and PTSD symptoms. (c) 2008 John Wiley & Sons, Ltd.

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

PMID: 18457339 [PubMed - in process]

 

Res Nurs Health. 2008 Dec;31(6):576-85.

Perceived stress in survivors of suicide: psychometric properties of the Perceived Stress Scale.

Mitchell AM, Crane PA, Kim Y.

Department of Health and Community Systems, University of Pittsburgh School of Nursing and School of Medicine, 3500 Victoria Street, 415 Victoria Building, Pittsburgh, PA 15261, USA.

The purpose of this study was to evaluate the psychometric properties of three versions of the Perceived Stress Scale (PSS; American Sociological Association) in adults who had survived the death of a family member or significant other by suicide. Reliability and validity were examined. Exploratory factor analysis was  conducted to assess dimensionality of the underlying constructs. All three versions of the PSS demonstrated acceptable reliability. Two shorter versions retained good psychometric properties and demonstrated convergent and concurrent  validity with measures of posttraumatic stress symptoms and mental health quality of life. Factor analysis provided further evidence of their usefulness as brief and valid measures of perceived stress in acutely bereaved adult survivors of suicide. In a sub-sample of closely related survivors, the psychometric properties of the 4-item version of the PSS were retained. (c) 2008 Wiley Periodicals, Inc.

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

PMID: 18449942 [PubMed - indexed for MEDLINE]

 

Schmerz. 2008 Dec;22(6):644-51.

[PTSD and chronic pain: development, maintenance and comorbidity - a review.]

[Article in German]

Liedl A, Knaevelsrud C.

Behandlungszentrum für Folteropfer Berlin, Turmstr. 21, 10559, Berlin, Deutschland, a.liedl@bzfo.de.

In addition to posttraumatic stress disorder (PTSD) many traumatized individuals  also suffer from chronic pain. Understanding the development and maintenance of these two disorders and how they interact is of crucial importance for treatment. This article provides an overview of the current literature on mechanisms of development, maintenance and comorbidity of PTSD and chronic pain. Moreover the perpetual avoidance model and its implications for practical application are presented.

Publication Types:      English Abstract

PMID: 18726123 [PubMed - in process]

 

Soc Sci Med. 2008 Dec;67(11):1737-46. Epub 2008 Oct 22.

Scientific resistance to research, training and utilization of eye movement desensitization and reprocessing (EMDR) therapy in treating post-war disorders.

Russell MC.

Psychology, U.S. Naval Hospital Yokosuka, Japan. mark.russell2@med.navy.mil

In this study, Barber's [(1961). Resistance by scientists to scientific discovery. Science, 134, 596-602] analysis of scientists' resistance to discoveries is examined in relation to an 18-year controversy between the dominant cognitive-behavioral paradigm or zeitgeist and its chief rival - eye movement desensitization and reprocessing (EMDR) in treating trauma-related disorders. Reasons for persistent opposition to training, utilization and research into an identified 'evidence-based treatment for post-traumatic stress disorder' (EBT-PTSD) within US military and veterans' agencies closely parallels  Barber's description of resistance based upon socio-cultural factors and scientific bias versus genuine scientific skepticism. The implications of sustained resistance to EMDR for combat veterans and other trauma sufferers are discussed. A unified or super-ordinate goal is offered to reverse negative trends impacting current and future mental healthcare of military personnel, veterans and other trauma survivors, and to bridge the scientific impasse.

PMID: 18950925 [PubMed - in process]

 

Transcult Psychiatry. 2008 Dec;45(4):611-38.

Daily stressors, war experiences, and mental health in afghanistan.

Miller KE, Omidian P, Rasmussen A, Yaqubi A, Daudzai H.

Boston Center for Refugee Health and Human Rights at Boston University. millerk@bu.edu.

Working in Afghanistan's capital city of Kabul, the authors assessed the relative contribution of daily stressors and war-related experiences of violence and loss  to levels of depression, PTSD, impaired functioning, and a culturally specific measure of general psychological distress. For women, daily stressors were a better predictor than war experiences of all mental health outcomes except for PTSD; for men, daily stressors were a better predictor of depression and functional impairment, while war experiences and daily stressors were similarly predictive of general distress. For men, daily stressors moderated the relationship between war experiences and PTSD, which was significant only under conditions of low daily stress. The study's implications for research and intervention in conflict and post-conflict settings are considered.

PMID: 19091728 [PubMed - in process]

 

J Psychiatr Res. 2008 Nov 27. [Epub ahead of print]

Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the  effects of abortion in the national comorbidity survey.

Coleman PK, Coyle CT, Shuping M, Rue VM.

Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, United States.

The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without  hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables.  Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future  research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

PMID: 19046750 [PubMed - as supplied by publisher]

 

Child Abuse Negl. 2008 Nov 26. [Epub ahead of print]

Children's expressed emotions when disclosing maltreatment.

Sayfan L, Mitchell EB, Goodman GS, Eisen ML, Qin J.

Department of Psychology, University of California, One Shields Avenue, Davis, CA 95616, USA.

OBJECTIVE: Our goal was to examine children's expressed emotions when they disclose maltreatment. Little scientific research exists on this topic, and yet children's emotional expressions at disclosure may inform psychological theory and play a crucial role in legal determinations. METHOD: One hundred and twenty-four videotaped forensic interviews were coded for children's emotional displays. In addition, children's trauma-related symptoms (depression, dissociation, and PTSD) and global adaptive functioning were assessed, and abuse  type and frequency were documented. RESULTS: Most children in the sample evinced  neutral emotion during disclosure. However, stronger negative reactions were linked to indices of psychopathology. Number of abuse experiences was inversely related to negative emotional displays. CONCLUSION: Fact finders may profit from  knowing that maltreated children do not necessarily cry or display strong emotion when disclosing maltreatment experiences. Nevertheless, predictors of greater negative affect at disclosure can be identified: fewer abuse experiences; higher  global adaptive functioning; and for sexually abused children, greater dissociative tendencies. PRACTICE IMPLICATIONS: Although further research is needed, practitioners should consider that children who disclose abuse may display relatively neutral affect despite having experienced maltreatment.

PMID: 19041134 [PubMed - as supplied by publisher]

 

J Abnorm Child Psychol. 2008 Nov 26. [Epub ahead of print]

Impact of Traumatic Life Events in a Community Sample of Toddlers.

Mongillo EA, Briggs-Gowan M, Ford JD, Carter AS.

Department of Psychology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125-3393, USA.

Toddlers may be at particularly high risk for a number of psychiatric, developmental and neurobiological consequences in the aftermath of trauma. The social and emotional impact of potentially traumatic life events experienced between 6 and 36-months of age was assessed in an epidemiological birth cohort of 18- to 36-month-olds from the Greater New Haven Area. Event-exposed toddlers evidenced greater symptom severity on the ITSEA Internalizing, Externalizing, Dysregulation, Atypical and Maladaptive scales, as well on the CBCL Internalizing and Externalizing scales than those not exposed. Approximately one-fifth of event-exposed toddlers were reported by their parents to have experienced a dramatic change in functioning following the event, and were described as experiencing higher levels of symptoms consistent with Post-Traumatic Stress Disorder (PTSD), namely re-experiencing and arousal, than exposed toddlers whose  parents did not report a change in their functioning. Implications for clinicians and child care providers working with toddlers and their parents are discussed.

PMID: 19034643 [PubMed - as supplied by publisher]

 

Psychol Psychother. 2008 Nov 26. [Epub ahead of print]

Traditional versus modern values, self-perceived interpersonal factors, and posttraumatic stress in Chinese and German crime victims.

Maercker A, Mohiyeddini C, Müller M, Xie W, Yang ZH, Wang J, Müller J.

Objectives The influence of cultural factors on mental health is not disputed in  general - but elaborated research approaches are still lacking. We investigate cultural influences not only by nationality but also by value orientation (modern vs. traditional). A cross-cultural comparison with Chinese and German crime victims included an assessment of value orientation according to Schwartz's theory (Schwartz, 1994) of personal values. Design Chinese and German adult crime victims were assessed. By means of structural equation multi-sample analysis, data of the two groups were compared. Method Traditional (conformity, benevolence, customs orientation) and modern values (achievement, hedonism, stimulation), traumatic exposure, posttraumatic stress (PTS), and two self-perceived interpersonal mediator processes (disclosure intentions, social acknowledgement as a victim) were assessed by self-report measures in 130 Chinese and 151 German crime victims. Results The two patterns of prediction for PTS differed between the countries: In the German sample both value types but in the  Chinese sample only traditional values were directly or indirectly predictive of  PTS. Traditional values inhibited social acknowledgement as a victim in China and Germany. In Germany, traditional values were related to increased PTS severity. Modern values predicted social acknowledgement as well as lower symptoms in Germany, but not in China. Conclusions The study shows cultural and interpersonal factors that may contribute to the development of PTSD that are under-researched  in contemporary psychology and psychotherapy.

PMID: 19040793 [PubMed - as supplied by publisher]

 

Cases J. 2008 Nov 25;1(1):352.

A case of PTSD presenting with psychotic symptomatology: a case report.

Floros GD, Charatsidou I, Lavrentiadis G.

2nd Department of Psychiatry, Psychiatric Hospital of Thessaloniki, 196 Langada str,, 564 29 Thessaloniki, Greece. georgefloros@gmail.com.

ABSTRACT: A male patient aged 43 presented with psychotic symptomatology after a  traumatic event involving accidental mutilation of the fingers. Initial presentation was uncommon although the patient responded well to pharmacotherapy. The theoretical framework, management plan and details of the treatment are presented.

PMID: 19032788 [PubMed - in process]

 

Addict Behav. 2008 Nov 21. [Epub ahead of print]

Trauma-related risk factors for substance abuse among male versus female young adults.

Danielson CK, Amstadter AB, Dangelmaier RE, Resnick HS, Saunders BE, Kilpatrick DG.

National Crime Victims Research & Treatment Center, Medical University of South Carolina, United States.

Clinical efforts to reduce risk for Substance Use Disorders (SUDs) among young adults rely on the empirical identification of risk factors for addictive behaviors in this population. Exposure to traumatic events and Posttraumatic Stress Disorder (PTSD) have been linked with SUDs in various populations. Emerging data, particularly from adolescent samples, suggest that traumatic event exposure increases risk for SUDs for young women, but not young men. The purpose  of the current study was to examine trauma-related risk factors for alcohol and drug abuse among a national sample of young adults and compare such risk factors  between men and women. Participants were 1753 young adults who participated in the 7-8 year follow-up telephone-based survey to the original National Survey of  Adolescents. In the full sample, 29.1% met criteria for substance abuse. Trauma-related risk factors for alcohol and drug abuse differed for men and women. Clinical implications of these results are discussed.

PMID: 19110381 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2008 Nov 21. [Epub ahead of print]

Psychometric properties of the Trauma Assessment for Adults.

Gray MJ, Elhai JD, Owen JR, Monroe R.

Department of Psychology, University of Wyoming, Laramie, Wyoming.

Background: The Trauma Assessment for Adults (TAA) was developed to facilitate the assessment of exposure to traumatic events that could result in posttraumatic stress disorder (PTSD). The TAA inquires about numerous potentially traumatic events that an individual may have experienced. Although the TAA has been used extensively for clinical and research purposes, its psychometric properties have  never been formally evaluated. The objective of the present investigation was to  evaluate the psychometric properties of this frequently used measure. Methods: The studies reported here describe the performance of the TAA in two samples-college undergraduates (N=142) and community mental health center clients (N=67). Among undergraduates, 1-week temporal stability was evaluated and, in both samples, item- and scale-level convergence of the TAA with an established trauma exposure measure was assessed. Convergence of the TAA with clinically related constructs was also evaluated. Results: The TAA exhibited adequate temporal stability (r=.80) and satisfactory item-level convergence with existing  measures of trauma history among college students. In the clinical sample, the TAA again converged well with an established measure of trauma exposure (r=.65).  It was not as strongly predictive, in either sample, of trauma-related distress relative to an alternate trauma exposure measure. Conclusion: Although it performs satisfactorily, the TAA does not appear to be superior to other existing measures of trauma exposure. Depression and Anxiety 0:1-6, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 19031486 [PubMed - as supplied by publisher]

 

Sleep Breath. 2008 Nov 21. [Epub ahead of print]

Psychometric properties of the Persian version of the Pittsburgh Sleep Quality Index addendum for PTSD (PSQI-A).

Farrahi J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A.

Kerman Neuroscience Research Center, Kerman University of Medical Sciences, 76195-1447, Kerman, Iran.

BACKGROUND: Considering the frequent occurrence of natural disasters in Iran, the need for an inventory assessing the quality of sleep in the posttraumatic stress  disorder (PTSD) patients is clearly evident. The Pittsburgh Sleep Quality Index addendum for PTSD (PSQI-A) has been recently developed to assess the disruptive nocturnal behaviors in the PTSD patients. This study was aimed to explore the reliability and validity of the Persian version of the PSQI-A. MATERIALS AND METHODS: Eighty-five PTSD patients related to the two recent major earthquakes of Kerman Province were enrolled in the study, and 133 healthy subjects were conveniently selected as the control group. The inventory was translated and then back-translated according to standard methods. The reliability was checked by computing the Cronbach;s alpha coefficient and corrected item-total correlation.  The sensitivity and specificity were assessed by comparing the PSQI-A score with  the DSM-IV-TR diagnosis. Convergent validity was checked against the General Health Questionnaire 12 (GHQ-12). RESULTS: The mean (+/-SD) of the two groups were 42.1(+/-13.8) and 34.2 (+/-9.8), respectively. The sex distribution was comparable in the two groups (females consisted 55% and 58% of the PTSD and control groups, respectively). There were significant differences between the items comparing the two groups except for the "acting out dreams". Overall the Cronbach;s alpha coefficient was 0.89, and the item-total correlation of all the  seven items were over 0.4 except for the acting out dreams. At cut-off of 7/8, the sensitivity and specificity were 100% and 93%, respectively. The sum score showed a correlation of 0.66 with the GHQ-12. CONCLUSION: Although the psychometric properties of one of the seven items of the inventory were to some extent unsatisfactory, the overall reliability and validity of the questionnaire  were acceptable.

PMID: 19023608 [PubMed - as supplied by publisher]

 

Neuropsychopharmacology. 2008 Nov 19. [Epub ahead of print]

CRF(1) and CRF(2) Receptors are Required for Potentiated Startle to Contextual but not Discrete Cues.

Risbrough VB, Geyer MA, Hauger RL, Coste S, Stenzel-Poore M, Wurst W, Holsboer F.

[1] 1Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA [2] 2Psychiatry Service, VA Healthcare System, San Diego, CA, USA.

Corticotropin-releasing factor (CRF) peptides and their receptors have crucial roles in behavioral and endocrine responses to stress. Dysregulation of CRF signaling has been linked to post-traumatic stress disorder, which is associated  with increased startle reactivity in response to threat. Thus, understanding the  mechanisms underlying CRF regulation of startle may identify pathways involved in this disorder. Here, we tested the hypothesis that both CRF(1) and CRF(2) receptors contribute to fear-induced increases in startle. Startle responses of wild type (WT) and mice with null mutations (knockout, KO) for CRF(1) or CRF(2) receptor genes were measured immediately after footshock (shock sensitization) or in the presence of cues previously associated with footshock (ie fear-potentiated startle, FPS). WT mice exhibited robust increases in startle immediately after footshock, which was dependent upon contextual cues. This effect was completely absent in CRF(1) KO mice, and significantly attenuated in CRF(2) KO mice. In contrast, CRF(1) and CRF(2) KO mice exhibited normal potentiation of startle by discrete conditioned cues. Blockade of both receptors via CRF(1) receptor antagonist treatment in CRF(2) KO mice also had no effect on FPS. These results support an additive model of CRF(1) and CRF(2) receptor activation effects on potentiated startle. These data also indicate that both CRF receptor subtypes contribute to contextual fear but are not required for discrete cued fear effects on startle reactivity. Thus, we suggest that either CRF(1) or CRF(2) could contribute to the increased startle observed in anxiety disorders with CRF system abnormalities.Neuropsychopharmacology advance online publication, 19 November 2008; doi:10.1038/npp.2008.205.

PMID: 19020499 [PubMed - as supplied by publisher]

 

Ann Gen Psychiatry. 2008 Nov 18;7:24.

Risk factors predict post-traumatic stress disorder differently in men and women.

Christiansen DM, Elklit A.

Department of Psychology, University of Aarhus, Aarhus, Denmark. aske@psy.au.dk.

ABSTRACT: BACKGROUND: About twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic  events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable. METHODS: The present work examines the effect of age,  previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident. RESULTS: Some gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than  in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD  for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender. CONCLUSION: Gender differences in the predictive value of social support on PTSD appear to be very complex, and no  clear conclusions can be made based on the two studies included in this article.

PMID: 19017412 [PubMed - in process]

 

J Anxiety Disord. 2008 Nov 18. [Epub ahead of print]

Memory modification as an outcome variable in anxiety disorder treatment.

Tryon WW, McKay D.

Department of Psychology, Fordham University, Bronx, NY 10458-9993, United States.

Learning and memory are interdependent processes. Memories are learned, and cumulative learning requires memory. It is generally accepted that learning contributes to psychopathology and consequently to pertinent memory formation. Neuroscience and psychological research have established that memory is an active reconstructive process that is influenced by thoughts, feelings, and behaviors including post-event information. Recent research on the treatment of anxiety disorders using medications (i.e., d-cyclcloserine) to alter neurological systems associated with memory used in conjunction with behavior therapy suggests that memory is part of a central mechanism in the etiology and maintenance of these conditions. The main thesis of this article is that learning-based interventions  create new memories that may modify existing ones. This raises the possibility of using such memory modifications to measure intervention outcome. A connectionist  context for understanding this phenomenon and informing intervention is provided, with specific reference to post-traumatic stress disorder, obsessive-compulsive disorder, and generalized anxiety disorder. Recommendations for future research examining the role of memory change in treatment outcome are suggested.

PMID: 19117720 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Nov 18. [Epub ahead of print]

Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers.

Giosan C, Malta L, Jayasinghe N, Spielman L, Difede J.

Department of Psychiatry, Weill Medical College of Cornell University, New York,  United States.

The present study examined the relationships between memories for a single incident traumatic event - the 9/11 attack on the World Trade Center (WTC) - and  posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed  at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that,  of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.

PMID: 19117719 [PubMed - as supplied by publisher]

 

J Clin Psychiatry. 2008 Nov 18. pii: ej07m04024. [Epub ahead of print]

A Multisite Study of Initial Respiration Rate and Heart Rate as Predictors of Posttraumatic Stress Disorder.

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

From the School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. r.bryant@unsw.edu.au.

OBJECTIVE: Fear-conditioning models posit that increased arousal at the time of trauma predicts subsequent posttraumatic stress disorder (PTSD). This multisite study evaluated the extent to which acute heart rate and respiration rate predict subsequent chronic PTSD. METHOD: Traumatically injured patients admitted to 4 hospitals across Australia between April 2004 and February 2006 were initially assessed during hospital admission (N = 1105) and were reassessed 3 months later  for PTSD by using the Clinician-Administered PTSD Scale-IV and for major depressive disorder (MDD) by using the Mini-International Neuropsychiatric Interview (English version 5.0.0) (N = 955). Heart rate, respiration rate, and blood pressure were assessed on the initial day of traumatic injury. RESULTS: Ninety patients (10%) met criteria for PTSD and 159 patients (17%) met criteria for MDD at the 3-month assessment. Patients with PTSD compared to those without PTSD had higher heart rate (90.16 +/- 18.66 vs. 84.84 +/-17.41, t = 2.74, p < .01) and respiration rate (20.24 +/- 5.16 vs. 18.58 +/- 4.29, t = 3.43, p < .001) immediately after injury. There were no heart rate or respiration rate differences between patients who did and did not develop MDD. Patients were more  likely to develop PTSD at 3 months if they had a heart rate of at least 96 beats  per minute (15% vs. 8%, OR = 2.12, 95% CI = 1.34 to 3.33) or respiration rate of  at least 22 breaths per minute (18% vs. 8%, OR = 2.42, 95% CI = 1.48 to 3.94). CONCLUSIONS: Elevated heart rate and respiration rate are predictors of subsequent PTSD. These data underscore the need for future research into secondary prevention strategies that reduce acute arousal immediately after trauma and may limit PTSD development in some individuals.

PMID: 19014750 [PubMed - as supplied by publisher]

 

Prog Neuropsychopharmacol Biol Psychiatry. 2008 Nov 14. [Epub ahead of print]

Homocysteine and serum lipids concentration in male war veterans with posttraumatic stress disorder.

Jendričko T, Vidović A, Grubišić-Ilić M, Romić Z, Kovačić Z, Kozarić-Kovačić D.

