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T Peri

Publications and source records attributed to T Peri.

At least 19 recordsLinked to original sources
PubMed2000

Psychophysiologic assessment of aversive conditioning in posttraumatic stress disorder.

BACKGROUND: The objective of this study was to evaluate the acquisition, generalization, and extinction of conditioned physiologic responses to aversive stimuli in posttraumatic stress disorder (PTSD). METHODS: Thirty-six PTSD patients, 20 individuals with past trauma and no current PTSD, and 30 mentally healthy individuals without exposure to major trauma underwent a differential aversive conditioning experiment. Bursts of 105 dB white noise were used as unconditioned stimuli (UCSs), and 35x24 mm slides of different colors served as either CS+ (paired) or CS- (unpaired) stimuli. Heart rate (HR) and nondominant palm skin conductance (SC) were measured at rest and between 1 and 4 sec following each CS presentation. RESULTS: The PTSD group showed higher levels of resting SC and resting HR, larger SC responses to the initial presentation of unpaired CSs, larger HR responses following paired CS+ stimuli, larger SC responses to unpaired CS- during acquisition and extinction, and larger SC and HR responses to CS+ during extinction. The group differences in responses to CS+ during extinction remained statistically significant after controlling for age, resting physiologic levels, and initial responsivity. CONCLUSIONS: PTSD is associated with elevated autonomic responses to both innocuous and aversive stimuli, with larger responses to unpaired cues and with reduced extinction of conditioned responses.

Adult↗
PubMed2000

Auditory startle response in trauma survivors with posttraumatic stress disorder: a prospective study.

OBJECTIVE: Previous studies have shown elevated autonomic responses to startling tones in trauma survivors with chronic posttraumatic stress disorder (PTSD). The origin of these abnormal responses is obscure. The present study attempted to clarify this issue by prospectively evaluating responses to sudden, loud tones in individuals who arrived at a hospital emergency room after psychologically traumatic events. METHOD: By using a previously established protocol, autonomic and muscular responses to the tones were evaluated at 1 week, 1 month, and 4 months after the traumatic event. Structured diagnostic interviews performed at 4 months classified subjects into groups with (N=36) and without (N=182) PTSD, which were further subdivided according to the presence or absence of major depressive disorder as follows: neither PTSD nor depression (N=166), depression alone (N=16), PTSD alone (N=21), and both PTSD and depression (N=15). RESULTS: The groups showed comparable physiological responses to the tones at 1 week posttrauma. However, at 1 and 4 months posttrauma, the subjects with PTSD showed a greater heart rate response and required more stimulus trials to reach the criteria of skin conductance and orbicularis oculi electromyogram nonresponse. These findings were not significantly influenced by comorbid depression and were not explained by the severity of the traumatic event or by the intensity of the initial symptoms. CONCLUSIONS: Differences in physiological response to startling tones develop along with PTSD in the months that follow a traumatic event. This pattern supports the theories that associate PTSD with progressive neuronal sensitization.

Accidents, Traffic↗
PubMed2000

De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder.

Differential conditioning was assessed in 15 medication-free individuals meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for chronic posttraumatic stress disorder (PTSD) and 18 trauma-exposed individuals who never developed PTSD (non-PTSD). Conditioned stimuli (CSs) were colored circles, and the unconditioned stimulus was a "highly annoying" electrical stimulus. Individuals with PTSD had higher resting heart rate (HR) and skin conductance (SC) levels and produced larger SC orienting responses. During conditioning, the PTSD group showed larger differential SC, HR, and electromyogram responses to the reinforced vs. nonreinforced stimuli (CS+ vs. CS-) compared with the non-PTSD group. Only PTSD participants continued to show differential SC responses to CS+ vs. CS- during extinction trials. Results suggest that individuals with PTSD have higher sympathetic nervous system arousal at the time of conditioning and are more conditionable than trauma-exposed individuals without PTSD.

Adult↗
PubMed1999

Predictors of chronic post-traumatic stress disorder. A prospective study.

