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Biomedical subjects

R K Pitman

Publications and source records attributed to R K Pitman.

At least 19 recordsLinked to original sources
PubMed1996

Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder.

This study used quantitative volumetric magnetic resonance imaging techniques to explore the neuroanatomic correlates of chronic, combat-related posttraumatic stress disorder (PTSD) in seven Vietnam veterans with PTSD compared with seven nonPTSD combat veterans and eight normal nonveterans. Both left and right hippocampi were significantly smaller in the PTSD subjects compared to the Combat Control and Normal subjects, even after adjusting for age, whole brain volume, and lifetime alcohol consumption. There were no statistically significant group differences in intracranial cavity, whole brain, ventricles, ventricle:brain ratio, or amygdala. Subarachnoidal cerebrospinal fluid was increased in both veteran groups. Our finding of decreased hippocampal volume in PTSD subjects is consistent with results of other investigations which utilized only trauma-unexposed control groups. Hippocampal volume was directly correlated with combat exposure, which suggests that traumatic stress may damage the hippocampus. Alternatively, smaller hippocampi volume may be a pre-existing risk factor for combat exposure and/or the development of PTSD upon combat exposure.

Adult↗
PubMed1996

Neural effects of visualizing and perceiving aversive stimuli: a PET investigation.

Cerebral blood flow was recorded (using positron emission tomography) while middle-aged subjects viewed or visualized pictures of neutral or aversive stimuli, and then determined whether auditorily presented statements correctly described the stimuli. Visualizing aversive stimuli enhanced cerebral blood flow, relative to visualizing neutral stimuli, in areas 17 (right) and 18 (bilateral), as well as the anterior insula (bilateral) and middle frontal cortex (left). Areas 17 and 18 have been identified as supporting the representations that underlie the experience of imagery, and the anterior insula is a major cortical recipient of input from the autonomic nervous system. Perceiving aversive stimuli enhanced cerebral blood flow, relative to neutral stimuli, in area 46, the angular gyrus and area 19, area 47, and the middle temporal gyrus (all in the left hemisphere). All of these areas have previously been implicated in visual object identification. It is striking that negative emotion did not modulate activation in any areas in the same way during imagery and perception.

Brain↗
PubMed1996

A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery.

BACKGROUND: Previous studies have used symptom provocation and positron emission tomography to delineate the brain systems that mediate various anxiety states. Using an analogous approach, the goal of this study was to measure regional cerebral blood flow changes associated with posttraumatic stress disorder (PTSD) symptoms. METHODS: Eight patients with PTSD, screened as physiologically responsive to a script-driven imagery symptom provocation paradigm, were exposed sequentially to audiotaped traumatic and neutral scripts in conjunction with positron emission tomography. Heart rate and subjective measures of emotional state were obtained for each condition. Statistical mapping techniques were used to determine locations of significant brain activation. RESULTS: Increases in normalized blood flow were found for the traumatic as compared with control conditions in right-sided limbic, paralimbic, and visual areas; decreases were found in left inferior frontal and middle temporal cortex. CONCLUSIONS: The results suggest that emotions associated with the PTSD symptomatic state are mediated by the limbic and paralimbic systems within the right hemisphere. Activation of visual cortex may correspond to the visual component of PTSD reexperiencing phenomena.

Adult↗
PubMed1995

Autobiographical memory disturbance in combat-related posttraumatic stress disorder.

Vietnam combat veterans with (n = 19) and without (n = 13) posttraumatic stress disorder (PTSD) participated in an autobiographical memory experiment in which they attempted to retrieve specific personal memories exemplifying traits denoted by positive (e.g. loyal) and negative (e.g. guilty) cue words. Veterans with PTSD exhibited difficulties retrieving specific autobiographical memories, especially in response to positive trait cue words. These deficits were especially pronounced in PTSD Ss who wore Vietnam War regalia (e.g. medals, fatigues) to the laboratory. Regalia-wearing PTSD Ss disproportionately retrieved memories from the Vietnam War, unlike other Ss who retrieved relatively recent memories. Wearing regalia in daily life may be emblematic of psychological fixation to a war fought more than two decades ago. Difficulties remembering one's past may underlie difficulties envisioning one's future, as reflected in the PTSD symptom of 'future foreshortening', and difficulties using memory specifically may also hamper efforts to solve personal problems.

Adult↗
PubMed1995

Physiologic responses to loud tones in Vietnam veterans with posttraumatic stress disorder.