University Hospital Dubrava, Department of Psychiatry, Refferal Centre of the Ministry of Health and Social Welfare for Stress-related Disorders, Avenija Gojka Suska 6, HR-10000 Zagreb, Croatia.

The evidence of increased cardiovascular disease (CVD) risk in posttraumatic stress disorder (PTSD) is accumulating. The present study aimed to determine whether chronic, combat-related PTSD is associated with serum lipid and homocysteine concentrations that could indicate higher CVD risk. The authors tested 66 war veterans with PTSD, 33 war veterans without PTSD, and 42 healthy volunteers for serum concentrations of homocysteine, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides. All the subjects were men and the analyses were adjusted for age, body mass index and smoking. Potential influences of depression, anxiety, and psychotic symptoms on the outcome measures were checked  by introducing the scores from the Hamilton Depression Rating Scale (HAM-D-17), the Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS) into the overall statistical model. No differences in total cholesterol,  LDL-C, HDL-C and triglycerides were found between the groups. Non-smoking PTSD war veterans had higher homocysteine concentrations (mean=10.4 mumol/L, SD=1.7) when compared to non-smoking war veterans without PTSD (mean=8.2 mumol/L, SD=4.0, P=0.014) and both smoking (mean=8.7 mumol/L, SD=2.3, P=0.008) and non-smoking healthy volunteers (mean=8.8 mumol/L, SD=2.2, P=0.021). The results of our cross-sectional study are possibly confounded by many factors, especially behavioral and life-style related which are difficult to control comprehensively  and might have influenced serum lipids and homocysteine concentration in a complex manner. An increase in the homocysteine concentration observed in the non-smoking PTSD patients needs further investigation with a carefully designed prospective study to confirm associated, possibly enhanced CVD risk.

PMID: 19038303 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Nov 8. [Epub ahead of print]

The effect of retrieval on recall of information in individuals with posttraumatic stress disorder.

Amir N, Badour CL, Freese B.

SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University, CA 92120-4913, United States.

Cognitive theories of posttraumatic stress disorder (PTSD) suggest that associative memory processes may play a crucial role in the development and maintenance of the disorder. In the current study we examined the effect of associative pair rehearsal on recall ability for threatening and non-threatening  information using the retrieval-practice paradigm in individuals with PTSD, traumatized controls (TC), and non-traumatized controls (NAC). Across word type,  NACs demonstrated a typical retrieval-induced forgetting effect. However, individuals with PTSD benefited less from rehearsal, and failed to inhibit recall of unpracticed words in practiced categories. Participants in the TC group displayed a retrieval-induced forgetting effect similar to those individuals in the PTSD group. These findings are consistent with research indicating that individuals with PTSD may derive less benefit from rehearsal and display general  inhibitory difficulties when compared to non-traumatized controls.

PMID: 19070459 [PubMed - as supplied by publisher]

 

Int J Psychophysiol. 2008 Nov 5. [Epub ahead of print]

Altered resting psychophysiology and startle response in Croatian combat veterans with PTSD.

Jovanovic T, Norrholm SD, Sakoman AJ, Esterajher S, Kozarić-Kovačić D.

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

Posttraumatic stress disorder (PTSD) is a prolonged reaction to an extremely traumatic experience. One of the core symptoms of PTSD is hyper-arousal which can be the result of an elevated activation of the autonomic nervous system. Including psychophysiological assessment methods in PTSD research can point to the neurobiological bases of the disorder. The studies of psychophysiology of PTSD to date have mostly measured reactivity. The aim of the current study was to compare resting state psychophysiology and startle reflexes in PTSD patients and  controls in a sample of Croatian combat veterans. We measured heart-rate, respiratory sinus arrhythmia, skin conductance, and eyeblink muscle contraction during an acclimation period and during the presentation of startle stimuli in 45 male PTSD patients and 33 male healthy controls. We found that PTSD patient had elevated baseline heart-rate and decreased respiratory sinus arrhythmia compared  to the controls. Furthermore, PTSD patients had impaired habituation to the startle probe, but there was no group difference in initial startle magnitude. There was also no group difference in skin conductance level or skin conductance  response. Startle habituation and baseline heart-rate appear to offer the most reliable psychophysiological indices of PTSD. This finding replicates trends in the literature in a new population of PTSD patients.

PMID: 19013485 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Nov 5. [Epub ahead of print]

Anxiety disorders moderate the association between externalizing problems and substance use disorders: Data from the National Comorbidity Survey-Revised.

Hofmann SG, Richey JA, Kashdan TB, McKnight PE.

Boston University, Boston, United States.

Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6-8.1), alcohol dependence (OR: 7.6, CI: 5.9-9.6), substance abuse (OR: 9.9, CI: 8.1-12.2), and substance dependence (OR: 13.1, CI: 9.6-17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4-15.5). Individuals who met  diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the  fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.

PMID: 19059752 [PubMed - as supplied by publisher]

 

Psychiatr Prax. 2008 Nov 4. [Epub ahead of print]

[Are Migrants More Susceptible to Mental Disorders?]

[Article in German]

Glaesmer H, Wittig U, Brähler E, Martin A, Mewes R, Rief W.

Universität Leipzig, Abteilung für Medizinische Psychologie und Soziologie.

OBJECTIVES There are few, methodically heterogeneous and unsatisfactory studies about the mental health of immigrants. Commonly, these studies refer to a single  group of immigrants and in consequence general statements about the mental health of immigrants are impossible. METHODS In a representative population survey in Germany (N = 2 510) depressive and somatoform symptoms were screened with the Patients Health Questionnaire, Post Traumatic Stress Disorder was screened with the PTDS. If at least one parent was born abroad, people are classified as immigrants. RESULTS 11.1 % of the sample are immigrants, which are mostly better  integrated ones. There are no significant differences in the prevalence of the investigated mental disorders of immigrants compared to the native population. CONCLUSION The sample includes a large variety of immigrants living in Germany and does not refer to a single group. Asylum seekers and undocumented migrants are not included, those immigrants with low language skills might be underrepresented because of the methodology. Against our expectations, no differences in the mental health between imigrants and native Germans could be proven. This finding stands in a marked contrast to the well established deficit-oriented point of view on the health of immigrants.

PMID: 18988144 [PubMed - as supplied by publisher]

 

Br J Health Psychol. 2008 Nov 3. [Epub ahead of print]

What predicts posttraumatic stress following spinal cord injury?

Hatcher MB, Whitaker C, Karl A.

Objectives Spinal cord injury (SCI) is a severe, traumatic event and recently research into the role of post-traumatic stress disorder (PTSD) subsequent to the injury has become of increasing interest. This study has been conducted in order  to investigate potential risk factors for the development of post-traumatic stress disorder symptoms in those with SCI. Design This cross-sectional study used multiple regression analysis to look for associations between posttraumatic  stress symptom severity, SCI-related factors and previously identified risk factors for PTSD such as dysfunctional cognitions, demographic factors and personality predispositions (neuroticism, alexithymia). Method A total of 102 participants with SCI completed measures of posttraumatic stress severity, acceptance of injury, posttraumatic cognitions, social support, neuroticism and alexithymia. In addition, information about type, level and cause of the SCI was  assessed. Results High levels of posttraumatic stress symptoms were found. Potential risk factors for the development of PTSD were negative cognitions of self and neuroticism. Variables that added to the variance explained by the models included time since injury and difficulty identifying feelings. Acceptance of injury was mediated by negative cognitions of the self and neuroticism. Conclusions The study highlights the need for services to be aware of the psychological difficulties experienced by this client group. An important finding is that the acceptance of the injury is mediated by negative cognitions of the self which need to be identified as potential risk factors in order to prevent the development of posttraumatic symptoms in this population.

PMID: 18983727 [PubMed - as supplied by publisher]

 

Ugeskr Laeger. 2008 Nov 3;170(45):3643-5.

[Stress disorder in parents of premature neonates--secondary publication]

[Article in Danish]

Elklit A, Hartvig T, Christiansen M.

Psykologisk Institut, Aarhus Universitet, DK-8000 Arhus C. aske@psy.au.dk

The current study evaluated the psychological sequelae in 66 parents of premature neonates (mean weight 842 grams). A total of 35% of the parents reported that their child had a handicap, while 20% of the women met the criteria of post-traumatic stress disorder (PTSD) at the time of the study, and an additional 10% met the criteria for subclinical PTSD. Female gender, the child's handicap, general distress during hospitalization, distressing contact with hospital staff, experienced distress at homecoming, and emotional coping explained 72% of the degree of traumatization.

Publication Types:      English Abstract

PMID: 18988368 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2008 Nov;33(11):1448-53. Epub 2008 May 22.

Smoking in help-seeking veterans with PTSD returning from Afghanistan and Iraq.

Kirby AC, Hertzberg BP, Collie CF, Yeatts B, Dennis MF, McDonald SD, Calhoun PS,  Beckham JC.

Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.

Past research has shown that veterans and individuals with posttraumatic stress disorder (PTSD) have increased rates of smoking. However, the rates of smoking in younger help-seeking veterans returning from Afghanistan and Iraq, and possible correlates of smoking among this population are unknown. In this study, we evaluated the rate of lifetime and current smoking among a sample of 90 returning male veterans diagnosed with PTSD. Fifty-nine percent reported a lifetime history of smoking including 32% that were current smokers. Current smokers were significantly younger than non-smokers. Current smokers (mean age=31) reported a  mean age of smoking onset as 15.86 with a pack year history of 8.89. These smokers reported on average five previous quit attempts. According to a stages of change model, one-half of the smokers were in the contemplation phase of stopping smoking (50%), 29% were in the pre-contemplation phase and 21% were in the preparation phase. The results are placed in the context of non-psychiatric and psychiatric smokers.

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

PMID: 18571871 [PubMed - in process]

 

Addict Behav. 2008 Nov;33(11):1441-7. Epub 2008 Apr 8.

Relationship between PTSD symptomatology and nicotine dependence severity in crime victims.

Baschnagel JS, Coffey SF, Schumacher JA, Drobes DJ, Saladin ME.

The University at Mississippi Medical Center, Department of Psychiatry and Human  Behavior, 2500 North State St. Jackson, MS 39216, USA. jbaschnagel@psychiatry.umsmed.edu

Smoking rates are higher and cessation rates are lower among individuals with posttraumatic stress disorder (PTSD) compared to the general population, thus understanding the relationship between PTSD and nicotine dependence is important. In a sample of 213 participants with a crime-related trauma (109 with PTSD), the  relationship between PTSD status, smoking status (smoker vs. non-smoker), substance abuse diagnosis (SUD), PTSD symptoms, and sex was assessed. SUD diagnosis was significantly related to smoking status, but PTSD symptomatology and sex were not. Among smokers (n=117), increased nicotine dependence severity was associated with being male and with increased level of PTSD avoidance symptoms. Correlations indicated that PTSD avoidance and hyperarousal symptom clusters and total PTSD symptom scores were significantly related to nicotine dependence severity in males, while PTSD symptomatology in general did not correlate with dependence severity for females. The results suggest that level of PTSD symptomatology, particularly avoidance symptoms, may be important targets for smoking cessation treatment among male smokers who have experienced a traumatic event.

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

PMID: 18442884 [PubMed - in process]

 

Aging Ment Health. 2008 Nov;12(6):807-19.

Can the past keep life pleasant even for old-old trauma survivors?

Shrira A, Shmotkin D.

Department of Psychology, Tel Aviv University, Tel Aviv, Israel. amitshar@post.tau.ac.il

OBJECTIVES: This study examined the relative effect of positive and negative autobiographical aspects in later life as a function of the traumatic experience  of the Holocaust and age. METHOD: Old (age <or=80) and old-old (age >80) participants who were identified as Holocaust survivors (n = 225), and comparison of pre-war (n = 103) and post-war (n = 254) European-descent immigrants referred  to their past in a biographical interview. The participants depicted personally perceived outstanding life periods defined as anchor periods (Shmotkin, D. (2005). Happiness in face of adversity: Reformulating the dynamic and modular bases of subjective well-being. Review of General Psychology, 9, 291-325). They rated their happiness and suffering during major anchor periods ('the happiest period' and 'the most miserable period') as well as their life satisfaction. RESULTS: The findings suggest that even after massive trauma and under accelerating decline associated with old-old age, the past can keep life pleasant, as indicated by the stronger association of past happiness, compared to that of past suffering, with life satisfaction. Nevertheless, past suffering was  associated with life satisfaction among the Holocaust survivors and manifested a  stronger effect among most of the old-old participants. CONCLUSION: Holocaust survivors demonstrated a greater difficulty to compensate for age-related losses  while the comparison groups showed a greater optimization of satisfaction through narrative means in old-old age.

Publication Types:      Comparative Study

PMID: 19023733 [PubMed - indexed for MEDLINE]

 

AIDS Care. 2008 Nov;20(10):1279-83.

The relationship between behavioural inhibition, anxiety disorders, depression and CD4 counts in HIV-positive adults: a cross-sectional controlled study.

Fincham D, Smit J, Carey P, Stein DJ, Seedat S.

MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, South Africa. dylan@sun.ac.za

This study examined the relationships between behavioural inhibition (BI), anxiety disorders, depression and CD4 counts in 456 HIV-infected adults attending primary healthcare HIV clinics in South Africa. Our first hypothesis was that BI  would be positively correlated with anxiety disorders and with depression. Our second hypothesis was that BI, anxiety disorders and depression would be negatively correlated with CD4 counts. Participants completed the Retrospective Self-Report of Childhood Inhibition scale (RSRCI), the Center for Epidemiologic Studies Depression scale (CES-D) and the Mini-International Neuropsychiatric Interview (MINI). We found that BI was positively correlated with depression, agoraphobia, social phobia (social anxiety disorder) and posttraumatic stress disorder (PTSD). In addition, we found that BI, anxiety disorders and depression  were not associated with CD4 counts. Finally, we found no gender effects for BI,  depression, CD4 counts or any anxiety disorder diagnosis. While BI was linked to  certain anxiety disorders, we found no evidence to suggest that BI, a diagnosis of an anxiety disorder, and/or depressive symptoms were associated with CD4 counts among HIV-positive adults.

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

PMID: 19012085 [PubMed - in process]

 

Alcohol Alcohol. 2008 Nov-Dec;43(6):706-12. Epub 2008 Sep 12.

Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak.

Wu P, Liu X, Fang Y, Fan B, Fuller CJ, Guan Z, Yao Z, Kong J, Lu J, Litvak IJ.

Mailman School of Public Health, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 43, NY 10032, USA. pw11@columbia.edu

AIMS: The aim of this study was to examine alcohol abuse/dependence symptoms among hospital employees exposed to a severe acute respiratory syndrome (SARS) outbreak, and the relationship between types of exposure to the SARS outbreak and subsequent alcohol abuse/dependence symptoms. METHODS: A survey was conducted among 549 randomly selected hospital employees in Beijing, China, concerning the  psychological impact of the 2003 SARS outbreak. Subjects were assessed on sociodemographic factors and types of exposure to the outbreak, and on symptoms of post-traumatic stress (PTS), alcohol abuse/dependence and depression. RESULTS: Current alcohol abuse/dependence symptom counts 3 years after the outbreak were positively associated with having been quarantined, or worked in high-risk locations such as SARS wards, during the outbreak. However, having had family members or friends contract, SARS was not related to alcohol abuse/dependence symptom count. Symptoms of PTS and of depression, and having used drinking as a coping method, were also significantly associated with increased alcohol abuse/dependence symptoms. The relationship between outbreak exposure and alcohol abuse/dependence symptom count remained significant even when sociodemographic and other factors were controlled for. When the intrusion, avoidance and hyperarousal PTS symptom clusters were entered into the model, hyperarousal was found to be significantly associated with alcohol abuse/dependence symptoms. CONCLUSIONS: Exposure to an outbreak of a severe infectious disease can, like other disaster exposures, lead not only to PTSD but also to other psychiatric conditions, such as alcohol abuse/dependence. The findings will help policy makers and health professionals to better prepare for potential outbreaks of diseases such as SARS or avian flu.

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

PMID: 18790829 [PubMed - in process]

 

Am J Addict. 2008 Nov-Dec;17(6):478-87.

The relationship between posttraumatic growth and substance use in homeless women with histories of traumatic experience.

Stump MJ, Smith JE.

Department of Psychology, St. Louis University, St. Louis, Missouri, USA.

Posttraumatic growth (PTG)--namely, the experience of positive change in oneself  or one's life following trauma--is particularly relevant for homeless women because they have greater trauma exposure than the general population, as well as higher rates of substance use. The present study examined PTG and substance use in this population. Fifty homeless women with trauma histories participated. In line with predictions, more current substance use was related to less PTG, more reliance on avoidant coping once approach coping was accounted for, and greater PTSD symptomatology. Levels of growth were comparable to those found in samples with less trauma exposure.

PMID: 19034739 [PubMed - in process]

 

Am J Crit Care. 2008 Nov;17(6):534-43; quiz 544.

Symptoms of acute posttraumatic stress disorder after intensive care.

Wallen K, Chaboyer W, Thalib L, Creedy DK.

Research Centre for Clinical Practice Innovation, Griffith University Gold Coast, Queensland, Australia. K.Wallen@griffith.edu.au

BACKGROUND: Admission to intensive care is often a sudden and unexpected event precipitated by a life-threatening condition, 2 determinants thought to influence the development of posttraumatic stress disorder. OBJECTIVES: To identify the frequency of acute symptoms of posttraumatic stress disorder and to describe factors predictive of these symptoms in patients 1 month after discharge from intensive care. METHODS: In this prospective cohort study, all patients meeting the inclusion criteria during the study period were invited to participate. Participants completed the Impact of Event Scale-Revised, and demographic and clinical data were accessed from an intensive care unit database. RESULTS: During a 9-month period, 114 of 137 patients who met the inclusion criteria consented to participate in the study, and 100 (88%) completed it. The mean total score on the Impact of Event Scale-Revised was 17.8 (SD, 13.4; possible range, 0-88). A total  of 13 participants (13%) scored higher than the cutoff score for clinical posttraumatic stress disorder. Neither sex nor length of stay was predictive of acute symptoms of post-traumatic stress disorder. In multivariate analysis, the only independent predictor of symptoms was age. Patients younger than 65 years were 5.6 times (95% confidence interval, 1.17-26.89) more likely than those 65 years and older to report symptoms. CONCLUSION: The rate of symptoms of posttraumatic stress disorder 1 month after discharge from intensive care was relatively low. Consistent with findings of previous research, being younger than 65 years was the only independent predictor of symptoms.

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

PMID: 18978238 [PubMed - indexed for MEDLINE]

 

Am J Nurs. 2008 Nov;108(11):60-8; quiz 68-9.

The Impact of Event Scale--Revised: a quick measure of a patient's response to trauma.

Hyer K, Brown LM.

School of Aging Studies, University of South Florida, Tampa, USA. khyer@cas.usf.edu

A person may suffer debilitating anxiety and other physical and psychological symptoms without recognizing that they're a response to a traumatic event. And older adults in particular may be reluctant to admit to experiencing such symptoms. The Impact of Event Scale--Revised (IES-R) is an easy-to-administer questionnaire used to evaluate the degree of distress a patient feels in response to trauma. It provides a structured way for a patient to communicate distress when she or he may not have the words to do so. For a free online video showing nurses using the IES-R with an older patient, go to http://links.lww.com/A316.

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

PMID: 18946269 [PubMed - indexed for MEDLINE]

 

Anesthesiology. 2008 Nov;109(5):927-9.

Operating room desensitization as a novel treatment for post-traumatic stress disorder after intraoperative awareness.

Mashour GA, Wang LY, Esaki RK, Naughton NN.

Department of Anesthesiology, University of Michigan, 1H247 University Hospital,  Ann Arbor, MI 48109-0048, USA. gmashour@umich.edu

Publication Types:      Case Reports

PMID: 18946306 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2008 Nov;65(11):1324-30.

Posttraumatic stress symptoms and predicted mortality in patients with implantable cardioverter-defibrillators: results from the prospective living with an implanted cardioverter-defibrillator study.

Ladwig KH, Baumert J, Marten-Mittag B, Kolb C, Zrenner B, Schmitt C.