BACKGROUND: Most individuals who, shortly after trauma, express symptoms of post-traumatic stress disorder (PTSD) recover within one year of their traumatic experiences. In contrast, those who remain ill for one year rarely recover completely. The early identification of the latter is, therefore, very important. AIMS: To prospectively evaluate predictors of PTSD at four months and one year. METHOD: We followed 236 trauma survivors recruited from admissions to a general hospital's emergency room for four months, at which point 41 (17.4%) met diagnostic criteria for PTSD. Twenty-three of these individuals, and 39 individuals without PTSD at four months, were assessed again at one year. RESULTS: Depressive symptoms were the best predictors of PTSD at both time points. Intrusive symptoms and peri-traumatic dissociation were better at predicting four-month PTSD than one-year PTSD. CONCLUSIONS: The occurrence of depression during the months that follow a traumatic event is an important mediator of chronicity in PTSD.

Adult↗
PubMed1998

Alprazolam reduces response to loud tones in panic disorder but not in posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) and panic disorder (PD) share several clinical features, and theory postulates that phasic arousal is similarly dysregulated in both. The modulation of phasic arousal can be probed by measuring the effect of pharmacologic agents on auditory startle. METHODS: Eyeblink electromyogram, heart rate, and skin conductance (SC) responses to 15 consecutive presentations of 1000-Hz, 95-dB, zero rise-time pure tones were measured, before and during treatment with alprazolam, in 9 PTSD and 9 PD patients. Concurrent anxiety was assessed by the Hamilton Anxiety Rating Scale. RESULTS: The groups did not differ in initial psychometric and physiological measures. Significant decrease in anxiety was observed in both groups during treatment. A decrease in response probability and a decrease in the SC responses were observed in PD, but not in PTSD. CONCLUSIONS: The results may reflect a difference in the modulation of phasic arousal between the disorders. They may also express an impaired between-session habituation or contextual sensitization in PTSD.

Acoustic Stimulation↗
PubMed1998

A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.

BACKGROUND: Physiological arousal during traumatic events may trigger the neurobiological processes that lead to posttraumatic stress disorder (PTSD). This study prospectively examined the relationship between heart rate and blood pressure recorded immediately following a traumatic event and the subsequent development of PTSD. METHODS: Eighty-six trauma survivors who presented at the emergency department of a general hospital were followed up for 4 months. Heart rate and blood pressure were recorded on arrival at the emergency department. Heart rate, anxiety, depression, and PTSD symptoms were assessed 1 week, 1 month, and 4 months later. The clinician-administered PTSD scale defined PTSD status at 4 months. RESULTS: twenty subjects (23%) met PTSD diagnostic criteria at the 4-month assessment (PTSD group), and 66 (77%) did not (non-PTSD group). Subjects who developed PTSD had higher heart rates at the emergency department (95.5+/-13.9 vs 83.3+/-10.9 beats per minute, t=4.4, P<.001) and 1 week later (77.8+/-11.9 vs 72.0+/-9.5 beats per minute, t=2.25, P<.03), but not after 1 and 4 months. The groups did not differ in initial blood pressure measurement. Repeated-measures analysis of variance (ANOVA) for heart rate showed a significant group effect (P<.02), time effect (P<.001), and group x time interaction (P<.001). The time effect and group x time interaction remained significant when adjusted for sex, age, trauma severity, immediate response, and dissociation during the traumatic event. CONCLUSION: Elevated heart rate shortly after trauma is associated with the later development of PTSD.

Adult↗
PubMed1998

Prospective study of posttraumatic stress disorder and depression following trauma.