The authors evaluated eyeblink and autonomic components of the acoustic startle response in combat-related posttraumatic stress disorder (PTSD). Thirty-seven Vietnam combat veterans with current PTSD and 19 combat veterans without PTSD were exposed to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with 0-ms rise and fall times, while orbicularis oculi electromyogram, skin conductance, and heart rate responses were measured. PTSD veterans produced larger averaged electromyographic and heart rate responses, and a slower decline in skin conductance responses, across the 15 tone presentations compared to non-PTSD veterans. Results of this study provide laboratory support for an exaggerated startle response in PTSD and replicate and extend previous findings of increased autonomic responses to loud tone stimuli in this disorder.

Acoustic Stimulation↗
PubMed1995

Effect of previous trauma on acute plasma cortisol level following rape.

OBJECTIVE: The authors examined the relationships among history of previous assault, severity of rape, acute plasma cortisol level after rape, and development of rape-related post-traumatic stress disorder (PTSD). METHOD: Blood samples were drawn from 37 adult female rape victims within 51 hours after they had been raped. The subjects were assessed for history of previous assault and for the presence of PTSD 17-157 days (mean = 90 days) after the rape. RESULTS: Women with a history of previous assault had a lower mean acute cortisol level after the rape but a higher probability of subsequently developing PTSD. A significant interaction between history of previous assault and the severity of the index rape was observed: only women who had never been assaulted before had higher cortisol levels following high-severity rapes (those which included injury or multiple types of penetration) than low-severity rapes. CONCLUSIONS: The authors conclude that previous traumatization may attenuate the acute cortisol response to trauma.

Adult↗
PubMed1993

Effects of intranasal vasopressin and oxytocin on physiologic responding during personal combat imagery in Vietnam veterans with posttraumatic stress disorder.

This study measured heart rate, skin conductance, and lateral frontalis electromyographic (EMG) responses in 43 male Vietnam veterans with posttraumatic stress disorder during personal combat imagery. In a double-blind research design, subjects were randomly assigned to receive intranasal arginine vasopressin (20 IU), placebo, or oxytocin (20 IU) an hour before the experiment. The group order of physiologic responding was as predicted: vasopressin > placebo > oxytocin. The most specific effect was exerted by vasopressin on EMG responses. This drug effect was not accounted for by nonspecific changes in responsiveness. Results are consistent with enhancing and inhibiting effects on memory retrieval and conditioned responding of vasopressin and oxytocin, respectively.

Administration, Intranasal↗
PubMed1993

Psychophysiological assessment of posttraumatic stress disorder imagery in World War II and Korean combat veterans.

We assessed the heart rate, skin conductance, and left lateral frontalis electromyographic responses of World War II (WWII) and Korean War male veterans to recollection of their combat experiences by using a script-driven imagery technique previously validated in Vietnam veterans (Pitman et al., 1990; Pitman, Orr, Forgue, de Jong, & Claiborn, 1987). Medication-free subjects were classified on the basis of criteria from the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders into posttraumatic stress disorder (PTSD; n = 8) and non-PTSD (n = 12) groups, which did not differ in overall combat exposure or severity of personal combat events. PTSD subjects' physiological responses during personal combat imagery were markedly larger than those of non-PTSD subjects', even though the self-reported emotional responses of the two groups were comparable. A physiological discriminant function derived from Vietnam veterans (Orr et al., 1990) correctly classified 7 of the 8 PTSD subjects (sensitivity was 88%) and 12 of the 12 non-PTSD subjects (specificity was 100%; p < .001).

Aged↗
PubMed1993

Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder.

OBJECTIVE: This study used a script-driven imagery technique, previously used with combat veterans, to assess physiologic responses of Israeli survivors of noncombat traumas. METHOD: Each subject had experienced an event meeting DSM-III-R criterion A for posttraumatic stress disorder (PTSD). The subjects were classified on the basis of the full DSM-III-R criteria into a current PTSD group (N = 13) and a non-PTSD group (N = 13). Thirty-second scripts describing each subject's personal traumatic event, as well as other events, were prepared. The scripts incorporated subjective visceral and muscular responses reported to have accompanied each experience. In the laboratory, the scripts were read one at a time to the subject, who was instructed to imagine each event portrayed as vividly as possible, while heart rate, skin conductance, and left lateral frontalis electromyogram levels were measured. RESULTS: Multivariate analysis of variance revealed that the physiologic responses of the PTSD subjects during imagery of their personal traumatic experiences were significantly greater than those of the non-PTSD subjects. This difference was not explained by age, gender, or rated severity of the traumatic event. A physiologic discriminant function derived from previously studied Vietnam veterans correctly classified nine of the 13 PTSD subjects (sensitivity = 69%) and 10 of the 13 non-PTSD subjects (specificity = 77%). CONCLUSIONS: These results replicate previous findings of heightened physiologic responses during personal combat imagery in male American war veterans and extend them to a group of male and female Israeli civilian victims of trauma, supporting the robustness of physiologic responding during personal traumatic imagery as a measure of PTSD.