Institute of Epidemiology, Helmholtz Zentrum National Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. ladwig@helmholtz-muenchen.de

CONTEXT: Cardiac disease and treatment with an implantable cardioverter-defibrillator (ICD) may be psychologically traumatic. Posttraumatic  stress disorder (PTSD) is generally overlooked in cardiac patients, and no study  to date (to our knowledge) has evaluated the effect of PTSD symptoms on the prognosis in patients with ICDs. OBJECTIVE: To test whether PTSD symptoms at baseline predict long-term mortality risk in patients with ICDs. DESIGN: Prospective cohort study with a mean follow-up period of 5.1 years, accounting for 743 person-years observed. SETTING: Data were derived from the Living With an Implanted Cardioverter-Defibrillator-Study, which initially included 211 patients with ICDs routinely attending the German Heart Center Munich outpatient clinic. PARTICIPANTS: The Impact of Event Scale-Revised was used in 147 patients (125 men and 22 women) who qualified for the "A" criterion of PTSD (survival of a life-threatening event). Thirty-eight patients scoring in the upper quartile of the scale constituted the PTSD index group. MAIN OUTCOME MEASURES: Mortality risk per 1000 person-years as assessed by Cox proportional hazards regression analysis based on an appropriate model fit (area under the curve, >0.80). RESULTS: Index patients experienced more anxiety and depression, had more cardiac symptoms, but  showed no differences in left ventricular ejection fraction status or extent of ICD discharges compared with non-index patients. Forty-five patients (30.6%) died during the follow-up period. The relative mortality risk (multivariate adjusted for age, sex, diabetes mellitus, left ventricular ejection fraction, beta-blocker prescription, prior resuscitation, ICD shocks received, depression, and anxiety)  hazard ratio was 3.45 (95% confidence interval, 1.57-7.60; P = .002) for the PTSD group. Compared with 55 fatal events per 1000 person-years in patients without PTSD, the long-term absolute mortality risk accounted for 80 fatal events per 1000 person-years in patients with PTSD. CONCLUSION: The adverse effect of PTSD symptoms on the long-term mortality risk in ICD-treated cardiac event survivors,  independent of disease severity, supports the need for routinely applied interdisciplinary psychosocial aftercare.

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

PMID: 18981344 [PubMed - indexed for MEDLINE]

 

Behav Modif. 2008 Nov;32(6):876-96. Epub 2008 Jul 9.

Posttraumatic stress disorder and social support in female victims of sexual assault: the impact of spousal involvement on the efficacy of cognitive-behavioral therapy.

Billette V, Guay S, Marchand A.

Trauma Study Center, Centre de Recherche Fernand-Seguin of Louis-H. Lafontaine Hospital, Université du Québec à Montréal. valeriebillette@hotmail.com

The goal of this study is to enhance the efficacy of CBT with victims of sexual assault suffering from PTSD by getting the spouse involved. Thus, in addition to  attempting to reduce PTSD symptoms, the therapy focuses on improving the support  offered by the spouse and favors management of the impact of the traumatic event  within the couple. A single-case, multiple-baseline across-subjects design is used. Three victims of sexual assault with a diagnosis of PTSD participated in the study. Results at posttreatment and at 3-month follow-up are promising. None  of the participants presents a diagnosis of PTSD, and all report a significant improvement in their satisfaction with the support received from their spouses.

PMID: 18614698 [PubMed - in process]

 

Br J Psychiatry. 2008 Nov;193(5):378-82.

Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample.

Kelleher I, Harley M, Lynch F, Arseneault L, Fitzpatrick C, Cannon M.

Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.

BACKGROUND: Children and adolescents who report psychotic symptoms appear to be at increased risk for psychotic disorders in adulthood - a putative ;symptomatic' high-risk group. However, little research has investigated whether those in this  high-risk population have increased rates of exposure to traumatic events in childhood, as seen in patients who have a psychotic illness. AIMS: To examine whether adolescents with psychotic symptoms have an increased rate of traumatic experiences. METHOD: Psychiatric interviews were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about a number of early traumatic events including  physical and sexual abuse, exposure to domestic violence and bullying. RESULTS: Fourteen adolescents (6.6% of those interviewed) reported experiencing at least one psychotic symptom. Adolescents who reported psychotic symptoms were significantly more likely to have been physically abused in childhood, to have been exposed to domestic violence and to be identified as a bully/victim (that is, both a perpetrator and victim of bullying) than those who did not report such symptoms. These findings were not confounded by comorbid psychiatric illness or family history of psychiatric history. CONCLUSIONS: Our findings suggest that childhood trauma may increase the risk of psychotic experiences. The characteristics of bully/victims deserve further study.

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

PMID: 18978317 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Nov;32(11):1026-36.

Children's expressed emotions when disclosing maltreatment.

Sayfan L, Mitchell EB, Goodman GS, Eisen ML, Qin J.

Department of Psychology, University of California, One Shields Avenue, Davis, CA 95616, USA.

OBJECTIVE: Our goal was to examine children's expressed emotions when they disclose maltreatment. Little scientific research exists on this topic, and yet children's emotional expressions at disclosure may inform psychological theory and play a crucial role in legal determinations. METHOD: One hundred and twenty-four videotaped forensic interviews were coded for children's emotional displays. In addition, children's trauma-related symptoms (depression, dissociation, and PTSD) and global adaptive functioning were assessed, and abuse  type and frequency were documented. RESULTS: Most children in the sample evinced  neutral emotion during disclosure. However, stronger negative reactions were linked to indices of psychopathology. Number of abuse experiences was inversely related to negative emotional displays. CONCLUSION: Fact finders may profit from  knowing that maltreated children do not necessarily cry or display strong emotion when disclosing maltreatment experiences. Nevertheless, predictors of greater negative affect at disclosure can be identified: fewer abuse experiences; higher  global adaptive functioning; and for sexually abused children, greater dissociative tendencies. PRACTICE IMPLICATIONS: Although further research is needed, practitioners should consider that children who disclose abuse may display relatively neutral affect despite having experienced maltreatment.

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

PMID: 19090025 [PubMed - in process]

 

Evid Based Ment Health. 2008 Nov;11(4):126.

Comment on:     BMJ. 2008 Feb 16;336(7640):366-71.

Deployment with combat exposure increases the risk of new-onset PTSD.

Lapierre CB.

Tarleton State University - Central Texas, Killeen, Texas, USA.

Publication Types:      Comment

PMID: 18952975 [PubMed]

 

Expert Opin Drug Saf. 2008 Nov;7(6):783-94.

Paroxetine: safety and tolerability issues.

Marks DM, Park MH, Ham BJ, Han C, Patkar AA, Masand PS, Pae CU.

Duke University Medical Center, Department of Psychiatry and Behavioural Sciences, 2218 Elder Street, Durham 27705, USA.

Paroxetine is a selective serotonin re-uptake inhibitor (SSRI) available in immediate release and controlled release (CR) formulations. Paroxetine is the most potent inhibitor of serotonin re-uptake among the now available SSRIs. Paroxetine has been approved for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder (PD), generalised anxiety disorder, post traumatic stress disorder (PTSD), and social anxiety disorder (SAD) in adults, whereas paroxetine CR is approved for the treatment of MDD, SAD, PD and premenstrual dysphoric disorder in adults. The overall efficacy of paroxetine seems to be comparable to other SSRIs in the treatment of approved indications, although paroxetine treatment induces more sedation, constipation, sexual dysfunction, discontinuation syndrome and weight gain than other SSRIs. Recent data suggest that paroxetine treatment leads to increased rates of congenital malformations, although this evidence is not conclusive. Paroxetine and paroxetine CR are not indicated for use in the paediatric population and are  categorised as Pregnancy Class D. In conclusion, whether the tolerability profile of paroxetine differs substantially from other new antidepressants (including other SSRIs) needs to be determined in adequately powered well-designed randomised controlled comparative clinical trials.

PMID: 18983224 [PubMed - in process]

 

Gen Hosp Psychiatry. 2008 Nov-Dec;30(6):536-45. Epub 2008 Sep 5.

Physician-reported practice of managing childhood posttraumatic stress in pediatric primary care.

Banh MK, Saxe G, Mangione T, Horton NJ.

Department of Psychology, Boston University, Boston, MA 02215, USA. my.banh@gmail.com

OBJECTIVE: This study investigated pediatrician-reported practices in identifying, assessing, and treating traumatic exposure and posttraumatic stress  disorder (PTSD) in children. METHOD: Focus groups guided the development of a survey that was mailed to primary care pediatricians in Massachusetts in 2005. Descriptive statistics and multivariate analyses were used to describe clinical practices and perceived barriers to care. RESULTS: A 60% (N=597) survey response-rate was obtained. On average, pediatricians reported that less than 8%  of patients had psychological problems that may be related to traumatic exposure. Only 18% of pediatricians agreed that they had adequate knowledge of childhood PTSD. About 15% of pediatricians reported frequently learning about traumatic event(s) from direct inquiry in the past year. Only 10% of pediatricians reported frequent assessment and treatment of posttraumatic stress symptoms. Most pediatricians (72%) agreed that greater collaborations with mental health providers would improve pediatric assessment of PTSD. Finally, having received PTSD-specific training and believing that pediatricians should identify and manage PTSD were each significantly associated with learning about a traumatic event from direct inquiry. CONCLUSION(S): Providing PTSD-specific training and changing pediatricians' attitudes about childhood PTSD may be useful first steps  in improving care for children.

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

PMID: 19061680 [PubMed - in process]

 

J Affect Disord. 2008 Nov;111(1):74-82. Epub 2008 Apr 2.

Consistent impaired verbal memory in PTSD: a meta-analysis.

Johnsen GE, Asbjørnsen AE.

Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway. grethe.johnsen@psybp.uib.no

BACKGROUND: Qualitative review papers have indicated that verbal memory impairment is found to be the most consistent cognitive impairment related to PTSD. These review papers have used qualitative methods to describe the effects,  and consequently they have not been able to estimate the strength of the memory-PTSD association. METHODS: This meta-analysis of 28 studies examined the empirical evidence for this relationship, and factors affecting the results. RESULTS: Overall, the results showed medium effect sizes in patients with PTSD compared to controls on verbal memory across studies. Marked impairment was found in the patient groups compared to healthy controls, while modest impairment was found compared to exposed non-PTSD controls. Meta-analyses found strongest effects in war veterans compared to sexual and physical assault related PTSD. Rather unexpectedly no effect was found for the sexually abused PTSD groups compared to exposed controls. The analyses further showed that the effect was dependent on the test procedures used. The studies using WMS and AVLT had stronger effects than studies using CVLT. LIMITATIONS: Insufficient data were available to analyze a more complete attention-memory profile. CONCLUSIONS: This  meta-analysis confirms that verbal memory impairment is present in adults with PTSD, and they are consistent across studies. This impairment should be the focus of work in clinical settings.

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

PMID: 18377999 [PubMed - indexed for MEDLINE]

 

J Epidemiol Community Health. 2008 Nov;62(11):980-6.

Food insecurity, stressful life events and symptoms of anxiety and depression in  east Africa: evidence from the Gilgel Gibe growth and development study.

Hadley C, Tegegn A, Tessema F, Cowan JA, Asefa M, Galea S.

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. chadley@emory.edu

OBJECTIVES: Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in  sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among  adults. METHODS: The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms. RESULTS: Among  902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress. CONCLUSIONS: Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.

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

PMID: 18854502 [PubMed - in process]

 

J Exp Psychol Gen. 2008 Nov;137(4):591-614.

Memory in posttraumatic stress disorder: properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms.

Rubin DC, Boals A, Berntsen D.

Department of Psychology and Neuroscience, Duke University, Durham, NC 27708-0086, USA. david.rubin@duke.edu

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed  tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD.  (c) 2008 APA, all rights reserved

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

PMID: 18999355 [PubMed - indexed for MEDLINE]

 

J Forensic Leg Med. 2008 Nov;15(8):527-8. Epub 2008 Aug 8.

The need for measures to prevent "solitary deaths" after large earthquakes - based on current conditions following the Great Hanshin-Awaji Earthquake.

Fujita Y, Inoue K, Seki N, Inoue T, Sakuta A, Miyazawa T, Eguchi K.

Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kanagawa, Japan.

Publication Types:      Comparative Study

PMID: 18926507 [PubMed - indexed for MEDLINE]

 

J Health Psychol. 2008 Nov;13(8):1008-11.

Application of the DSM-IV Criteria to the Experience of Living with AIDS: Some Concerns.

Kagee A.

Stellenbosch University, South Africa. skagee@sun.ac.za.

A diagnosis with HIV is often considered traumatic. According to the DSM-IV-TR's  criteria for PTSD, a traumatic event precipitates a set of reactions in an individual that includes avoidant behaviour, intrusive thoughts, and physiologic  hyperarousal. However, persons diagnosed with HIV are typically concerned with events that will occur in the future such as physical decline and death, access to treatment, the welfare of dependants, and stigma and discrimination. Their concerns are thus future-oriented rather than anchored to a past traumatic event, which is the requirement of PTSD. This article argues that an HIV diagnosis may be inappropriately regarded as traumatic.

PMID: 18987073 [PubMed - in process]

 

J Interpers Violence. 2008 Nov;23(11):1555-78. Epub 2008 Mar 18.

The role of young adolescents' perception in understanding the severity of exposure to community violence and PTSD.

Aisenberg E, Ayón C, Orozco-Figueroa A.

University of Washington, Seattle, WA 98105-6299, USA. ginoa@u.washington.edu

This study seeks to (a) identify and measure the lifetime exposure to community violence of 137 African American and Latino middle school students from a low income neighborhood and apply numerical weights to each violent event; (b) examine the relationship between the objective severity of child self reported violence exposure and the child's subjective perception of the most bothersome event; and (c) examine the relationship between child's exposure and posttraumatic stress disorder (PTSD). Results highlight that students' designation of their most bothersome exposure to community violence did not correspond to the most severe violent event they experienced. Regression analyses reveal the weight of the most severe event explains a larger percentage of the variance in PTSD compared with the relationship to victim, level of exposure, weight of the most bothersome exposure, and cumulative weight of all exposure. This study underscores the importance of assessing a child's perception of violent events.

PMID: 18349341 [PubMed - indexed for MEDLINE]

 

J Med Ethics. 2008 Nov;34(11):e23.

Propranolol, post-traumatic stress disorder and narrative identity.

Bell J.

Dalhousie University, Halifax, Nova Scotia, Canada. jah.bell@utoronto.ca

FUNDING: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object  to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President's Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat to the self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don't respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case.

PMID: 18974403 [PubMed - in process]

 

J Midwifery Womens Health. 2008 Nov-Dec;53(6):538-46.

Physical health and posttraumatic stress disorder symptoms in women experiencing  intimate partner violence.

Woods SJ, Hall RJ, Campbell JC, Angott DM.

University of Akron College of Nursing, Akron, OH 44325-3701, USA. sw5@uakron.edu

This correlational-predictive study addresses the associations between intimate partner violence (IPV) and physical health and posttraumatic stress disorder (PTSD) symptoms, including: 1) detailed physical health symptoms reported and health care sought by women in intimate abusive relationships, 2) relationships between physical health symptoms, IPV, and PTSD, and 3) unique predictors of physical health symptoms. An ethnically diverse sample of 157 abused women was recruited from crisis shelters and the community. The women averaged almost 34 years of age and had been in the abusive relationship for slightly more than 5 years. The women experienced physical health symptoms falling into 4 groups: neuromuscular, stress, sleep, and gynecologic symptoms. Women experiencing more severe IPV reported more physical health and PTSD symptomatology. PTSD avoidance  and threats of violence or risk of homicide uniquely predicted physical health. More than 75% of the women had sought treatment from a health care professional in the previous 9 months. Implications for practice are discussed.

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

PMID: 18984510 [PubMed - in process]

 

J Nerv Ment Dis. 2008 Nov;196(11):852-5.

Negative affect predicts posttraumatic stress symptoms in Brazilian volunteer United Nations peacekeepers in Haiti.

Souza WF, Figueira I, Mendlowicz MV, Volchan E, Mendonça-de-Souza AC, Duarte AF,  Monteiro da Silva AM, Marques-Portella C, Mari JJ, Coutinho ES.

Department of Epidemiology, National School of Public Health (ENSP-FIOCRUZ), Federal University of Rio de Janeiro, Brazil. wanderson.souza@gmail.com

Our study evaluated the relationship between positive affect (PA) and negative affect (NA) traits on the development of posttraumatic stress symptoms (PTSS) among peacekeepers. A longitudinal study with 138 army personnel deployed to a peacekeeping mission in Haiti was conducted. An instrument for measuring PA and NA traits was used before deployment. PTSS, indexed by posttraumatic stress disorder Checklist--Military Version (PCL-M) and frequency of stressful situations were measured after return. Regression analysis showed that both NA and number of stressful situations contributed toward increasing PCL-M scores (Adjusted R = 0.25; p < 0.001). We also found that NA traits interact with intensively stressful situations enhancing the occurrence of PTSS (Adjusted R = 0.32; p < 0.001). These findings suggest that NA traits are an important predictor for PTSS among peacekeepers and also worsen the consequences of being exposed to stressful situations.

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

PMID: 19008738 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Nov;196(11):844-6.

Anger and posttraumatic stress disorder in disaster relief workers exposed to the September 11, 2001 World Trade Center disaster: one-year follow-up study.

Jayasinghe N, Giosan C, Evans S, Spielman L, Difede J.

Department of Psychiatry, Weill Medical College of Cornell University, New York,  New York 10065, USA. nij2001@med.cornell.edu

Although anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 () indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a 1-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.

PMID: 19008736 [PubMed - indexed for MEDLINE]

 

J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1275-81. Epub 2008 May 9.

The effect of telephone counselling on reducing post-traumatic symptoms after mild traumatic brain injury: a randomised trial.

Bell KR, Hoffman JM, Temkin NR, Powell JM, Fraser RT, Esselman PC, Barber JK, Dikmen S.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA. krbell@u.washington.edu

BACKGROUND: Mild traumatic brain injury (MTBI) is a significant public health problem affecting approximately 1 million people annually in the USA. A total of  10-15% of individuals are estimated to have persistent post-traumatic symptoms. This study aimed to determine whether focused, scheduled telephone counselling during the first 3 months after MTBI decreases symptoms and improves functioning  at 6 months. METHODS: This was a two-group, parallel, randomised clinical trial with the outcome assessed by blinded examiner at 6 months after injury. 366 of 389 eligible subjects aged 16 years or older with MTBI were enrolled in the emergency department, with an 85% follow-up completion rate. Five telephone calls were completed, individualised for patient concerns and scripted to address education, reassurance and reactivation. Two composites were analysed, one relating to post-traumatic symptoms that developed or worsened after injury and their impact on functioning, the other related to general health status. RESULTS: The telephone counselling group had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval (CI) 1.2  to 12.0), but no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI 2.2 to 5.2). A smaller proportion of the treatment  group had each individual symptom (except anxiety) at assessment. Similarly, fewer of the treatment group had daily functioning negatively impacted by symptoms with the largest differences in work, leisure activities, memory and concentration and financial independence. CONCLUSIONS: Telephone counselling, focusing on symptom management, was successful in reducing chronic symptoms after MTBI. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, #NCT00483444.

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

PMID: 18469027 [PubMed - indexed for MEDLINE]

 

J Pain. 2008 Nov;9(11):1049-57. Epub 2008 Aug 13.

Chronic pain in women survivors of intimate partner violence.

Wuest J, Merritt-Gray M, Ford-Gilboe M, Lent B, Varcoe C, Campbell JC.

University of New Brunswick, Faculty of Nursing, Fredericton, New Brunswick, Canada. wuest@unb.ca

In this descriptive study of chronic pain in a community sample of 292 women who  had separated from their abusive partners on average 20 months previously, more than one-third experienced high disability pain as measured by Von Korff's Chronic Pain Grade. Beyond the usual pain locations associated with abuse, 43.2%  reported swollen/painful joints. More interference in daily life was attributed to joint pain than to back, head, stomach, pelvic or bowel pain. Women with high  disability pain were more likely to have experienced child abuse, adult sexual assault, more severe spousal abuse, lifetime abuse-related injuries, symptoms of  depression and post-traumatic stress disorder, lifetime suicide attempts, difficulty sleeping, and unemployment. High disability pain also was associated with visits to a family doctor and psychiatrist and use of medication in more than prescribed dosages. Less than 25% of women with high disability pain were taking opioids, or prescription nonsteroidal anti-inflammatory medications. Interestingly, high disability pain was not related to smoking, use of street drugs, potential for alcohol dependence, age, income, or education. The findings  add to knowledge of severity and patterns of chronic pain in abused women and support the need for further multivariate analysis of the relationships among abuse experiences, mental health, and chronic pain severity to better inform decisions regarding diagnosis and treatment. PERSPECTIVE: Understanding patterns  of chronic pain in abuse survivors and their associations with abuse history, mental health symptoms, health service use, and medication is important for clinical assessment and intervention. Chronic pain persisted long after leaving abusive partners and extended beyond usual locations (back, headache, pelvic, gastrointestinal) to include swollen/painful joints.

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

PMID: 18701353 [PubMed - indexed for MEDLINE]

 

J Psychosoc Nurs Ment Health Serv. 2008 Nov;46(11):39-44.