OBJECTIVE: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) and major depression following traumatic events. METHOD: The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview for DSM-III-R and the Clinician-Administered PTSD Scale) were administered 1 week, 1 month, and 4 months after the traumatic event. Heart rate was assessed upon arrival at the emergency room for subjects with physical injury. Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year. RESULTS: Major depression and PTSD occurred early on after trauma; patients with these diagnoses had similar recovery rates: 63 survivors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met criteria for major depression at 1 month, and 30 (14.2%) had major depression at 4 months. Comorbid depression occurred in 44.5% of PTSD patients at 1 month and in 43.2% at 4 months. Comorbidity was associated with greater symptom severity and lower levels of functioning. Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms, exaggerated startle, and peritraumatic dissociation than those with major depression. Prior depression was associated with a higher prevalence of major depression and with more reported symptoms. CONCLUSIONS: Major depression and PTSD are independent sequelae of traumatic events, have similar prognoses, and interact to increase distress and dysfunction. Both should be targeted by early treatment interventions and by neurobiological research.

Accidents, Home↗
PubMed1998

Historical group debriefing after combat exposure.

BACKGROUND: Studies of group debriefing after extreme events have failed to show a significant long-term effect of this technique. However, the heterogeneity of the interventions studied and the length of time between debriefing and its assessment do not allow a proper interpretation of these findings. OBJECTIVE: This study evaluates the immediate effect of debriefing in Israeli soldiers exposed to combat. METHOD: Six small units (N = 39) have undergone historical group debriefing within 72 hours of exposure. State anxiety, self-efficacy, and combat evaluation were measured before and immediately after the sessions. RESULTS: Debriefing was followed by reduction in anxiety, improvement in self-efficacy, and increased homogeneity of the group. CONCLUSION: These effects may be attributable to enhancing group cohesion or to a proper beneficial effect of debriefing.

Crisis Intervention↗
PubMed1997

Auditory startle responses in help-seeking trauma survivors.

Studies of the acoustic startle reflex in post-traumatic stress disorder (PTSD) yielded controversial results, whilst PTSD patients consistently report exaggerated startle. Addressing methodological difficulties of previous studies, the authors investigated the eyeblink, skin conductance and heart rate responses to 15 consecutive 95-dB, 500-ms, 1000-Hz sudden tones in 58 consecutive referrals of unmedicated help-seeking trauma survivors (30 with PTSD and 28 without PTSD). PTSD patients had higher average eyeblink and skin conductance responses to the tones. Differences between reports of exaggerated startle in PTSD and negative experimental findings may be explained by specific experimental conditions, such as reduced environmental input, and by concurrent use of medication.

Adult↗
PubMed1997

Physiologic responses to loud tones in Israeli veterans of the 1973 Yom Kippur War.

Eyeblink and autonomic components of the acoustic startle response were evaluated in a community sample of Israeli veterans of the Yom Kippur war. Individuals were solicited by mail and telephone to participate in the study; they were not seeking treatment or compensation. Nineteen Israeli veterans with current posttraumatic stress disorder (PTSD) and 74 veterans without PTSD were exposed to 15 consecutive 95-dB, 500-msec, 1000-Hz tones with 0-msec rise and fall times, while orbicularis oculi electromyogram, skin conductance, and heart rate responses were measured. Individuals with PTSD produced larger averaged heart rate responses, and a slower decline in skin conductance responses, across the 15 tone presentations compared to non-PTSD subjects. There was no group difference in the magnitude of the averaged electromyogram response. Results of this study replicate previous findings of increased autonomic responses to loud tone stimuli in this disorder.

Acoustic Stimulation↗
PubMed1997

Predicting PTSD in trauma survivors: prospective evaluation of self-report and clinician-administered instruments.

BACKGROUND: This study examined the ability of commonly used questionnaires and a structured clinical interview to predict PTSD in recent trauma survivors. METHOD: Horowitz's Impact of Event Scale (IES), Speilberger's State Anxiety (SANX) and the Peri Traumatic Dissociation Questionnaire (PDEQ) were administered one week post-trauma to 239 traumatised individuals recruited from a general hospital emergency room. The IES, the SANX, the civilian version of the Mississippi Scale for Combat Related PTSD (MISS), and the Clinician Administered PTSD Scale (CAPS) were administered one month and four months post-trauma. Receiver operator characteristic (ROC) analysis was used with these data. RESULTS: All questionnaires were better than chance at predicting PTSD. The so-called PTSD questionnaires (IES and MISS) were not better than the more general ones. No difference in predictive value was found when questionnaires were carried out one week or one month after a trauma. Recovery was better predicted than PTSD, and the CAPS was better than the questionnaires. DISCUSSION: The use of psychometrics and clinical interviews to predict PTSD should be guided by clinical relevance and by the availability of resources.