Adult↗
PubMed1993

Neurological status of Vietnam veterans with chronic posttraumatic stress disorder.

This study investigated neurological status in 27 medication-free outpatient Vietnam veterans meeting DSM-III-R criteria for posttraumatic stress disorder (PTSD) and 15 non-PTSD combat control subjects, all without alcohol or drug dependence or abuse during the past year. Subjects underwent neurological examination, neuropsychological testing, and sleep-deprived EEG. PTSD subjects showed significantly more neurological soft signs than non-PTSD subjects. Neither substance dependence/abuse nor the more frequent history of developmental problems in PTSD subjects accounted for this difference. There were no significant EEG or neuropsychological testing group differences; however, there were significant correlations between several neuropsychological test scores and total neurological soft signs.

Adult↗
PubMed1993

Psychophysiologic testing for post-traumatic stress disorder: forensic psychiatric application.

The validity of the post-traumatic stress disorder (PTSD) diagnosis is limited by both the illusory objectivity of the traumatic event and the subjectivity of the ensuing syndrome. These limitations are especially problematic in the forensic setting. Psychophysiologic measurements may strengthen PTSD's forensic value by offering a more objective assessment technique for cases that find their way into the courtroom. Based upon the results of published research studies conducted in a range of military and civilian, PTSD and non-PTSD subjects, psychophysiologic data can provide evidence helping to establish or refute the presence of the DSM-III-R PTSD arousal criteria, as well as aid psychiatric experts in estimating the probability of the disorder's presence in a given claimant. Psychophysiologic testing should be viewed as one component of a multimethod forensic psychiatric evaluation for PTSD. It is likely that it will soon be offered and, given current legal standards, admitted as evidence in civil and criminal litigation.

Arousal↗
PubMed1992

Physiologic responses to loud tones in Israeli patients with posttraumatic stress disorder.

Orbicularis oculi (eye blink) electromyogram, skin conductance, and heart rate responses to 15 consecutive 95-dB, 500-millisecond, 1000-Hz tones with 0-millisecond rise and fall times were measured in 14 patients with posttraumatic stress disorder, 14 patients with other anxiety disorders, 15 mentally healthy subjects with past traumatic experiences, and 19 mentally healthy subjects with no trauma history. The patients with posttraumatic stress disorder showed significantly larger skin conductance and heart rate responses and a trend toward larger electromyogram responses to the tones than every other group. These effects were not explained by subjective anxiety, resting physiologic arousal, physiologic arousal preceding the tone trials, or initial physiologic responsivity. The group with posttraumatic stress disorder was the only one that failed to show habituation of skin conductance responses.

Acoustic Stimulation↗
PubMed1992

Psychophysiologic response during script-driven imagery as an outcome measure in posttraumatic stress disorder.

BACKGROUND: A psychophysiologic method previously validated in Vietnam veterans was used to evaluate the responses of medication-free Israeli posttraumatic stress disorder (PTSD) patients to script-driven imagery, before and after treatment with systematic desensitization. METHOD: Skin conductance, heart rate, and frontalis EMG responses during imagery of traumatic events were assessed in three unmedicated Israeli PTSD patients. The t test of significance was used to compare the magnitude of the response to traumatic imagery with that of responses to imagery of nine other events. RESULTS: The elevated physiologic responses to traumatic imagery, observed before treatment, normalized after systematic desensitization. Imagery of traumata that were not treated by desensitization continued to produce elevated responses. CONCLUSION: Physiologic response during traumatic imagery may be useful in the evaluation of differential treatment outcome in PTSD.

Adult↗
PubMed1991

Psychiatric complications during flooding therapy for posttraumatic stress disorder.

The authors use six case vignettes to illustrate underrecognized complications occurring during flooding therapy for posttraumatic stress disorder (PTSD), including exacerbation of depression, relapse of alcoholism, and precipitation of panic disorder. A common denominator to the majority of these cases appears to be the mobilization of negative posttrauma appraisal, accompanied by shame, guilt, and anger. The authors suggest that flooding may not be helpful for these negative emotions in the manner that it is for anxiety. Suggestions for preventing and treating complications of flooding therapy for PTSD include employing more cognitive forms of therapy in cases at risk; supporting abstinence from alcohol and other substances; providing adjunctive pharmacologic treatment as indicated, e.g., tricyclics for depression or panic; and providing long-term follow-up.

Acute Disease↗