Late-onset posttraumatic stress disorder.

Snyder M.

University of Illinois at Chicago, Department of Health Systems Science, Chicago, Illinois 60612-7350, USA. snyderm@uic.edu

Posttraumatic stress disorder (PTSD) is a complex psychological response to a perceived life-threatening trauma that includes re-experiencing the trauma, avoidance, intrusive thoughts, hyperarousal, and dissociation. Exposure to trauma in early adulthood increases the potential for further psychological threats throughout life. In older adult populations, PTSD is an underrecognized and undertreated disorder that can result in psychosocial disability, substance use,  and other negative health outcomes. This article examines the range of symptoms related to PTSD in older adults and expands on health care provider sensitivity to the interrelationship of mental and physical health when addressing the needs  of older adults with this disorder.

PMID: 19051577 [PubMed - in process]

 

J Trauma. 2008 Nov;65(5):1054-65.

Ethnic differences in posttraumatic stress disorder after musculoskeletal trauma.

Williams AE, Smith WR, Starr AJ, Webster DC, Martinez RJ, Vojir CP, Sakalys JA, Morgan SJ.

Eastern Colorado Health Care System, Denver, Colorado, USA. allison.williams3@va.gov

BACKGROUND: Psychological distress is known to contribute to poor outcomes in orthopedic patients. Limited information exists concerning ethnic differences in  psychological sequelae after musculoskeletal injury. This study examined ethnic variations in prevalence of posttraumatic stress disorder (PTSD) after musculoskeletal trauma. METHODS: A secondary analysis was conducted using data collected for a study examining PTSD after musculoskeletal trauma. Two hundred eleven consecutive patients with musculoskeletal injuries were enrolled. Psychological status was assessed using the Revised Civilian Mississippi Scale for PTSD. A chart review was completed to gather demographic and injury information. Independent samples t tests, Fisher's exact, Chi-square, and logistic regression analyses were performed to assess differences. RESULTS: Ninety-six (45.5%) Hispanic and 115 (54.5%) non-Hispanic White adults participated. Few significant demographic or health differences were found. No significant differences were found regarding injury characteristics. Fisher's exact tests indicated a higher prevalence of PTSD symptomatology among Hispanics  than non-Hispanic Whites (p < 0.01). Additionally, U.S. born Hispanics were more  likely than non-U.S. born Hispanics to have PTSD symptomatology (p = 0.004). Odds ratios indicated that women (OR = 2.2), persons with a psychiatric comorbidity (OR = 5.1), Hispanics (OR = 6.6), and persons born in the United States (OR = 3.7) had an increased likelihood of PTSD symptomatology. CONCLUSIONS: Results indicate an ethnic difference in prevalence of PTSD symptomatology after musculoskeletal injury. Hispanic participants were nearly seven times more likely to be positive for PTSD symptomatology. Furthermore, U.S. born Hispanic participants had a higher prevalence of PTSD symptomatology. Future research should explore factors contributing to these differences.

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

PMID: 19001973 [PubMed - indexed for MEDLINE]

 

J Urban Health. 2008 Nov;85(6):880-909. Epub 2008 Sep 11.

An Overview of 9/11 Experiences and Respiratory and Mental Health Conditions among World Trade Center Health Registry Enrollees.

Farfel M, Digrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson D, Frieden TR, Thorpe L.

New York City Department of Health and Mental Hygiene, New York, NY, USA, mfarfel@health.nyc.gov.

To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2-3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR  to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were  self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable  posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income <$25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600-70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.

PMID: 18785012 [PubMed - in process]

 

Mil Med. 2008 Nov;173(11):1136-41.

Trichotillomania and post-traumatic stress disorder: a case study.

Corso KA, McGeary DD.

Eglin Hospital, Suite 114, 307 Boatner Road, Eglin Air Force Base, FL 32542, USA. kentcorso@gmail.com

This is a clinical case study of a 45-year-old, Caucasian male, active duty military officer. It demonstrates the short-term efficacy of habit-reversal training on the treatment of trichotillomania (TTM) in three 50-minute sessions,  with concomitant, but unanticipated decreases in post-traumatic stress disorder (PTSD) symptoms and emotional distress as measured by the PTSD Checklist, Form PCL-M and OQ-45, respectively. This study discusses the benefits and limitations  of such a short treatment for comorbid TTM and PTSD, while positing the relationship between the two disorders. Finally, it lends support for the classification of TTM as an anxiety disorder rather than an impulse-control disorder.

PMID: 19055191 [PubMed - in process]

 

Psychophysiology. 2008 Nov;45(6):886-95. Epub 2008 Sep 24.

Neural activity and diurnal variation of cortisol: evidence from brain electrical tomography analysis and relevance to anhedonia.

Putnam KM, Pizzagalli DA, Gooding DC, Kalin NH, Davidson RJ.

National Center for PTSD, VA Boston Healthcare Center, Department of Psychiatry,  Boston University School of Medicine, Boston, Massachusetts 02130, USA. katherine.putnam.va.gov

The medial prefrontal cortex (mPFC), hippocampus, and amygdala are implicated in  the regulation of affect and physiological processes, including hypothalamic-pituitary-adrenal (HPA) axis function. Anhedonia is likely associated with dysregulation of these processes. Dense-array resting electroencephalographic and cortisol were obtained from healthy and anhedonic groups. Low-resolution electromagnetic tomography was used to compute intracerebral current density. For the control group, voxelwise analyses found a  relationship between current density in beta and gamma bands and steeper cortisol slope (indicative of more adaptive HPA axis functioning) in regions of the hippocampus, parahippocampal gyrus, and mPFC. For the anhedonic group, the mPFC finding was absent. Anhedonia may be characterized by disruptions of mPFC-mediated neuroendocrine regulation, which could constitute a vulnerability to the development of stress-related disorders.

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: 18823425 [PubMed - in process]

 

Psychosom Med. 2008 Nov;70(9):1028-34. Epub 2008 Nov 3.

Acute stress disorder after myocardial infarction: prevalence and associated factors.

Roberge MA, Dupuis G, Marchand A.

Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.

OBJECTIVE: To examine the prevalence of acute stress disorder (ASD) after a myocardial infarction (MI) and the factors associated with its development. METHODS: Of 1344 MI patients admitted to three Canadian hospitals, 474 patients did not meet the inclusion criteria and 393 declined participation in the study;  477 patients consented to participate in the study. A structured interview and questionnaires were administered to patients 48 hours to 14 days post MI (mean +/- standard deviation = 4 +/- 2.73 days). RESULTS: Four percent were classified  as having ASD using the Structured Clinical Interview for DSM-IV, ASD module. The presence of symptoms of depression (Beck Depression Inventory; odds ratio (OR) =  29.92) and the presence of perceived distress during the MI (measured using the question "How difficult/upsetting was the experience of your MI?"; OR = 3.42, R(2) = .35) were associated with the presence of symptoms of ASD on the Modified  PTSD Symptom Scale. The intensity of the symptoms of depression was associated with the intensity of ASD symptoms (R = .65). The models for the detection and estimation of ASD symptoms were validated by applying the regression equations to 72 participants not included in the initial regressions. The results obtained in  the validation sample did not differ from those obtained in the initial sample. CONCLUSIONS: The symptoms of depression and the subjective distress during the MI could be used to improve the detection of ASD.

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

PMID: 18981272 [PubMed - in process]

 

Soc Sci Med. 2008 Nov;67(10):1589-95. Epub 2008 Sep 5.

Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa.

Kaminer D, Grimsrud A, Myer L, Stein DJ, Williams DR.

Department of Psychology, University of Cape Town, South Africa. Debbie.Kaminer@uct.ac.za

The South African population is exposed to multiple forms of violence. Using nationally representative data from 4351 South African adults, this study examined the relative risk for post-traumatic stress disorder (PTSD) associated with political, domestic, criminal, sexual and other (miscellaneous) forms of assault in the South African population. Violence exposure was assessed using the 'worst event' list from the WHO's Composite International Diagnostic Interview (CIDI) and a separate questionnaire assessing experiences of human rights abuses, and lifetime PTSD was assessed according to the APA's Diagnostic and Statistical  Manual of Mental Disorders criteria using the CIDI. Findings indicated that over  a third of the South African population has been exposed to some form of violence. The most common forms of violence experienced by men were criminal and  miscellaneous assaults, while physical abuse by an intimate partner, childhood physical abuse and criminal assaults were most common for women. Among men, political detention and torture were the forms of violence most strongly associated with a lifetime diagnosis of PTSD, while rape had the strongest association with PTSD among women. At a population level, criminal assault and childhood abuse were associated with the greatest number of PTSD cases among men, while intimate partner violence was associated with the greatest number of PTSD cases among women. Recommendations for mental health service provision in South Africa and for future research on the relative risk for PTSD are offered.

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

PMID: 18774211 [PubMed - in process]

 

J Anxiety Disord. 2008 Oct 31. [Epub ahead of print]

The epidemiology of anxiety disorders in the Arab world: A review.

Tanios CY, Abou-Saleh MT, Karam AN, Salamoun MM, Mneimneh ZN, Karam EG.

Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.

Epidemiological studies are quite rare in the Arab world. The Institute for Development Research Advocacy and Applied Care (IDRAAC) has conducted a systematic review of all epidemiologic research on anxiety disorders in the Arab  world up to 2006. Specific keywords were used in the search for affective disorders, namely anxiety, generalized anxiety disorder, GAD, panic, separation anxiety disorder, SAD, overanxious disorder, OAD, phobia, fear, post-traumatic stress disorder, PTSD, obsessive compulsive disorder (OCD), obsessive compulsive  symptom (OCS), obsession, compulsion, obsessive, compulsive. All results were screened and categorized. Epidemiological data on prevalence, gender differences, age of onset, comorbidity, risk factors and treatment of anxiety disorders in the Arab world were found in clinical and community samples. There is an evident need for national data on anxiety disorders in the Arab world in order to identify the magnitude of these diseases and their burden on the individual and community.

PMID: 19091509 [PubMed - as supplied by publisher]

 

BMJ. 2008 Oct 30;337:a2267. doi: 10.1136/bmj.a2267.

Childhood stress linked to emotional disorders.

Hitchen L.

Publication Types:      News

PMID: 18974254 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 Oct 30;161(1):67-75. Epub 2008 Sep 11.

Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression?

Ehring T, Ehlers A, Cleare AJ, Glucksman E.

Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. t.w.a.ehring@uva.nl

The study investigated the relationship between the acute psychological and psychobiological trauma response and the subsequent development of posttraumatic  stress disorder (PTSD) and depressive symptoms in 53 accident survivors attending an emergency department. Lower levels of salivary cortisol measured in the emergency room predicted greater symptom levels of PTSD and depression 6 months later, and lower diastolic blood pressure, past emotional problems, greater dissociation and data-driven processing predicted greater PTSD symptoms. Heart rate was not predictive. Low cortisol levels correlated with data-driven processing during the accident, and, in female participants only, with prior trauma and prior emotional problems. Higher evening cortisol 6 months after the accident correlated with PTSD and depressive symptoms at 6 months, but this relationship was no longer significant when levels of pain were controlled. The results support the role of the acute response to trauma in the development and maintenance of PTSD and provide promising preliminary evidence for a meaningful relationship between psychobiological and psychological factors in the acute trauma phase.

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

PMID: 18789538 [PubMed - in process]

 

Fed Regist. 2008 Oct 29;73(210):64208-10.

Posttraumatic stress disorder. Interim final rule.

Department of Veterans Affairs.

The Department of Veterans Affairs (VA) is amending its adjudication regulations  regarding service connection for posttraumatic stress disorder (PTSD) by eliminating the requirement of evidence corroborating occurrence of the claimed in-service stressor in claims in which PTSD is diagnosed in service. This amendment is necessary to facilitate the proof of service connection in such claims. By this amendment, we intend to reduce claim-processing time for such claims.

PMID: 19115527 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct 28. [Epub ahead of print]

Anger potentiates the reporting of threatening interpretations: An experimental study.

Barazzone N, Davey GC.

The University of Sussex, UK.

This paper reports the results of an experiment investigating the effect of induced anger on interpretational bias using the homophone spelling task. Four groups of participants experienced anger, anxiety, happy or neutral mood inductions and then completed the homophone spelling task. Participants who experienced anger and anxiety inductions reported significantly more threat/neutral homophones as threats compared to control participants; moods had  an emotion-congruent effect on threat reporting, with negative moods increasing the tendency to report threat/neutral homophones as threats and positive moods increasing the tendency to report positive/neutral homophones as positive. The findings provide evidence that anger potentiates the reporting of threatening interpretations and does so independently of any effect of concurrent levels of state and trait anxiety. The mechanism mediating this effect is unclear, but the  results do lend support to those theories of psychopathology - and especially of  PTSD - that see a causal role for anger in the maintenance of symptoms.

PMID: 19070989 [PubMed - as supplied by publisher]

 

Int Arch Occup Environ Health. 2008 Oct 25. [Epub ahead of print]

Specificity of the links between workplace harassment and PTSD: primary results using court decisions, a pilot study in France.

Bonafons C, Jehel L, Coroller-Béquet A.

Laboratoire d'éthique médicale, Université Paris Descartes, 75006, Paris, France, bonafons.claire@free.fr.

OBJECTIVES: France is one of the first countries to have passed specific legislation concerning "mental harassment" (In French the term used in the legislation is "harcèlement moral" referring to harassment or bullying leading to mental or psychological distress.) in the workplace. However, the definition of mental harassment at work remains fairly vague. It is, indeed, a complex issue, since no objective and precise consensual definition has been given so far. The objective of this study is to clarify the criteria that French judges consider as characteristic of mental harassment, and to check whether the specific links between mental harassment at work and PTSD pointed to in recent international studies have been taken into account. This study proposes the main lines for debate in countries that have not yet adopted legal clauses on mental harassment  at work. METHODS: Our study is based on a sample of 22 people who were legally recognised as having been mentally harassed at work; this sample is taken as representative of all court decisions passed on harassment and published as such  on the French Ministry of Justice website. RESULTS: To establish whether they were considering a case of harassment, the judges based their decisions on the nature of the accusations. In all cases (22/22), the charges brought against the  defendant had to do with offences against the employee's dignity. Five cases out  of 22 dealt with an offence infringing their rights, 10 cases out of 22 related to the employee's future within the company being compromised, while half of the  cases (11/22) concerned a deterioration in the person's health. In more than half of the cases, the judges also looked for other factors, such as repetition and duration of the period of harassment. Whenever the judges noted a deterioration in the victim's mental health, they also referred to medical certificates reporting anxio-depressive syndromes or psychological disorders without providing further detail. No PTSD-like symptomatology was mentioned among these cases, although several studies have shown that many victims of mental harassment at work have specific symptoms of PTSD. CONCLUSIONS: This study is the first study to be carried out on mental harassment at work and to refer to court decisions since the law was promulgated in France (2002). It appears that, in order to be recognised as a victim of mental harassment at work, numerous proofs of harassment or bullying need to be produced. It must have been repeated and have led to consequences in several domains. Several attestations and documents are required demonstrating clearly that harassment or bullying did indeed occur. Further to this, although to date judges have not considered PTSD to be an element contributing to the presumption of harassment, connections between bullying or harassment and clinical signs of PTSD have been attested by several studies that confirm that bullied victims can suffer from PTSD-like symptoms, although they do not necessarily match the strict DSM-IV criteria (absence of A1  criterion). It would seem advisable to request psychiatric examination in cases of harassment.

PMID: 18953560 [PubMed - as supplied by publisher]

 

Neuron. 2008 Oct 23;60(2):353-66.

Inducible and selective erasure of memories in the mouse brain via chemical-genetic manipulation.

Cao X, Wang H, Mei B, An S, Yin L, Wang LP, Tsien JZ.

Shanghai Institute of Brain Functional Genomics, Key Laboratory of Brain Functional Genomics, MOE & STCSM, East China Normal University, Shanghai, China.

Rapid and selective erasures of certain types of memories in the brain would be desirable under certain clinical circumstances. By employing an inducible and reversible chemical-genetic technique, we find that transient alphaCaMKII overexpression at the time of recall impairs the retrieval of both newly formed one-hour object recognition memory and fear memories, as well as 1-month-old fear memories. Systematic analyses suggest that excessive alphaCaMKII activity-induced recall deficits are not caused by disrupting the retrieval access to the stored information but are, rather, due to the active erasure of the stored memories. Further experiments show that the recall-induced erasure of fear memories is highly restricted to the memory being retrieved while leaving other memories intact. Therefore, our study reveals a molecular genetic paradigm through which a given memory, such as new or old fear memory, can be rapidly and specifically erased in a controlled and inducible manner in the brain.

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

PMID: 18957226 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Oct 22. [Epub ahead of print]

The Relationship Between Type of Trauma Exposure and Posttraumatic Stress Disorder Among Urban Children and Adolescents.

Luthra R, Abramovitz R, Greenberg R, Schoor A, Newcorn J, Schmeidler J, Levine P, Nomura Y, Chemtob CM.

Mount Sinai School of Medicine, New York.

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses  are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.

PMID: 18945918 [PubMed - as supplied by publisher]

 

J Psychiatr Res. 2008 Oct 22. [Epub ahead of print]

The impact of posttraumatic stress disorder on impairment in the UK military at the time of the Iraq war.

Rona RJ, Jones M, Iversen A, Hull L, Greenberg N, Fear NT, Hotopf M, Wessely S.

King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London SE1 9RJ, UK.

The aims of this study were to assess: (1) the relationship between PTSD and impairment, (2) whether there is a threshold in the association of PTSD score and impairment, and (3) whether any of the PTSD criteria are more strongly associated with impairment. We studied 10,069 service personnel from a representative sample of the British Armed Forces to assess the effects of the Iraq war. Participants completed the PTSD checklist (PCL), the general health questionnaire-12 (GHQ-12), the alcohol use disorder identification test (AUDIT) and five questions to assess impairment. 78% of those with a PCL-score of 50 or more endorsed at least one impairment item in comparison to 27% of those with a score below 50. The odds ratio (OR) of impairment in the PCL group with a score of 50 or more was 16.7 (95% CI 12.9-21.6). There was an increasing risk of impairment with an increasing category of PCL-score without a noticeable threshold. For each PTSD subscale: intrusiveness, avoidance/numbing and hyper-arousal, divided into four score categories, there was an increased association with impairment, but the association of avoidance/numbing with impairment was the greatest and independent of the other two criteria (OR 7.2 (95% CI 4.8-10.9). Having a good relationship with a partner had minimal effect on the level of association between PTSD and impairment. Functional impairment is a serious problem for those with PTSD. The impairment is not confined to those with the highest PCL-score. Avoidance/numbing is the criterion which makes the greatest independent contribution to impairment.

PMID: 18950801 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Oct 21. [Epub ahead of print]

Hypothalamus-Pituitary-Adrenal Axis Hyperresponsiveness Is Associated with Increased Social Avoidance Behavior in Social Phobia.

Roelofs K, van Peer J, Berretty E, Jong PD, Spinhoven P, Elzinga BM.

Clinical Psychology Unit, Leiden University Institute for Psychological Research, Leiden, The Netherlands.

BACKGROUND: Social avoidance and inhibition in animals is associated with hyperresponsiveness of the glucocorticoid stress-system. In humans, the relation  between glucocorticoid stress-reactivity and social avoidance behavior remains largely unexplored. We investigated whether increased cortisol stress-responsiveness is linked to increased social avoidance behavior in patients with social anxiety disorder (SAD). METHODS: Patients with SAD (n = 18)  as well as two control groups of healthy participants (n = 22) and patients with  posttraumatic stress disorder (PTSD; n = 17), respectively, performed a social approach-avoidance task (AA-task) in a baseline condition and in a social stress  condition (provided by the Trier Social Stress Test). The AA-task is a computerized reaction-time task measuring the speed of manual approach and avoidance responses to visually presented social threat cues (angry faces). Salivary cortisol, blood pressure, and subjective anxiety were assessed throughout the experiment. RESULTS: Patients with SAD showed larger cortisol responses to the social stress test, as compared with healthy and PTSD control subjects. Most crucially, these increased cortisol responses were significantly correlated to the increase in social avoidance behavior measured by the AA-task in the social stress condition in SAD. An additional regression analysis showed that the cortisol responses predicted the stress-induced increase in social avoidance tendencies over and above the effects of blood pressure and subjective  anxiety. CONCLUSIONS: These findings provide the first evidence for a direct link between increased cortisol stress-responsiveness and social avoidance behavior in patients with SAD. The results support animal models of social avoidance and inhibition and might have important treatment implications.

PMID: 18947821 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Oct 15;64(8):681-90. Epub 2008 Jul 17.

Functional activation and neural networks in women with posttraumatic stress disorder related to intimate partner violence.

Simmons AN, Paulus MP, Thorp SR, Matthews SC, Norman SB, Stein MB.

Department of Psychiatry, University of California San Diego, and VA San Diego Healthcare System, San Diego, California 92037, USA. ansimmons@ucsd.edu

BACKGROUND: Intimate partner violence (IPV) is one of the most common causes of posttraumatic stress disorder (PTSD) in women. Victims of IPV are often preoccupied by the anticipation of impending harm. This investigation tested the  hypothesis that IPV-related PTSD individuals show exaggerated insula reactivity to the anticipation of aversive stimuli. METHODS: Fifteen women with a history of IPV and consequent PTSD (IPV-PTSD) and 15 non-traumatized control (NTC) women performed a task involving cued anticipation to images of positive and negative events during functional magnetic resonance imaging. RESULTS: Both groups showed  increased activation of bilateral anterior insula during anticipation of negative images minus anticipation of positive images. Activation in right anterior/middle insula was significantly greater in the IPV-PTSD relative to the NTC group. Functional connectivity analysis revealed that changes in activation in right middle insula and bilateral anterior insula were more strongly associated with amygdala activation changes in NTC than in IPV-PTSD subjects. CONCLUSIONS: This study revealed increased activation in the anterior/middle insula during negative anticipation in women with IPV-related PTSD. These findings in women with IPV could be a consequence of the IPV exposure, reflect pre-existing differences in insular function, or be due to the development of PTSD. Thus, future longitudinal studies need to examine these possibilities.

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

PMID: 18639236 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2008 Oct 15;64(8):708-17. Epub 2008 Jul 17.

Early post-stressor intervention with high-dose corticosterone attenuates posttraumatic stress response in an animal model of posttraumatic stress disorder.

Cohen H, Matar MA, Buskila D, Kaplan Z, Zohar J.

Ministry of Health Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. hagitc@bgu.ac.il

BACKGROUND: The therapeutic value of corticosteroids in the aftermath of traumatic experience has been questioned. We used an animal model of posttraumatic stress disorder (PTSD) to assess long-term behavioral effects of a  single administration of various doses of corticosterone (CORT), administered immediately after exposure to psychogenic stress. METHODS: Animals were exposed to predator scent stress and treated 1 hour later with various doses of CORT or saline. The outcome measures included behavior in an elevated plus-maze (EPM) and acoustic startle response (ASR) 30 days after the initial exposure and freezing behavior upon exposure to a trauma-related cue on day 31. Pre-set cut-off behavioral criteria (CBC) classified exposed animals according to behavioral responses in EPM and ASR paradigms as those with "extreme behavioral response," "minimal behavioral response," or "intermediate response." Non-spatial memory task and 24-hour locomotor activity were assessed immediately after injection with CORT or vehicle. RESULTS: Early treatment with high-dose CORT reduced the prevalence of PTSD-like behavioral responses relative to saline-control treatment. Cue-induced freezing was significantly lower in the high-dose CORT-treated group. Lower doses of CORT significantly increased anxiety-like behavior, mean startle amplitude, and prevalence of PTSD-like behavioral disruptions, compared with saline-control treatment. The attenuated cue-responsiveness and impaired performance on a memory task imply that one key factor in this effect is the disruption of traumatic memory consolidation. CONCLUSIONS: Single treatment with high-dose CORT immediately after stressful exposure reduces the prevalence rate of extreme behavioral disruption 30 days later. Corticosterone might disrupt the consolidation of aversive or fearful memories.

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

PMID: 18635156 [PubMed - indexed for MEDLINE]

 

Acta Psychiatr Scand. 2008 Oct 14. [Epub ahead of print]

Memory and prefrontal functions in earthquake survivors: differences between current and past post-traumatic stress disorder patients.

Eren-Koçak E, Kılıç C, Aydın I, Hızlı FG.

Institute of Neurological Sciences and Psychiatry, Faculty of Medicine, Hacettepe University, Ankara.

Many studies reported deficits in cognitive functions in post-traumatic stress disorder (PTSD). Most were, however, conducted on man-made trauma survivors. The  high comorbidity of alcohol use and depression with PTSD in these studies further complicated the interpretation of their results. We compared prefrontal lobe functions and memory in three earthquake survivor groups: current PTSD, past PTSD and no PTSD. We hypothesized that prefrontal performances of the current and past PTSD groups would be worse than that of control group. Method: Survivors of the 1999 earthquakes in Turkey were evaluated for current and lifetime PTSD. Memory and prefrontal functions were assessed by a neuropsychological test battery. Results: Current PTSD patients performed worse on attention, verbal memory, verbal fluency, and psychomotor speed. Past PTSD group was similar to the controls on most cognitive measures, except for their vulnerability to proactive  interference and low performance in verbal fluency for animal names. Conclusion:  Our findings indicate that the prefrontal organization and monitorization of verbally processed information are defective in earthquake-related PTSD patients, more so in the current PTSD group.

PMID: 18853946 [PubMed - as supplied by publisher]

 

J Affect Disord. 2008 Oct 7. [Epub ahead of print]

Is tonic immobility the core sign among conventional peritraumatic signs and symptoms listed for PTSD?

Rocha-Rego V, Fiszman A, Portugal LC, Garcia Pereira M, de Oliveira L, Mendlowicz MV, Marques-Portella C, Berger W, Freire Coutinho ES, Mari JJ, Figueira I, Volchan E.

Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (IBCCF-UFRJ), Brazil.

BACKGROUND: Previous studies suggested the importance of peritraumatic reactions  as predictors of PSTD symptoms severity. Despite mounting evidence that tonic immobility occurs under intense life threats its role as predictor of PTSD severity remains by and large understudied. The objective of this study was to investigate the role of peritraumatic reactions (tonic immobility, panic and dissociation) as predictors of PTSD symptoms severity. METHODS: Participants were 32 victims of urban violence with PTSD diagnosed through the SCID-I. In order to  evaluate PTSD symptoms at baseline, we used the Post-Traumatic Stress Disorder Checklist - Civilian Version. To assess peritraumatic reactions we employed the Physical Reactions Scale, the Peritraumatic Dissociative Experiences Questionnaire and Tonic Immobility questions. As confounding variables, we considered negative affect (measured by the Positive and Negative Affect Schedule - Trait Version), sex and time elapsed since trauma. RESULTS: Tonic immobility was the only predictor of PTSD symptoms severity that kept the statistical significance after controlling for potential confounders. LIMITATIONS: This study was based on a relatively small sample recruited in a tertiary clinic, a fact that may limit the generalizability of its findings. The retrospective design may have predisposed to recall bias. CONCLUSIONS: Our study provides good reason to conduct more research on tonic immobility in PTSD with other samples and with different time frames in an attempt to replicate these stimulating results.

PMID: 18845342 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Oct 6. [Epub ahead of print]

Hippocampal N-acetylaspartate Levels Before Trauma Predict the Development of Long-Lasting Posttraumatic Stress Disorder-like Symptoms in Mice.

Siegmund A, Kaltwasser SF, Holsboer F, Czisch M, Wotjak CT.

Max Planck Institute of Psychiatry, Munich, Germany.

BACKGROUND: Only a certain proportion of individuals develop posttraumatic stress disorder (PTSD) in the aftermath of a trauma. Biomarkers of individual susceptibility are not yet known but would enable selected primary and secondary  prevention of PTSD. METHODS: Hippocampal N-acetylaspartate (NAA) levels were assessed by proton magnetic resonance spectroscopy ((1)H-MRS) in C57BL/6N mice prior to the perception of a 1.5 mA electric footshock. Associative (freezing to  trauma context) and nonassociative (freezing to a neutral tone; i.e., hyperarousal) symptoms of PTSD-like fear were assessed 4, 5, 18, and 32 weeks after trauma. RESULTS: Low NAA levels in the left dorsal hippocampus predicted persistent PTSD-like symptoms (both contextual freezing and hyperarousal), while  animals with pretraumatic high levels of NAA decreased their fear reactions to control levels in consequence of re-exposure to associative and nonassociative cues. N-AA levels in the right dorsal hippocampus, in contrast, were only partially predictive of the individual susceptibility to develop PTSD-like symptoms. CONCLUSIONS: Left hippocampal NAA levels might be a predictor of an increased susceptibility to develop PTSD after trauma.

PMID: 18842254 [PubMed - as supplied by publisher]

 

Soc Psychiatry Psychiatr Epidemiol. 2008 Oct 4. [Epub ahead of print]

Posttraumatic stress disorder six months after an earthquake : Findings from a community sample in a rural region in Italy.

Priebe S, Grappasonni I, Mari M, Dewey M, Petrelli F, Costa A.

Unit for Social and Community Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health,  London, E13 8SP, UK, s.priebe@qmul.ac.uk.

BACKGROUND AND AIMS: Various studies assessed rates of post-traumatic stress disorder (PTSD) following natural disasters including earthquakes. Yet, samples were often non-representative or small or both. This study aims to assess the prevalence of PTSD and predictors of PTSD 6 months after an earthquake in a rural region of Italy. METHODS: A questionnaire was handed out to a representative sample of approximate 3,000 people in the region of Molise in Italy 6 months after an earthquake in October/November 2002. The questionnaire assessed socio-demographic characteristics, aspects of the event, the experience of symptoms immediately after the earthquake, and symptoms of PTSD. RESULTS: Questionnaires of 2,148 people were returned, representing a response rate of 73.7%. The final analysis was based on 1,680 people. The screening tool provided  a PTSD prevalence rate of 14.5%. Male gender, age under 55 years, and better school education predicted lower rates of PTSD. More variance was explained when  psychological symptoms of immediately after the event were also included as predictors. CONCLUSION: The findings on predictors are consistent with the literature. Whilst personal characteristics explain only a small variance of PTSD six months after the event, early psychological distress allows a better prediction of who is likely to have PTSD 6 months later.

PMID: 18836882 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2008 Oct 2. [Epub ahead of print]

The DRD2 gene 957C>T polymorphism is associated with posttraumatic stress disorder in war veterans.

Voisey J, Swagell CD, Hughes IP, Morris CP, van Daal A, Noble EP, Kann B, Heslop  KA, Young RM, Lawford BR.

Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.

Background: Variations in genes related to the dopaminergic pathway have been implicated in neuropsychiatric disorders such as schizophrenia, substance misuse, Alzheimer's disease and Post Traumatic Stress Disorder (PTSD). A single nucleotide polymorphism (SNP) (957C>T) and a deletion polymorphism (-141delC) in  the DRD2 gene and a SNP (Taq1A) in a gene directly downstream of DRD2 have all been implicated in dopamine functioning in the brain. Methods: To test the importance of these three polymorphisms in PTSD susceptibility, a genetic screen  was performed in 127 war veterans diagnosed with PTSD and 228 control individuals without a history of PTSD. Results: No significant association was found between  PTSD and the Taq1A or -141delC polymorphisms. However, a significant association  was observed with PTSD and the 957C>T polymorphism. PTSD individuals were more likely to carry the C allele compared to the controls (P=0.021). Conclusions: Our findings suggest that the 957C>T polymorphism in the DRD2 gene is one of the genetic factors for susceptibility to PTSD. Depression Anxiety 0:1-6, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 18833581 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Oct 2. [Epub ahead of print]

PTSD symptoms in response to traumatic and non-traumatic events: The role of respondent perception and A2 criterion.

Boals A, Schuettler D.

University of North Texas, Denton, TX 76203, United States.

The current study attempted to replicate the unexpected findings by Gold, Marx, Soler-Baillo, and Sloan [Gold, S. D., Marx, B. P., Soler-Baillo, J. M., & Sloan,  D. M. (2005). Is life stress more traumatic than traumatic stress? Journal of Anxiety Disorders, 19, 687-698] that non-traumatic events were associated with greater levels of PTSD symptoms than traumatic events. The current study had two  notable methodological differences. First, we included A2 trauma criteria (a response of intense fear, helplessness, or horror) in addition to A1 trauma criteria (the event is life-threatening) in defining traumatic events. Second, A1 and A2 trauma criteria were based on participants' ratings, as opposed to classification by coders. Using this alternative methodology, results obtained were opposite of Gold et al. PTSD symptoms were greater for DSM-defined traumatic events in comparison to non-traumatic events. In addition, A1 trauma criterion had little to no relationship to PTSD symptoms when A2 criterion was considered.  These results call into question the role of A1 trauma criterion and the definition of traumatic events.

PMID: 19013754 [PubMed - as supplied by publisher]

 

Acta Psychiatr Scand. 2008 Oct;118(4):281-90. Epub 2008 Aug 27.

Amygdala and hippocampal volumes and cognition in adult survivors of childhood abuse with dissociative disorders.

Weniger G, Lange C, Sachsse U, Irle E.

Department of Social and General Psychiatry, University of Zürich, Zürich, Switzerland.

OBJECTIVE: Trauma-exposed individuals with post-traumatic stress disorder (PTSD)  display reduced amygdala and hippocampal size and impaired cognition. However, studies on trauma-exposed individuals with dissociative amnesia (DA) or dissociative identity disorder (DID) are lacking. METHOD: Twenty-three young women who had experienced severe childhood sexual/physical abuse, diagnosed with  DA/DID or PTSD, and 25 healthy control subjects were subjected to 3D structural magnetic resonance imaging of amygdala and hippocampus and a clinical and neuropsychological investigation. RESULTS: Compared with controls, trauma-exposed subjects with PTSD (n = 10) displayed significantly reduced amygdala and hippocampal size and significantly impaired cognition. By contrast, trauma-exposed subjects with DA or DID (n = 13) displayed normal amygdala and hippocampal size and normal cognition. CONCLUSION: We report for the first time volumetric results in subjects with DA/DID without PTSD as comorbid diagnosis. Our results indicate preserved amygdala and hippocampal size and preserved cognition in subjects with these disorders.

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

PMID: 18759808 [PubMed - indexed for MEDLINE]

 

Adv Neonatal Care. 2008 Oct;8(5):276-84.

Assessing the feasibility and acceptability of an intervention to reduce anxiety  and enhance sensitivity among mothers of very low birth-weight infants.

Feeley N, Zelkowitz P, Charbonneau L, Cormier C, Lacroix A, Marie CS, Papageorgiou A.

1Sir Mortimer B. Davis Jewish General Hospital; 2McGill University; 3GRISIM (Groupe de recherche interuniversitaire en soins infirmiers de Montréal); 4Charles Lemoinge Hospital; and 5St Justine's Hospital, Montreal, Quebec, Canada.

PURPOSE: A pilot study was conducted to assess the feasibility and acceptability  of an intervention program for mothers of very low birth-weight infants in the neonatal intensive care unit (NICU). SUBJECTS: Thirty-three mothers of infants born weighing less than 1500 g. DESIGN: A single-group, pretest-posttest design was used. METHODS: Preintervention mothers completed self-report questionnaires and their interaction with their infant was observed. Mothers then received the intervention program. Mothers were assessed twice postintervention, first when the infant was 1/2 months old and again at 6 months. At the postintervention assessments, mothers completed the same questionnaires and interaction was observed. MAIN OUTCOME MEASURES: Mothers completed the State-Trait Anxiety Inventory, the revised Parental Stress Scale: Neonatal Intensive Care Unit, the NICU Parental Beliefs Scale, and the Perinatal PTSD Questionnaire. Interactions between mothers and infants were rated by trained research staff using the Index  of Parental Behaviour in the NICU. Postintervention mothers also responded to a questionnaire that assessed their perceptions of the intervention program. RESULTS: It was feasible to enroll mothers because 62% of eligible mothers agreed to participate. However, 39% of mothers who enrolled withdrew. Most of the mothers who withdrew did so before even beginning the intervention, and many of these women were mothers of multiples. It was also feasible to provide the intervention because more than 80% of mothers who began the intervention received all 6 teaching sessions. Mothers found both the content and the format of the program to be acceptable. There were nonetheless several challenges in conducting an intervention study with mothers early in the NICU hospitalization. CONCLUSIONS: The results of this pilot study are encouraging. It was found to be  both feasible and acceptable to provide the intervention program to mothers during the NICU hospitalization. The effectiveness of this program needs to be assessed in a randomized controlled trial.

PMID: 18827517 [PubMed - in process]

 

Am J Geriatr Psychiatry. 2008 Oct;16(10):804-12.

Pharmacotherapy for older veterans diagnosed with posttraumatic stress disorder in Veterans Administration.

Mohamed S, Rosenheck R.

New England Mental Illness, Research, Education and Clinical Center, Department of Psychiatry, Yale Medical School, West Haven, CT 06516, USA. somaia.mohamed@yale.edu

OBJECTIVES: Despite increasing numbers of older veterans diagnosed with posttraumatic stress disorder (PTSD) in veterans administration (VA), limited research has focused on pharmacotherapy of PTSD among the elderly. DESIGN: The authors examined pharmacotherapy provided to patients carrying a clinical diagnosis of PTSD in VA. SETTING: Data on outpatients treated at VA nationally were utilized. PARTICIPANTS: Patients were veterans over 45 years of age diagnosed with PTSD in FY 2004 (N = 244,947) grouped into five age cohorts with patients 45-55 as the reference group. MEASURES: Psychotropic prescriptions were  examined. Descriptive statistics and multivariable logistic regression adjusting  for confounding characteristics, including receipt of VA service connected disability benefits which may create incentives to artificially maintain historical diagnoses, were used to identify the relationship of age to receipt of psychotropic medications net of these factors. All analyses were repeated using data only from nonservice connected veterans. RESULTS: Most older veterans received psychotropic medication and among these, 88.3% were prescribed antidepressants, 61.2% anxiolytics/sedative hypnotics, and 32.9% antipsychotics.  A pronounced monotonic trend showed decrease use of any psychotropic medication and of each subclass with age. Medication use was higher among those treated in specialty mental health clinics than among those treated exclusively in primary care or medical clinics and interaction analysis of age by clinic type showed significantly more steeply declining use of medications with age among patients treated in specialty mental health clinics. Data from nonservice connected veterans revealed the same patterns. CONCLUSION: Diverse psychotropic medication  classes are used to treat veterans diagnosed with PTSD in VA with declining use among older veterans. Medication utilization is greater in mental health clinics  but declined more steeply with age, perhaps reflecting the greater sensitivity of specialists to the risks of elderly veterans. Older veterans diagnosed with PTSD  appear to receive conservative, cautious treatment although observed patterns of  care may reflect some degree of undertreatment.

PMID: 18827226 [PubMed - in process]

 

Am J Geriatr Psychiatry. 2008 Oct;16(10):853-6. Epub 2008 May 12.

Trauma exposure and posttraumatic stress disorder in the elderly: a community prevalence study.

Creamer M, Parslow R.

Department of Psychiatry, University of Melbourne, Australian Centre for Posttraumatic Mental Health, Heidelberg, Victoria, Australia. markcc@unimelb.edu.au

OBJECTIVE: Little prevalence data exist on trauma exposure and posttraumatic stress disorder (PTSD) in the elderly. The authors examined lifetime exposure to  trauma and 12-month PTSD in a large community sample. METHOD: Data were drawn from the Australian National Survey of Mental Health. Of the total 10,641 participants, 1,792 were over the age of 65. The Composite International Diagnostic Interview provided trauma exposure and diagnostic status. RESULTS: A curvilinear pattern of lifetime exposure to trauma across the lifespan was obtained for women, whereas men showed a linear increase. This difference was explained by combat exposure. PTSD prevalence reduced with age and participants over 65 reported negligible rates. Around 10% of the elderly reported reexperiencing symptoms. CONCLUSIONS: PTSD rates are lower in older age cohorts,  although reasons for this are unclear. With 10% reporting reexperiencing symptoms associated with past events, however, greater awareness of treatments that target traumatic memories may be beneficial.

PMID: 18474685 [PubMed - in process]

 

Am J Ind Med. 2008 Oct;51(10):758-68.

Shift-work and suicide ideation among police officers.

Violanti JM, Charles LE, Hartley TA, Mnatsakanova A, Andrew ME, Fekedulegn D, Vila B, Burchfiel CM.

Department of Social & Preventive Medicine, School of Public Health & Health Professions, State University of NY at Buffalo, Buffalo, New York.

BACKGROUND: This cross-sectional study assessed the association of shift work with suicide ideation among police officers. METHODS: Shift work was based on daily payroll records over 5 years (41 women, 70 men). Standardized psychological measures were employed. ANOVA and Poisson regression were used to evaluate associations. RESULTS: Among policewomen with increased depressive symptoms, prevalence of suicide ideation increased by 116% for every 10-unit increase in percentage of hours worked on day shift (prevalence ratio (PR) = 2.16; 95% confidence interval (CI) = 1.22-3.71). Among policemen with higher (but not lower) posttraumatic stress disorder (PTSD) symptoms, prevalence of suicide ideation increased by 13% with every 10-unit increase in the percentage of hours  worked on afternoon shift (PR = 1.13; 95% CI = 1.00-1.22). CONCLUSION: Prevalence of suicide ideation significantly increased among policewomen with higher depressive symptoms and increasing day shift hours, and among policemen with higher PTSD symptoms with increasing afternoon shift hours. Published 2008 Wiley-Liss, Inc.

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

PMID: 18704914 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Oct;165(10):1237-9.

Comment on:     Am J Psychiatry. 2008 Oct;165(10):1326-37.

Developmental considerations for diagnosing PTSD and acute stress disorder in preschool and school-age children.

Scheeringa MS.

Publication Types:      Comment     Editorial

PMID: 18829877 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Oct;165(10):1326-37. Epub 2008 Aug 1.

Comment in:     Am J Psychiatry. 2008 Oct;165(10):1237-9.

The posttraumatic stress disorder diagnosis in preschool- and elementary school-age children exposed to motor vehicle accidents.

Meiser-Stedman R, Smith P, Glucksman E, Yule W, Dalgleish T.

Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE58AF, UK. r.meiser-stedman@iop.kcl.ac.uk

OBJECTIVE: Increasingly, children are being diagnosed with psychiatric disorders, including preschool-age children. These diagnoses in young children raise questions pertaining to 1) how diagnostic algorithms for individual disorders should be modified for young age groups, 2) how psychopathology is best detected  at an early stage, and 3) how to make use of multiple informants. The authors examined these issues in a prospective longitudinal assessment of preschool- and  elementary school-age children who were exposed to a traumatic event. METHOD: Participants were 114 children (age range: 2-10 years) who had experienced a motor vehicle accident. Parents and older children (age range: 7-10 years) completed structured interviews 2-4 weeks (initial assessment) and 6 months (6-month follow-up) after the traumatic event. A recently proposed alternative symptom algorithm for diagnosing posttraumatic stress disorder (PTSD) was utilized and compared with the standard DSM-IV algorithms for diagnosing PTSD and acute stress disorder. RESULTS: At the 2- to 4-week assessment, 11.5% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria per parent report, and 13.9% met criteria for this diagnosis at the 6-month follow-up. These percentages were much higher than those for DSM-IV diagnoses of acute stress disorder and PTSD. Among 7- to 10-year-old subjects, the use of combined parent- and child-reported symptoms to derive a diagnosis resulted in an increased number of children in this age group who were  identified with psychiatric illness relative to the use of parent report alone. Agreement between parent and child on symptoms for 1) a diagnosis of PTSD based on the alternative algorithm criteria and 2) diagnoses of DSM-IV acute stress disorder and PTSD in this age group was poor. Among 2- to 6-year-old subjects, the alternative algorithm PTSD diagnosis per parent report was a more sensitive predictor of later onset psychopathology relative to a diagnosis of DSM-IV acute  stress disorder or PTSD per parent report. However, among 7- to 10-year-old subjects, a combined symptom report (from both parent and child) was optimal in predicting posttraumatic psychopathology. CONCLUSIONS: These findings support the use of the proposed alternative algorithm for assessing PTSD in young children and suggest that the diagnosis of PTSD based on the alternative algorithm criteria is stable from the acute phase onward. When both parent- and child-reported symptoms are utilized for the assessment of PTSD among 7- to 10-year-old children, the alternative algorithm and DSM-IV criteria have broad comparable validity. However, in the absence of child-reported symptoms, the alternative algorithm criteria per parent report appears to be an optimal diagnostic measure of PTSD among children in this age group, relative to the standard DSM-IV algorithm for diagnosing the disorder.

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

PMID: 18676592 [PubMed - indexed for MEDLINE]

 

Ann N Y Acad Sci. 2008 Oct;1141:148-62.

An update on substance use and treatment following traumatic brain injury.

Graham DP, Cardon AL.

Houston Center for Quality of Care and Utilization Studies, Health Services Research, Houston, TX 77030, USA. david.graham@med.va.gov

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity among  young adults. Substance abusers constitute a disproportionate percentage of these patients. A history of substance abuse predicts increased disability, poorer prognosis, and delayed recovery. While consensus in the literature indicates that substance-abuse rates decline following injury, conflicting literature shows a significant history of brain injury in addicts. We reviewed the literature on substance abuse after TBI to explore the state of knowledge on TBI as a risk factor for substance abuse. While recent reviews regarding substance abuse in TBI patients concur that substance-abuse rates decline even after mild TBI, an emerging literature suggests mild TBI may cause subtle impairments in cognitive,  executive, and decision-making functions that are often poorly recognized in early diagnosis and treatment. When combined with difficulties in psychosocial adjustment and coping skills, these impairments may increase the risk for chronic substance abuse in a subset of TBI patients. Preliminary results from veterans indicate these patterns hold in a combat-related post-traumatic stress disorder population with TBI. This increasingly prevalent combination presents a specific  challenge in rehabilitation. While this comorbidity presents a challenge for the  successful treatment and rehabilitation of both disorders, there is sparse evidence to recommend any specific treatment strategy for these individuals. Mild TBI and substance abuse are bidirectionally related both for risks and treatment. Further understanding the neuropsychiatric pathology and different effects of different types of injuries will likely improve the implementation of effective treatments for each of these two conditions.

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

PMID: 18991956 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Oct;21(4):337-58.

Dispositional and situational coping and mental health among Palestinian political ex-prisoners.

Punamaki RL, Salo J, Komproe I, Qouta S, El-Masri M, De Jong JT.

Department of Psychology, University of Tampere, Finland. raija-leena.punamaki@uta.fi

We examined, first, differences in dispositional and situational coping, and psychological distress between political ex-prisoners and their matched controls, and second, coping effectiveness in protecting mental health from impacts of imprisonment and military trauma. Thirdly, we tested the hypothesis that compatibility ("goodness of fit") between dispositional and situational coping would predict low psychological distress. Participants were 184 men recruited from a Palestinian community sample, 92 were former political prisoners and 92 non-prisoners. The dispositional coping was assessed as a general response style  to hypothetical stressors and situational coping as responses to their own traumatic experiences. Psychological distress was measured by SCL-90-R, and posttraumatic stress disorder, depression and somatoform symptoms by scales based on CIDI 2.1 diagnostic interview. The results showed that, compared to non-prisoners, the political ex-prisoners employed less avoidant, denying, and emotion-focused coping strategies. Military trauma was associated with avoidant and denying coping only among non-prisoners. The ex-prisoners showed more mental  health and medical problems, especially when exposed to military trauma. None of  the coping styles or strategies were effective in protecting the mental health in general or in either groups. However, main effect results revealed that the high  level of active and constructive and low level of emotion-focused coping were associated with low levels of psychiatric symptoms and psychological distress.

PMID: 18686054 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Oct;21(4):325-35.

Parental support, family conflict, and overprotectiveness: predicting PTSD symptom levels of adolescents 28 months after a natural disaster.

Bokszczanin A.

Department of Psychology, Opole University, Poland. Anna.Bokszczanin@uni.opole.pl

The purpose of this study was to evaluate the role of family factors as predictors of posttraumatic stress disorder (PTSD) symptoms among adolescents, a  substantial period of time after a natural disaster. It was hypothesized that a lack of parental support, family conflict, and overprotectiveness are all risk factors with regard to levels of PTSD symptoms. A group of 533 schoolchildren and high-school students was investigated 28 months after a huge flood, which was one of the most devastating disasters in Poland. The results of a hierarchical regression analysis indicate that the extent of traumatic exposure, parental support, family conflict, and overprotectiveness, all predicted levels of PTSD symptoms in the group investigated. Furthermore, parental overprotectiveness moderated the effect of trauma, thus augmenting the impact of stress experienced  during the disaster on the level of PTSD symptoms. The findings suggest that excessive parental control and infantilization of children for a long time after  a disaster are harmful for adolescents' health and could be an obstacle in the recovery process. The results highlight the importance of studying parental ways  of coping in order to predict how adolescents cope with a traumatic event.

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

PMID: 18686053 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Oct;21(4):377-86.

Factors associated with traumatic symptoms and internalizing problems among adolescents who experienced a traumatic event.

Maja Deković, Koning IM, Stams GJ, Buist KL.

Department of Child and Adolescent Studies, Utrecht University, The Netherlands.  M.Dekovic@fss.uu.nl

The aim of the present study was to identify factors that are related to the traumatic symptoms and problem behavior among adolescents who experienced the New Years fire in 2001 in Volendam, The Netherlands. Three groups of factors were considered: pre-trauma (personality and coping), trauma-related (physical and emotional proximity to disaster), and post-trauma factors (received social support). Forty-five adolescents completed the questionnaire. Two years after the disaster, these adolescents experienced significant traumatic stress reaction (70% within the clinical range) and showed clinically significant levels of internalizing problems (37%). Pre-trauma, individual factors were identified as the most important predictors of distress, followed by received social support. The indicators of physical and emotional proximity to disaster explained little variance in distress.

PMID: 18608136 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2008 Oct;65(10):1205-12.

Estimating clinically relevant mental disorders in a rural and an urban setting in postconflict Timor Leste.

Silove D, Bateman CR, Brooks RT, Fonseca CA, Steel Z, Rodger J, Soosay I, Fox G,  Patel V, Bauman A.

Centre for Population Mental Health Research, Sydney South West Area Health Service and School of Psychiatry, The University of New South Wales, Australia. d.silove@unsw.edu.au

CONTEXT: Epidemiologic studies undertaken in postconflict countries have focused  primarily on trauma-related disorders. There is a need to include disabling psychotic disorders in order to plan clinical services in these settings. OBJECTIVES: To estimate the prevalence of key clinical disorders in Timor Leste (East Timor), and to assess cultural factors that may influence help-seeking patterns. DESIGN, SETTING, PARTICIPANTS: A 2-phase total population survey of 1544 adults in an urban and a rural area of Timor Leste. Phase 1 involved a household informant survey using indigenous terms to detect psychosis and a screen of all adults for posttraumatic stress disorder (PTSD) and symptoms of psychologic distress, including depression and anxiety. In phase 2, clinicians interviewed all those identified by household informants and half of those who screened positive in order to assign DSM-IV diagnoses. Disability, explanatory models, and perceived needs were also assessed. MAIN OUTCOME MEASURES: Phase 1: Demographic characteristics; trauma events and PTSD (Harvard Trauma Questionnaire); psychologic distress (Kessler-10 scale). Phase 2: Structured Clinical Interview for relevant DSM-IV diagnoses; the Global Assessment of Functioning Scale and the World Health Organization Disability Assessment Scales; and the modified Short Explanatory Model Interview. RESULTS: The household informant method in phase 1 detected mainly psychotic disorders, and the screen method detected PTSD and depression. Phase 2 yielded a DSM-IV point prevalence estimate of 5.1% (including psychosis, 1.35%; and PTSD, 1.47%). Psychotic disorders were most disabling, primarily attributed to supernatural causes and treated mainly by traditional healers. Those with depression and PTSD experienced substantial disability but had received little treatment. They attributed their mental problems to social and traumatic causes. CONCLUSIONS: Our 2-phase method proved effective for identifying the range of disorders relevant to planning clinical services in postconflict developing countries. The unmet needs of the mentally ill in countries such as Timor Leste pose a major challenge to psychiatry.

Publication Types:      Case Reports     Comparative Study

PMID: 18838637 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2008 Oct;46(10):1181-6. Epub 2008 Jun 27.

The self-concept of traumatized children and adolescents with or without PTSD.

Saigh PA, Yasik AE, Oberfield R, Halamandaris PV.

Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA. ps2121@columbia.edu

This study compared the Piers-Harris 2 scores of youth with PTSD (n=30) to the scores of traumatized youth without PTSD (n=60) and a non-traumatized comparison  group (n=39). In the absence of major comorbid disorders, youth with PTSD evidenced significantly lower scores than the traumatized PTSD negatives and controls on five of six Piers-Harris 2 scales. With the exception of scores on an index of perceived parental acceptance of child behavior, trauma exposure in the  absence of PTSD was not associated with lower Piers-Harris 2 scores.

PMID: 18707677 [PubMed - in process]

 

Biol Psychol. 2008 Oct;79(2):223-33. Epub 2008 Jun 10.

An event-related potential study of attention deficits in posttraumatic stress disorder during auditory and visual Go/NoGo continuous performance tasks.

Shucard JL, McCabe DC, Szymanski H.

Division of Cognitive and Behavioral Neurosciences, Department of Neurology/The Jacobs Neurological Institute, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA. shucard@buffalo.edu

Posttraumatic stress disorder (PTSD) is characterized by disturbances in attention, such as increased arousal and hypervigilance. This study examined the  event-related potential (ERP) P3 component to target detection (Go), response inhibition (NoGo) and irrelevant nontarget stimuli during auditory and visual A-X continuous performance tasks. NoGo N2 amplitude effects were also analyzed. Participants were 23 Vietnam veterans with PTSD and 13 civilian controls. No group differences were present for N2 or P3 amplitude to Go and NoGo stimuli. The PTSD group, however, had longer P3 latency to NoGo stimuli than controls, regardless of modality. The PTSD group also had greater frontal P3 amplitude to irrelevant nontarget stimuli than controls. Significant P3 amplitude and latency  findings were associated with higher hyperarousal and reexperiencing scores from  the Clinician-Administered PTSD Scale. The findings suggest that attentional problems in PTSD are related to slowed central processing when response inhibition is required, and to an impaired ability to screen irrelevant information. This study provides further evidence that the attentional impairments in PTSD are not confined to trauma-related stimuli. Heightened arousal appears to enhance the attentional dysregulation seen in PTSD.

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

PMID: 18590795 [PubMed - in process]

 

Brain Behav Immun. 2008 Oct;22(7):1108-14. Epub 2008 Jun 17.

Reducing post-traumatic anxiety by immunization.

Lewitus GM, Cohen H, Schwartz M.

Department of Neurobiology, The Weizmann Institute of Science, Rehovot 76100, Israel.

Trafficking of T lymphocytes to specific organs, such as the skin and lungs, is part of the body's defense mechanism following acute psychological stress. Here we demonstrate that T lymphocytes are also trafficking to the brain in response to psychological stress and are needed to alleviate its negative behavioral consequences. We show that short exposure of mice to a stressor (predator odor) enhanced T-cell infiltration to the brain, especially to the choroid plexus, and  that this infiltration was associated with increased ICAM-1 expression by choroid plexus cells. Systemic administration of corticosterone could mimic the effects of psychological stress on ICAM-1 expression. Furthermore, we found that the ability to cope with this stress is interrelated with T-cell trafficking and with the brain and hippocampal BDNF levels. Immunization with a CNS-related peptide reduced the stress-induced anxiety and the acoustic startle response, and restored levels of BDNF, shown to be important for stress resilience. These results identified T cells as novel players in coping with psychological stress,  and offers immunization with a myelin-related peptide as a new therapeutic approach to alleviate chronic consequences of acute psychological trauma, such as those found in posttraumatic stress disorder.

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

PMID: 18562161 [PubMed - indexed for MEDLINE]

 

CNS Neurosci Ther. 2008 Fall;14(3):171-81.

Post-traumatic stress disorder in Canada.

Van Ameringen M, Mancini C, Patterson B, Boyle MH.

Anxiety Disorders Clinic, McMaster University Medical Centre, Department of Psychiatry and Behavioural Neurociences, McMaster University, Hamilton, Ontario,  Canada. vanamer@mcmaster.ca

Post-traumatic stress disorder (PTSD) has become a global health issue, with prevalence rates ranging from 1.3% to 37.4%. As there is little current data on PTSD in Canada, an epidemiological study was conducted examining PTSD and related comorbid conditions. Modified versions of the Composite International Diagnostic  Interview (CIDI) PTSD module, the depression, alcohol and substance abuse sections of the Mini International Neuropsychiatric Interview (MINI), as well as  portions of the Childhood Trauma Questionnaire (CTQ) were combined, and administered via telephone interview in English or French. Random digit dialing was used to obtain a nationally representative sample of 2991, aged 18 years and  above from across Canada. The prevalence rate of lifetime PTSD in Canada was estimated to be 9.2%, with a rate of current (1-month) PTSD of 2.4%. Traumatic exposure to at least one event sufficient to cause PTSD was reported by 76.1% of  respondents. The most common forms of trauma resulting in PTSD included unexpected death of a loved one, sexual assault, and seeing someone badly injured or killed. In respondents meeting criteria for PTSD, the symptoms were chronic in nature, and associated with significant impairment and high rates of comorbidity. PTSD is a common psychiatric disorder in Canada. The results are surprising, given the comparably low rates of violent crime, a small military and few natural disasters. Potential implications of these findings are discussed.

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

PMID: 18801110 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2008 Oct;13(10):872-80.

Challenges in the Implementation of Manualized Psychotherapy in Combat-Related PTSD.

Linden M, Golier J.

The Mount Sinai School of Medicine, New York, NY, USA.

PMID: 18955942 [PubMed - in process]

 

Community Ment Health J. 2008 Oct;44(5):367-76. Epub 2008 May 1.

Client-level measures of services integration among chronically homeless adults.

Mares AS, Greenberg GA, Rosenheck RA.

College of Social Work, The Ohio State University, Columbus, OH 43210, USA. mares.2@osu.edu

INTRODUCTION: While several major studies have examined services integration at the system or interagency level, there has been far less effort to measure the integration of services at the client-level and its correlates. METHODS: This study presents three client-level measures of services integration, two objective measures, representing the proportion of needed services received and the number  of outpatient services received by each client, and one subjective measure, a five-item scale measuring perceived coordination of care among clients' service providers. Data from the evaluation of the collaborative initiative to help end chronic homelessness (CICH) are used to examine bivariate and multivariate relationships of these three client-level measures to two system-level measures of services integration, one addressing interagency services coordination/planning and the other interagency trust/respect as well as to baseline client characteristics among 734 chronically homeless adults in 11 cities. RESULTS: Client-level measures of service integration were not strongly associated to each other or to the system-level measures, except for weak associations (r = 0.10) between one objective client measure and the system-level measure of service coordination and planning, and another between client-level use of outpatient mental health services and system-level trust and respect. Multivariate analysis showed that clients who received a greater array of needed  services received more service overall and were more likely to have a diagnosis of PTSD and more medical problems, but less serious alcohol problems. Clients who reported more outpatient mental health and substance abuse visits were significantly more likely to be married, to be veterans, to have more serious drug problems, and to be dually diagnosed. Clients with more serious drug problems reported poorer coordination among their service providers on the subjective measure of client-level service integration. CONCLUSION: Three client-level measures of services integration were, at best, weakly associated with measures of system-level integration. Positive associations between client-level measures of integration and health status, outpatient service use and negative relationships with indicators of substance abuse suggest they may usefully represent the experiences of chronically homeless clients, even though they are not strongly related to system-level measures.

PMID: 18449640 [PubMed - in process]

 

Crit Care Clin. 2008 Oct;24(4):875-87, ix-x.

Posttraumatic stress disorder following critical illness.

Kross EK, Gries CJ, Curtis JR.

Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, School of Medicine, University of Washington, Seattle, WA 98104-2499, USA.

Posttraumatic stress disorder (PTSD) is a common psychiatric condition that can occur after a traumatic event. Individuals exposed to traumatic events are at risk for PTSD and other psychologic morbidity, such as depression, panic disorder, generalized anxiety disorder, and substance abuse. The burden of PTSD can be high, with inability to work or return to prior levels of functioning. Emerging literature suggests a significantly increased risk for symptoms of PTSD  among survivors of critical illness and the families of patients who survive or die after critical illness. This review summarizes these studies and provides suggestions for current clinical implications and for future research.

Publication Types:      Review

PMID: 18929945 [PubMed - indexed for MEDLINE]

 

Crit Care Med. 2008 Oct;36(10):2945-6.

Comment on:     Crit Care Med. 2008 Oct;36(10):2801-9.

The intensive care experience: what really matters?

Griffiths RD.

Publication Types:      Comment     Editorial

PMID: 18812804 [PubMed - indexed for MEDLINE]

 

Crit Care Med. 2008 Oct;36(10):2801-9.

Comment in:     Crit Care Med. 2008 Oct;36(10):2945-6.

Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis.

Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, Costa-Pereira A; JMIP Study Group.

Collaborators: Amaro A, Gomes E, Paixão AI, Esteves F, Amaro P, Coutinho P, Silva E, Moniz I, Vaz J, Ribeiro O, Pereira AC.

Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. cristina.granja@hph.min-saude.pt

OBJECTIVE: To assess the factual and delusional memories reported by intensive care unit survivors and its relationship with the development of Posttraumatic Stress Syndrome (PTSS). DESIGN: Multicenter observational cohort study. SETTING:  Nine Portuguese intensive care units, as part of a multicenter study. METHODS AND PATIENTS: Between January and June 2005, 1,174 patients were admitted across the  nine intensive care units. Two hundred thirty-nine patients were excluded, 14 with < 18 yrs old and 225 with a length of intensive care stay < or = 48 hrs. Thus a total of 935 patients were included in the study. One hundred ninety (20%) patients died in the intensive care unit, 90 (12%) patients died on the ward (30% in-hospital mortality rate), and another 56 (9%) died in the next 6 months after  intensive care unit discharge. RESULTS: From the 599 survivors at 6 months, 313 patients answered the questionnaires (52% response rate). From the 313 respondents, 58% (n = 183) were men, median age was 59. The median Simplified Acute Physiology Score II was 37, median intensive care unit length of stay was 8 days, 57% (n = 177) of the patients were admitted for medical reasons. Forty percent (n = 116) of the respondents did not remember their admission to hospital, 48% (n = 142) did not remember the time in the hospital before intensive care unit admission, 73% (n = 220) had factual memories and 39% (n = 118) had delusional memories. Twenty-three percent (n = 66) stated that they had  had intrusive memories. A higher number of "adverse" experiences were significantly associated with a higher PTSS-14 score. Eighteen percent (n = 54) of patients had a PTSS-14 score > 49, indicating a higher risk of developing posttraumatic stress disorder. A PTSS-14 score > 49 was significantly associated  with not remembering the hospital stay before intensive care unit admission. CONCLUSION: Amnesia for the early period of critical illness (early amnesia) was  positively associated with the level of posttraumatic stress disorder-related symptoms, which may be a proxy for severity of disease at the time of intensive care unit admission.

Publication Types:      Multicenter Study

PMID: 18766108 [PubMed - indexed for MEDLINE]

 

Cultur Divers Ethnic Minor Psychol. 2008 Oct;14(4):344-52.

Ethnic differences in the effects of spiritual well-being on long-term psychological and behavioral outcomes within a sample of homeless women.

Douglas AN, Jimenez S, Lin HJ, Frisman LK.

Mount Holyoke College, Department of Psychology, South Hadley, MA 01075, USA. adouglas@mtholyoke.edu

The present study examines ethnicity as a moderator variable between spiritual well-being (SWB) and psychological and behavioral outcomes. Participants included in this analysis were 88 African American (46.6%) and 101 non-African American (total N = 189) homeless mothers. Through structured interviews conducted at 3-month intervals over a period of 15 months, data were collected on spiritual well-being, mental health, trauma symptoms, substance use, parenting, and child behavior. Hierarchical linear model and general estimating equation results indicated that ethnicity moderates the relationship between SWB and anxiety, trauma symptoms, child behavior, and parenting outcomes. On average, African Americans reported significantly higher SWB than non-African Americans, indicating the relative importance of spirituality in their lives. These findings support previous research indicating a difference in the role that SWB plays in the lives of African Americans compared to non-African Americans.

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

PMID: 18954170 [PubMed - indexed for MEDLINE]

 

Dev Psychopathol. 2008 Fall;20(4):1145-59.

The development of antisocial behavior: what can we learn from functional neuroimaging studies?

Crowe SL, Blair RJ.

National Institute of Mental Health, National Institutes of Health, Bethesda, MD  20892, USA.

The recent development of low-risk imaging technologies, such as functional magnetic resonance imaging (fMRI), have had a significant impact on the investigation of psychopathologies in children and adolescents. This review considers what we can infer from fMRI work regarding the development of conduct disorder (CD) and oppositional defiant disorder (ODD). We make two central assumptions that are grounded in the empirical literature. First, the diagnoses of CD and ODD identify individuals with heterogeneous pathologies; that is, different developmental pathologies can receive a CDD or ODD diagnosis. This is indicated by the comorbidities associated with CD/ODD, some of which appear to be mutually exclusive at the biological level (e.g., posttraumatic stress disorder [PTSD] and psychopathic tendencies). Second, two populations of antisocial individuals can be identified: those that show an increased risk for only reactive aggression and those that show an increased risk for both reactive and instrumental aggression. We review the fMRI data indicating that particular comorbidities of CD/ODD (i.e., mood and anxiety conditions such as childhood bipolar disorder and PTSD) are associated with either increased responsiveness of neural regions implicated in the basic response to threat (e.g., the amygdala) or decreased responsiveness in regions of frontal cortex (e.g., ventromedial frontal cortex) that are implicated in the regulation of the basic threat response. We suggest why such pathology would increase the risk for reactive aggression and, in turn, lead to the association with a CD/ODD diagnosis. We also review the literature on psychopathic tendencies, a condition where the individual is at significantly elevated risk for both reactive and instrumental aggression. We show that in individuals with psychopathic tendencies, the functioning of the amygdala in stimulus-reinforcement learning and of the ventromedial frontal cortex in the representation of reinforcement expectancies is impaired. We suggest why such pathology would increase the risk for reactive and instrumental  aggression and thus also lead to the association with a CD/ODD diagnosis.

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

PMID: 18838035 [PubMed - in process]

 

Expert Rev Neurother. 2008 Oct;8(10):1449-55.

Repetitive transcranial magnetic stimulation as treatment for anxiety disorders.

Pigot M, Loo C, Sachdev P.

School of Psychiatry, University of New South Wales, Black Dog Institute, Prince  of Wales Hospital, Randwick, NSW 2031, Australia. m.pigot@unsw.edu.au

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and generally well-tolerated method of focally stimulating brain regions. It has been shown to be efficacious in the treatment for depression, but only to a limited degree. It has also been investigated for the treatment of some anxiety disorders, particularly obsessive-compulsive disorder, post-traumatic stress disorder and panic disorder. While anecdotal reports and open studies have suggested a therapeutic role for rTMS in anxiety disorders, controlled studies, which have varied greatly in terms of rTMS administration, have not shown it to be superior to placebo. Furthermore, reports in animal models of anxiety have not been consistent. Therefore, to date, there is no convincing evidence for the clinical role of rTMS in anxiety disorders. Further research is needed, drawing on advances in our understanding of pathological neurocircuitry in anxiety disorders and the mechanisms of action by which rTMS may alter that neurocircuitry. With advances in neuroimaging technology, this understanding is likely to be more accessible than it has been in the past.

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

PMID: 18928340 [PubMed - indexed for MEDLINE]

 

Harefuah. 2008 Oct;147(10):763-7, 839-40.

[Sleep spindles in post traumatic stress disorder: significant importance of selective serotonin reuptake inhibitors]

[Article in Hebrew]

Dotan Y, Suraiya S, Pillar G.

Sleep Laboratory, Rambam Hospital, Medicine Faculty, Technion Institute, Haifa, Israel. yanivdotan@gmail.com

BACKGROUND: Sleep spindles (SS) are conducted by the thalamus during sleep and have an inhibitory effect on information rising through the thalamus to the cortex, probably representing the mechanism called Arousal Inhibitory Mechanism.  They appear during sleep stage 2 but also in stages 3, 4 and REM (Rapid Eye Movements). Patients with post traumatic stress disorder (PTSD) complain of insomnia, although objective studies have revealed that their sleep is deeper and their awakening threshold is higher. The relationships between PTSD or selective  serotonin reuptake inhibitors (SSRI) to SS density are not described in the literature. GOALS: This study aimed to examine the hypothesis that the higher awakening threshold reflects an active defense process which would be manifested  in increased sleep spindles in patients with PTSD. METHODS: A total of 15 PTSD patients (36.3 +/- 11.4 years) comprised the research group and 15 healthy students (27.3 +/- 2.18 years) comprised the control group. Participants underwent a polysomnography study in the sleep laboratory at 'Rambam' Hospital, Haifa, Israel. RESULTS: There was no difference in the sleep spindles density per minute during stage 2 between the research group (2.54 +/- 1.14) and the control  group (2.86 +/- 1.3). However, sleep spindles density was highly affected by selective serotonin reuptake inhibitors, such that PTSD patients treated with SSRI's had significantly higher spindles density than the remaining PTSD patients (3.25 +/- 1.1 vs 1.72 +/- 0.46, p=0.0044). Stage 2 was shorter in the research group (47% +/- 8.75%) compared to the control group (58% +/- 8.5%, p=0.0014), while stages 3, 4 were longer (32% +/- 8% vs 18% +/- 6.26%, p<0.001). CONCLUSIONS: Sleep spindle density was generally not increased in patients with PTSD, thus other mechanisms are probably responsible for their stabilization of sleep. SSRI's were found to have an important role in spindles density, which supports a serotonergic mechanism in the stabilization of sleep, although it requires further research.

Publication Types:      English Abstract

PMID: 19039901 [PubMed - indexed for MEDLINE]

 

Int J Group Psychother. 2008 Oct;58(4):567-74.

Comment on:     Int J Group Psychother. 2008 Oct;58(4):441-54.

On the development of practice guidelines for evidence-based group approaches following disaster.

Foy DW.

Graduate School of Education & Psychology, Pepperdine University, 16830 Venture Boulevard, Encino, CA 91436, USA. David.Foy@pepperdine.edu

Publication Types:      Comment

PMID: 18837665 [PubMed - indexed for MEDLINE]

 

Int J Law Psychiatry. 2008 Oct-Nov;31(5):385-93. Epub 2008 Sep 21.

Physical victimization in prison: the role of mental illness.

Blitz CL, Wolff N, Shi J.

Center for Mental Health Services & Criminal Justice Research, Rutgers University, New Brunswick, N.J., USA. clblitz@rci.rutgers.edu

This study compares prison physical victimization rates (inmate-on-inmate and staff-on-inmate) for people with mental disorder to those without mental disorder in a state prison system. Inmate subjects were drawn from 14 adult prisons operated by a single mid-Atlantic State. A sample of 7,528 subjects aged 18 or older (7,221 men and 564 women) completed an audio-computer administered survey instrument. Mental disorder was based on self-reported mental health treatment ever for particular mental disorders. Approximately one-quarter of the sample reported some prior treatment for schizophrenia, bipolar disorder, depression, PTSD, or anxiety disorder. Rates of physical victimization for males with any mental disorder were 1.6 times (inmate-on-inmate) and 1.2 times (staff-on-inmate) higher than that of males with no mental disorder. Female inmates with mental disorder were 1.7 times more likely to report being physically victimized by another inmate than did their counterparts with no mental disorder. Overall, both males and females with mental disorder are disproportionately represented among victims of physical violence inside prison.

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

PMID: 18809210 [PubMed - indexed for MEDLINE]

 

Int Psychogeriatr. 2008 Oct;20(5):1014-8. Epub 2008 Mar 17.

Trauma and post-traumatic stress symptoms in former German child soldiers of World War II.

Kuwert P, Spitzer C, Rosenthal J, Freyberger HJ.

Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt University Greifswald, Germany. kuwert@uni-greifswald.de

BACKGROUND: The aim of the study was to determine the amount of trauma impact and significant post-traumatic stress symptoms, which can indicate a possible post-traumatic stress disorder (PTSD), in a sample of former German child soldiers of World War II. METHODS: 103 participants were recruited through the press, then administered a modified Post-traumatic Diagnostic Scale (PDS). RESULTS: Subjects reported a high degree of trauma exposure, with 4.9% reporting  significant post-traumatic stress symptoms after WW II, and 1.9% reporting that these symptoms persist to the present. CONCLUSION: In line with other studies on  child soldiers in actual conflict settings, our data document a high degree of trauma exposure during war. Surprisingly, the prevalence of significant post-traumatic stress symptoms indicating a possible PTSD was low compared to other groups of aging, long-term survivors of war trauma. Despite some limitations our data highlight the need for further studies to identify resilience and coping factors in traumatized child soldiers.

Publication Types:      Comparative Study

PMID: 18341750 [PubMed - indexed for MEDLINE]

 

Int Rev Psychiatry. 2008 Oct;20(5):441-4.

Mental health and the psychosocial consequences of natural disasters in Asia.

Udomratn P.

Faculty of Medicine, Department of Psychiatry, Prince of Songkla University, Thailand. upichet@medicine.psu.ac.th

This article presents an overview of natural disasters in Asia, as well as mental disorders and psychosocial interventions related to disasters. Although most of the top ten worst natural disasters occurred in Asia over the past century, little is known about the mental health and psychosocial aspects. After the tsunami incident in 2004, research reports in international journals related to Asian disasters have been growing. The prevalence rate of post-traumatic stress disorder related to natural disasters is currently between 8.6% and 57.3% depending on assessment methodologies, instruments and timing. Cognitive behaviour therapy has been found to be effective with Asian survivors but needs to be adapted for cultural and local sensitivities. Further research is needed in the areas of epidemiology for mental disorders and suitable psychosocial interventions for disaster survivors in Asia.

PMID: 19012129 [PubMed - in process]

 

J Adv Nurs. 2008 Oct;64(1):2-13. Epub 2008 Aug 21.

Emotional outcome after intensive care: literature review.

Rattray JE, Hull AM.

School of Nursing and Midwifery, University of Dundee, Ninewells Hospital, UK. j.z.rattray@dundee.ac.uk

AIM: This paper is a report of a literature review to identify (a) the prevalence of emotional and psychological problems after intensive care, (b) associated factors and (c) interventions that might improve this aspect of recovery. BACKGROUND: Being a patient in intensive care has been linked to both short- and  long-term emotional and psychological consequences. DATA SOURCES: The literature  search was conducted during 2006. Relevant journals and databases were searched,  i.e. Medline and CINAHL, between the years 1995 and 2006. REVIEW METHODS: The search terms were 'anxiety', 'depression', posttraumatic stress', 'posttraumatic  stress disorder' and 'intensive care'. RESULTS: Fifteen papers were reviewed representing research studies of anxiety, depression and posttraumatic stress, and seven that represented intensive care follow-up clinics and patient diaries.  Being in intensive care can result in significant emotional and psychological problems for a number of patients. For the majority of patients, symptoms of distress will decrease over time but for a number these will endure for some years. Current evidence indicates that emotional problems after intensive care are related to both subjective and objective indicators of a patient's intensive  care experience. Evidence suggests some benefit in an early rehabilitation programme, daily sedation withdrawal and the use of patient diaries. However, additional research is required to support such findings. CONCLUSION: Our understanding of the consequences of intensive care is improving. Psychological care for intensive care patients has lagged behind care for physical problems. We now need to focus on developing and evaluating appropriate interventions to improve psychological outcome in this patient group.

Publication Types:      Review

PMID: 18721158 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1244-54. Epub 2008 Jan 11.

An investigation of whether patients with post-traumatic stress disorder overestimate the probability and cost of future negative events.

White M, McManus F, Ehlers A.

Lowestoft Community Mental Health Team, Norfolk & Waverley NHS Foundation Trust,  Victoria House, 28 Alexandra Road, Lowestoft, UK.

This study compared estimations of the probability and cost of negative events occurring made by patients with post-traumatic stress disorder (PTSD) (n=43), patients with other anxiety disorders (n=29) and non-patients' (n=35). Prior to treatment PTSD patients overestimated the probability and cost of all types of traumatic events occurring relative to non-patients, and overestimated the probability and cost of the specific type of traumatic event that they had been traumatized by relative to the anxious controls as well as non-patients. These judgment biases were specific to traumatic events and did not generalise to all negative events. PTSD patients' estimations of the probability and cost of traumatic events were significantly reduced following treatment, and were no longer significantly different from those of non-patients. Results suggest that patients with PTSD show specific judgment biases in the estimation of probability and cost, which can be successfully modified by cognitive therapy.

PMID: 18316175 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1264-71. Epub 2008 Jan 18.

Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)--results of a preliminary investigation.

Sack M, Lempa W, Steinmetz A, Lamprecht F, Hofmann A.

Klinikum rechts der Isar, Department of Psychosomatic Medicine, Technical University Munich, Langerstrasse 3, 81675 Munich, Germany. m.sack@tum.de

EMDR combines stimuli that evoke divided attention--e.g. eye movements--with exposure to traumatic memories. Our objective was to investigate psycho-physiological correlates of EMDR during treatment sessions. A total of 55  treatment sessions from 10 patients with PTSD was monitored applying impedance cardiography. Onset of every stimulation/exposure period (n=811) was marked and effects within and across stimulation sets on heart rate (HR), heart rate variability (HRV), pre-ejection period (PEP) and respiration rate were examined.  At stimulation onsets a sharp increase of HRV and a significant decrease of HR was noticed indicating de-arousal. During ongoing stimulation, PEP and HRV decreased significantly while respiration rate significantly increased, indicating stress-related arousal. However, across entire sessions a significant  decrease of psycho-physiological activity was noticed, evidenced by progressively decreasing HR and increasing HRV. These findings suggest that EMDR is associated  with patterns of autonomic activity associated with substantial psycho-physiological de-arousal over time.

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

PMID: 18314305 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1214-26. Epub 2008 Jan 11.

Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology.

Marshall EC, Zvolensky MJ, Vujanovic AA, Gibson LE, Gregor K, Bernstein A.

Department of Psychology, University of Vermont, 2 Cholchester Avenue, Burlington, VT 05405, USA.

The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; C) in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences  were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.

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

PMID: 18282685 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1255-63. Epub 2008 Jan 18.

Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors.

Long ME, Elhai JD, Schweinle A, Gray MJ, Grubaugh AL, Frueh BC.

Disaster Mental Health Institute, Department of Psychology, The University of South Dakota, Vermillion, SD 57069, USA.

This study addresses the ongoing controversy regarding the definition of DSM-IV posttraumatic stress disorder's (PTSD) traumatic stressor criterion (A1). A sample of 119 college students completed the PTSD Symptom Scale separately in relation to both Criterion A1 and non-Criterion A1 stressful events, using a mixed between-groups (administration order) and within-subjects (stressor type) design. Contrary to what was expected, analyses revealed that non-Criterion A1 events were associated with greater likelihood of "probable" PTSD diagnoses and a greater PTSD symptom frequency than Criterion A1 events. Symptom frequency relationships, however, were moderated by the order in which the measures were administered. The non-Criterion A1 PTSD scores were only higher when non-Criterion A1 measures were presented first in the administration order. Similar patterns of differences in PTSD scores between stressor types were also found across the three PTSD symptom criteria. Implications are discussed as to the ongoing controversy of the PTSD construct.

Publication Types:      Randomized Controlled Trial

PMID: 18281192 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1137-45. Epub 2007 Dec 8.

The structure of post-traumatic stress disorder symptoms in three female trauma samples: a comparison of interview and self-report measures.

Scher CD, McCreary DR, Asmundson GJ, Resick PA.

Department of Psychology, California State University-Fullerton, Fullerton, CA 92834, USA. cscher@fullerton.edu

Empirical research increasingly suggests that post-traumatic stress disorder (PTSD) is comprised of four factors: re-experiencing, avoidance, numbing, and hyperarousal. Nonetheless, there remains some inconsistency in the findings of factor analyses that form the bulk of this empirical literature. One source of such inconsistency may be assessment measure idiosyncrasies. To examine this issue, we conducted confirmatory factor analyses of interview and self-report data across three trauma samples. Analyses of the interview data indicated a good fit for a four-factor model across all samples; analyses of the self-report data  indicated an adequate fit in two of three samples. Overall, findings suggest that measure idiosyncrasies may account for some of the inconsistency in previous factor analyses of PTSD symptoms.

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

PMID: 18206346 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1110-9. Epub 2007 Nov 21.

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

Su YJ, Chen SH.

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

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

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

PMID: 18162364 [PubMed - indexed for MEDLINE]

 

J Fam Psychol. 2008 Oct;22(5):659-66.

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

Solomon Z, Dekel R, Zerach G.

Bob Shappell School of Social Work, Tel Aviv University, Israel. Solomon@post.tau.ac.il

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD  avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of  219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. Copyright 2008 APA, all rights reserved.

PMID: 18855502 [PubMed - indexed for MEDLINE]

 

J Immigr Minor Health. 2008 Oct;10(5):407-14.

Smoking patterns within a primary care sample of resettled Bosnian refugees.

Weaver TL, Cajdrić A, Jackson ER.

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

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

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

PMID: 18071902 [PubMed - indexed for MEDLINE]

 

J Immigr Minor Health. 2008 Oct;10(5):389-96.

The "lost boys" of Sudan: use of health services and functional health outcomes of unaccompanied refugee minors resettled in the U.S.

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

Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA,  pgeltman@bu.edu

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

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

PMID: 18071901 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Oct;23(10):1323-42. Epub 2008 Feb 21.

Partner's stake in conformity and abused wives' psychological trauma.

Demaris A, Kaukinen C.

Bowling Green State University, Bowling Green, OH 43403, USA. ademari@bgnet.bgsu.edu

This study investigates the potential buffering effect of help-seeking in the association between intimate partner assault and women's psychological trauma, and how this, in turn, may depend on the partner's stake in conformity. The sample consists of 374 women reporting the experience of domestic violence from a current intimate partner, drawn from the larger survey Violence and Threats of Violence Against Women and Men in the United States, 1994-1996. Help-seeking did  not appear to buffer the impact of assault severity, contrary to expectation. However, the partner's stake in conformity did condition the effect of his or her having been arrested. Victims had higher levels of posttraumatic stress disorder  (PTSD) when police arrested partners of average or below-average stake in conformity. But victims of partners characterized by higher than average stake in conformity did not show elevated PTSD due to their partners having been arrested. On the other hand, PTSD was higher among women experiencing more emotional abuse  from the partner.

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

PMID: 18292403 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Oct;196(10):772-5.

The long-term psychosocial impact of a surprise chemical weapons attack on civilians in Halabja, Iraqi Kurdistan.

Dworkin J, Prescott M, Jamal R, Hardawan SA, Abdullah A, Galea S.

Internal Medicine Residency Program, University of Hawaii, Honolulu, Hawaii, USA.

War and human rights abuses contribute to increased prevalence of posttraumatic stress (PTS) disorder and low social functioning among populations affected. There is relatively little evidence, however about the long-term mental health impact of war on general populations. We examined the prevalence of PTS symptoms  and poor social functioning in Halabja, Iraqi Kurdistan, 18 years after a chemical attack on civilians in that town. We systematically sampled 291 persons  representative of the population of Halabja from the city emergency department and 4 outpatient clinical sites. PTS symptoms and poor social functioning were common. After adjustment for covariates, female gender, older age, and cumulative exposure to multiple traumas, all were associated with higher PTS scores and worse social functioning. Exposure to human rights abuses and warlike conditions  seem to continue to be risks for psychiatric and social dysfunction even decades  after the initial incident.

Publication Types:      Comparative Study     Multicenter Study

PMID: 18852622 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Oct;196(10):735-42.

Depressive symptoms after trauma: is self-esteem a mediating factor?

David M, Ceschi G, Billieux J, Van der Linden M.

Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland. Melissa.David@unige.ch

Traumatic events have predicted depressive symptoms. Despite this consensus, it remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. This study tested these relationships while considering depressive symptom types. One hundred thirty-two students reported the number of traumatic events experienced and self-esteem and depression levels. Results indicated 2 depressive symptom types: "cognitive-affective" and "somatic." Structural Equation Modeling tested an unmediated path from trauma to depressive symptoms and a path mediated by self-esteem. Results supported the unmediated relationship between trauma and "cognitive-affective" depressive symptoms, and did not support mediation by self-esteem. Findings are discussed in view of a dimensional rather than categorical approach to depression, and in consideration of alternative symptom clusters resulting from trauma in addition to those captured by posttraumatic stress disorder.

Publication Types:      Comparative Study

PMID: 18852617 [PubMed - indexed for MEDLINE]

 

J Postgrad Med. 2008 Oct-Dec;54(4):294-300.

Women survivors of intimate partner violence and post-traumatic stress disorder:  Prediction and prevention.

Dejonghe ES, Bogat GA, Levendosky AA, Eye A.

Department of Psychology and Sociology, California State Polytechnic University Pomona, Pomona, CA, USA. esdejonghe@csupomona.edu.

A considerable body of research has demonstrated that women who are abused by their male romantic partners are at substantially elevated risk for the development of post-traumatic stress disorder (PTSD). This article reviews recent literature regarding intimate partner violence (IPV) and resultant PTSD symptoms. The article is intended to be an introduction to the topic rather than an exhaustive review of the extensive literature in this area. Factors that enhance  and reduce the risk for PTSD, including social support, coping styles, and types  of abusive behavior experienced, are described. In addition, the unique risks associated with IPV for women who have children are discussed. Prevention efforts and treatment are briefly reviewed.

PMID: 18953149 [PubMed - in process]

 

J Psychiatr Res. 2008 Oct;42(14):1185-8. Epub 2008 Mar 14.

Blunted ACTH response to dexamethasone suppression-CRH stimulation in posttraumatic stress disorder.

Ströhle A, Scheel M, Modell S, Holsboer F.

Max Planck Institute of Psychiatry, Munich, Germany. andreas.stroehle@charite.de

Previous studies have suggested that patients with posttraumatic stress disorder  (PTSD) have an enhanced negative feedback sensitivity of the hypothalamic-pituitary-adrenal (HPA) system and a blunted ACTH response to corticotropin releasing hormone (CRH). The effects of two dexamethasone dosages (0.75 and 1.5 mg) on the ACTH and cortisol concentrations after CRH stimulation (100 microg) were studied in eight patients with PTSD and matched healthy control subjects. Compared to healthy subjects, patients with PTSD have a blunted ACTH response to CRH. Cortisol concentrations were only significantly influenced by dexamethasone dosage. Our results give further evidence for a central role of the pituitary in reflecting changes of the negative feedback sensitivity of the HPA system in patients with PTSD.

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

PMID: 18342888 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Oct;42(13):1112-21. Epub 2008 Mar 4.

Post-combat invincibility: violent combat experiences are associated with increased risk-taking propensity following deployment.

Killgore WD, Cotting DI, Thomas JL, Cox AL, McGurk D, Vo AH, Castro CA, Hoge CW.

Walter Reed Army Institute of Research, Silver Spring, MD, United States. Killgore@mclean.harvard.edu

Combat exposure is associated with increased rates of mental health problems such as post-traumatic stress disorder, depression, and anxiety when Soldiers return home. Another important health consequence of combat exposure involves the potential for increased risk-taking propensity and unsafe behavior among returning service members. Survey responses regarding 37 different combat experiences were collected from 1252 US Army Soldiers immediately upon return home from combat deployment during Operation Iraqi Freedom. A second survey that  included the Evaluation of Risks Scale (EVAR) and questions about recent risky behavior was administered to these same Soldiers 3 months after the initial post-deployment survey. Combat experiences were reduced to seven factors using principal components analysis and used to predict post-deployment risk-propensity scores. Although effect sizes were small, specific combat experiences, including  greater exposure to violent combat, killing another person, and contact with high levels of human trauma, were predictive of greater risk-taking propensity after homecoming. Greater exposure to these combat experiences was also predictive of actual risk-related behaviors in the preceding month, including more frequent and greater quantities of alcohol use and increased verbal and physical aggression toward others. Exposure to violent combat, human trauma, and having direct responsibility for taking the life of another person may alter an individual's perceived threshold of invincibility and slightly increase the propensity to engage in risky behavior upon returning home after wartime deployment. Findings highlight the importance of education and counseling for returning service members to mitigate the public health consequences of elevated risk-propensity associated with combat exposure.

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

PMID: 18291419 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Oct;42(13):1104-11. Epub 2008 Feb 20.

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors.

Yehuda R, Bell A, Bierer LM, Schmeidler J.

Traumatic Stress Studies Division, Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, OOMH, 130 West Kingsbridge Road, Bronx, NY 10468, United States. Rachel.Yehuda@va.gov

BACKGROUND: A significant association between parental PTSD and the occurrence of PTSD in offspring has been noted, consistent with the idea that risk for the development of PTSD is transmitted from parent to child. Two recent reports linking maternal PTSD and low offspring cortisol prompted us to examine the relative contributions of maternal vs. paternal PTSD in the prediction of PTSD and other psychiatric diagnoses in offspring. METHODS: One hundred seventeen men  and 167 women, recruited from the community, were evaluated using a comprehensive psychiatric battery designed to identify traumatic life experiences and lifetime  psychiatric diagnoses. 211 of these subjects were the adult offspring of Holocaust survivors and 73 were demographically comparable Jewish controls. Participants were further subdivided based on whether their mother, father, neither, or both parents met diagnostic criteria for lifetime PTSD. RESULTS: A higher prevalence of lifetime PTSD, mood, anxiety disorders, and to a lesser extent, substance abuse disorders, was observed in offspring of Holocaust survivors than controls. The presence of maternal PTSD was specifically associated with PTSD in adult offspring of Holocaust survivors. However, other psychiatric diagnoses did not show specific effects associated with maternal PTSD. CONCLUSION: The tendency for maternal PTSD to make a greater contribution than paternal PTSD to PTSD risk suggests that classic genetic mechanisms are not  the sole model of transmission, and paves way for the speculation that epigenetic factors may be involved. In contrast, PTSD in any parent contributes to risk for  depression, and parental traumatization is associated with increased anxiety disorders in offspring.

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

PMID: 18281061 [PubMed - indexed for MEDLINE]

 

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

Veterans, PTSD, & access to care.

Reeves RR.

Publication Types:      Comment     Letter

PMID: 18935931 [PubMed - in process]

 

J Subst Abuse Treat. 2008 Oct;35(3):304-11. Epub 2008 Feb 21.

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment.

Killeen T, Hien D, Campbell A, Brown C, Hansen C, Jiang H, Kristman-Valente A, Neuenfeldt C, Rocz-de la Luz N, Sampson R, Suarez-Morales L, Wells E, Brigham G,  Nunes E.

Clinical Neuroscience, Medical University of South Carolina, Charleston, SC 29451, USA. killeent@musc.edu

A substantial number of women who enter substance abuse treatment have a history  of trauma and meet criteria for posttraumatic stress disorder (PTSD). Fear regarding the extent to which PTSD treatment can evoke negative consequences remains a research question. This study explored adverse events related to the implementation of an integrated treatment for women with trauma and substance use disorder (Seeking Safety) compared with a nontrauma-focused intervention (Women's Health Education). Three hundred fifty-three women enrolled in community substance abuse treatment were randomized to 1 of the 2 study groups and monitored weekly for adverse events. There were no differences between the two intervention groups in the number of women reporting study-related adverse events (28 [9.6%] for the Seeking Safety group and 21[7.2%] for the Women's Health Education group). Implementing PTSD treatment in substance abuse treatment programs appears to be safe, with minimal impact on intervention-related adverse  psychiatric and substance abuse symptoms. More research is needed on the efficacy of such interventions to improve outcomes of PTSD and substance use.

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

PMID: 18294804 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Oct;21(5):497-500.

A pilot study of meditation for mental health workers following Hurricane Katrina.

Waelde LC, Uddo M, Marquett R, Ropelato M, Freightman S, Pardo A, Salazar J.

Pacific Graduate School of Psychology, Redwood City, CA 94063, USA. lwaelde@pgsp.edu

This pilot study examined the effects of a manualized meditation intervention (called Inner Resources) for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms among 20 African American and Caucasian mental health workers in New Orleans beginning 10 weeks after Hurricane Katrina. They participated in a 4-hour workshop followed by an 8-week home study program. Complete follow-up data were available for 15 participants. Results of intention-to-treat analyses indicated that participants' PTSD and anxiety symptoms significantly decreased over the 8 weeks of the intervention; these improvements were significantly correlated with the total number of minutes of daily meditation practice. The majority of participants reported good treatment adherence and improvements in well-being. These findings suggest that meditation  may be a feasible, acceptable, and effective postdisaster intervention.

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

PMID: 18956453 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):492-6.

Posttraumatic growth in adolescence: examining its components and relationship with PTSD.

Levine SZ, Laufer A, Hamama-Raz Y, Stein E, Solomon Z.

Department of Criminology, Bar Ilan University, Ramat Gan, Israel.

To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures  included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth  Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest  at moderate posttraumatic stress levels.

PMID: 18956452 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):471-8.

Avoidance symptoms and assessment of posttraumatic stress disorder in Arab immigrant women.

Norris AE, Aroian KJ.

College of Nursing, University of Central Florida, Orlando, FL 32816-2210, USA. anorris@mail.ucf.edu

This study investigates whether the avoidance symptom criterion required for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD) is overly conservative. Arab immigrant women (N = 453), many of whom reported experiencing multiple traumatic events, completed the Posttraumatic Diagnostic Scale in Arabic as part of a face to face interview. Analyses indicated all but one avoidance symptom was reported less frequently than reexperiencing and arousal symptoms. However, those who fully met reexperiencing, avoidance, and arousal symptom criteria had worse symptom severity and functioning than those who fully met reexperiencing and arousal symptom criteria, but only partially met avoidance symptom criterion. Study findings support importance of the PTSD avoidance symptom criterion.

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

PMID: 18956451 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):433-9.

Noninferiority and equivalence designs: issues and implications for mental health research.

Greene CJ, Morland LA, Durkalski VL, Frueh BC.

National Center for PTSD-Pacific Islands Division, of Veterans Affairs Pacific Islands Healthcare System, Honolulu, HI 96819, USA. Carolyn.Greene3@va.gov

The terms noninferiority and equivalence are often used interchangeably to refer  to trials in which the primary objective is to show that a novel intervention is  as effective as the standard intervention. The use of these designs is becoming increasingly relevant to mental health research. Despite the fundamental importance of these designs, they are often poorly understood, improperly applied, and subsequently misinterpreted. In this article, the authors explain noninferiority and equivalence designs and key methodological and statistical considerations. Decision points in using these designs are discussed, such as choice of control condition, determination of the noninferiority margin, and calculation of sample size and power. With increasing utilization of these designs, it is critical that researchers understand the methodological issues, advantages, disadvantages, and related challenges.

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

PMID: 18956449 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):487-91.

Adolescents' and parents' agreement on posttraumatic stress disorder symptoms and functioning after adolescent injury.

Ghesquiere A, Fan MY, Berliner L, Rivara FP, Jurkovich GJ, Russo J, Katon W, Zatzick DF.

Department of Psychiatry & Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104-2499, USA.

Few investigations have simultaneously assessed concordance between youth and parent ratings of posttraumatic stress disorder (PTSD) symptoms and functioning.  Randomly sampled adolescent injury survivors ages 12-18 and their parents were assessed on the inpatient ward and again at 2, 5, and 12-months postinjury (N = 99). Adolescent PTSD symptoms and functioning were rated by both adolescents and  parents. Parent PTSD was also assessed; 27% of parents endorsed symptoms consistent with a diagnosis of PTSD over the course of the year after adolescent  injury. The PTSD positive parents demonstrated significantly greater discordance  in ratings of adolescent PTSD symptoms, family cohesion, and mental health functioning. These findings suggest caution in clinical and policy applications of parental ratings of adolescent symptomatic and functional outcomes after injury.

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

PMID: 18956447 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):455-62.

Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey.

Darves-Bornoz JM, Alonso J, de Girolamo G, de Graaf R, Haro JM, Kovess-Masfety V, Lepine JP, Nachbaur G, Negre-Pages L, Vilagut G, Gasquet I; ESEMeD/MHEDEA 2000 Investigators.

Collaborators: Alonso J, Angermeyer M, Bernert S, Bruffaerts R, Brugha TS, de Girolamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC,  Kovess V, Lépine JP, Ormel J, Vilagut G.

Hôpital Henri-Ey, 15 Avenue de la Porte de Choisy, 75013 Paris, France.

A potentially traumatic event (PTE) contributes to trauma through its frequency,  conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.

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

PMID: 18956444 [PubMed - in process]

 

Memory. 2008 Oct;16(7):788-96.

"Hotspots" in trauma memories in the treatment of post-traumatic stress disorder: a replication.

Grey N, Holmes EA.

South London & Maudsley NHS Trust, King's College London, UK. n.grey@iop.kcl.ac.uk

"Hotspots" refer to memories of detailed moments of peak emotional distress during a traumatic event. This study investigates hotspot frequency, and the emotions and cognitions contained in hotspots of memory for trauma, to replicate  a previous study in this area (Holmes, Grey, & Young, 2005). Participants were patients receiving treatment for post-traumatic stress disorder (PTSD) at a specialist outpatient clinic after experiencing a range of traumatic events. The  main finding was that, after fear, the most common emotions reported were anger and sadness. Cognitions related to psychological threat to the self were more common than those related to physical threat.

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

PMID: 18720224 [PubMed - indexed for MEDLINE]

 

Memory. 2008 Oct;16(7):669-77.

Does overgeneral autobiographical memory result from poor memory for task instructions?

Yanes PK, Roberts JE, Carlos EL.

University at Buffalo, The State University of New York, NY 14260, USA.

Considerable previous research has shown that retrieval of overgeneral autobiographical memories (OGM) is elevated among individuals suffering from various emotional disorders and those with a history of trauma. Although previous theories suggest that OGM serves the function of regulating acute negative affect, it is also possible that OGM results from difficulties in keeping the instruction set for the Autobiographical Memory Test (AMT) in working memory, or  what has been coined "secondary goal neglect" (Dalgleish, 2004). The present study tested whether OGM is associated with poor memory for the task's instruction set, and whether an instruction set reminder would improve memory specificity over repeated trials. Multilevel modelling data-analytic techniques demonstrated a significant relationship between poor recall of instruction set and probability of retrieving OGMs. Providing an instruction set reminder for the AMT relative to a control task's instruction set improved memory specificity immediately afterward.

Publication Types:      Randomized Controlled Trial

PMID: 18608978 [PubMed - indexed for MEDLINE]

 

Neuropsychopharmacology. 2008 Oct;33(11):2595-604. Epub 2008 Jan 9.

Variation in mouse basolateral amygdala volume is associated with differences in  stress reactivity and fear learning.

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

Section on Behavioral Science and Genetics, Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD 20852-9411, USA.

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

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

PMID: 18185497 [PubMed - in process]

 

Psychiatr Serv. 2008 Oct;59(10):1184-90.

Pharmacologic treatment of posttraumatic stress disorder among privately insured  Americans.

Harpaz-Rotem I, Rosenheck RA, Mohamed S, Desai RA.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA. ilan.harpaz-rotem@yale.edu

OBJECTIVE: Although psychological trauma affects millions of Americans, few studies have examined treatment of posttraumatic stress disorder (PTSD) in real-world service environments. This study explored pharmacological treatment of PTSD among privately insured individuals. METHODS: Data were from the MarketScan  database, which compiles claims from private health insurance plans nationwide. Descriptive statistics and multivariate logistic regression were used to identify predictors of any use of a psychotropic medication and use of three medication classes: antidepressants, anxiolytics or sedative-hypnotics, and antipsychotics.  RESULTS: Of 860,090 adult mental health care users in 2005, only 10,636 (1.2%) had a diagnosis of PTSD. Sixty percent of PTSD patients received any psychotropic medication: 74.3% of those received antidepressants, 73.7% received anxiolytics or sedative-hypnotics, and 21.3% received antipsychotics. Greater likelihood of any medication use was associated with greater use of mental health services and  with several comorbid psychiatric disorders. Having a comorbid diagnosis of an indicated disorder was the most robust predictor of use of each of the three medication classes: major depressive disorder and dysthymia were most strongly associated with antidepressant use, schizophrenia and bipolar disorder were associated with antipsychotic use, and anxiety disorders were associated with use of anxiolytics or sedative-hypnotics. CONCLUSIONS: Psychotropic medications were  frequently used in the treatment of PTSD among privately insured clients. Although use targeted specifically to PTSD and to comorbid disorders was common,  substantial use appeared to be unrelated to diagnosis and may be targeted at specific symptoms rather than diagnosed illnesses. Further research is needed to  determine symptom-specific responses to medications across diagnoses.

PMID: 18832505 [PubMed - in process]

 

Psychiatry. 2008 Fall;71(3):234-45.

Ethnic/Racial diversity and posttraumatic distress in the acute care medical setting.

Santos MR, Russo J, Aisenberg G, Uehara E, Ghesquiere A, Zatzick DF.

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98104, USA.

Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma-focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages  or compared variations in early posttraumatic distress in representative samples  of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non-English speaking with 16 languages represented. English speaking, inpatients  were screened for posttraumatic stress disorder, peritraumatic dissociative, and  depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%,  and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy-relevant clinical investigations that combine evidence-based treatments, bilingual/bicultural care-management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality  of mental health care for diverse injured trauma survivors.

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

PMID: 18834274 [PubMed - indexed for MEDLINE]

 

Psychol Med. 2008 Oct;38(10):1427-34. Epub 2008 Feb 7.

Complex trauma of war captivity: a prospective study of attachment and post-traumatic stress disorder.

Solomon Z, Dekel R, Mikulincer M.

The Adler Research Center for Child Welfare and Protection, Tel Aviv University,  Israel. Solomon@post.tau.ac.il

BACKGROUND: Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation. METHOD: The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were  assessed at two points in time, 18 years and 30 years after the war. RESULTS: Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted  later attachment better than early attachment predicted later PTSD symptoms. CONCLUSIONS: The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.

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

PMID: 18257940 [PubMed - in process]

 

Psychol Med. 2008 Oct;38(10):1409-17. Epub 2008 Jan 4.

The relationship between trauma and beliefs about hearing voices: a study of psychiatric and non-psychiatric voice hearers.

Andrew EM, Gray NS, Snowden RJ.

Psychology Department, Royal Glamorgan Hospital, Llantrisant, UK. AndrewL1@cf.ac.uk