Adolescent↗
PubMed1996

Predictors of PTSD in injured trauma survivors: a prospective study.

OBJECTIVE: The aim of this study was to prospectively examine the relationship between immediate and short-term responses to a trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: All patients consecutively admitted to a general hospital were screened for the presence of physical injury due to a traumatic event. Fifty-one eligible subjects were assessed 1 week and 6 months after the trauma. The initial assessment included measures of event severity, peritraumatic dissociation, and symptoms of intrusion, avoidance, depression, and anxiety. The follow-up assessments added the PTSD module of the Structured Clinical Interview for DSM-III-R--Non-Patient Version and the civilian trauma version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. RESULTS: Thirteen subjects (25.5%) met PTSD diagnostic criteria at follow-up. Subjects who developed PTSD had higher levels of peritraumatic dissociation and more severe depression, anxiety, and intrusive symptoms at the 1-week assessment. Peritraumatic dissociation predicted a diagnosis of PTSD after 6 months over and above the contribution of other variables and explained 29.4% of the variance of PTSD symptom intensity. Initial scores on the Impact of Event Scale predicted PTSD status with 92.3% sensitivity and 34.2% specificity. Symptoms of avoidance that were initially very mild intensified in the subjects who developed PTSD. CONCLUSIONS: Peritraumatic dissociation is strongly associated with the later development of PTSD. Early dissociation and PTSD symptoms can help the clinician identify subjects at higher risk for developing PTSD.

Adult↗
PubMed1996

Treatment of recent trauma survivors with benzodiazepines: a prospective study.

BACKGROUND: Most types of psychotropic drugs have been tried in the treatment of chronic posttraumatic stress disorder (PTSD), but have yielded limited results. Theory and retrospective research predict that early treatment may be more efficacious. Specifically, high-potency benzodiazepines have been recommended for the treatment of acute responses to trauma and for prevention of PTSD. This study prospectively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms. METHOD: Thirteen trauma survivors (the benzodiazepine group) were treated within 6.7 +/- 5.8 days after the trauma (range, 2-18) with either clonazepam (N = 10, 2.7 +/- 0.8 mg/day) or alprazolam (N = 3, 2.5 mg/day). Thirteen other trauma survivors, pair-matched with subjects in the active treatment group for gender and symptom severity in the first week after the trauma, constitute the control group. Both groups were reevaluated 1 and 6 months after the trauma for PTSD symptoms (Horowitz Impact of Event Scale; Mississippi Rating Scale for Combat-Related PTSD-civilian trauma version), PTSD status (Clinician Administered PTSD Scale), state anxiety, depression, and resting heart rate. RESULTS: Subjects in the benzodiazepine group did not differ from controls in 1-month and 6-month PTSD and anxiety scores. Repeated measures ANOVA showed no group or group-by-time effect on psychometric measures. A trend toward group-by-time interaction in resting heart rate was noted (progressive decrease in the benzodiazepine group). Nine benzodiazepine subjects and 3 controls met PTSD diagnostic criteria 6 months after the trauma. CONCLUSION: Contrary to expectations, the early administration of benzodiazepines to trauma survivors with high levels of initial distress did not have a salient beneficial effect on the course of their illness, while reducing physiologic expression of arousal.

Alprazolam↗
PubMed1993

Auditory startle response in blind subjects.

Blindness is often associated with hypervigilance and arousal. The auditory startle response has been suggested as a measure of arousal. This study evaluated the auditory startle response of 10 blind individuals and 10 sighted controls who were exposed to a series of 15 1000-Hz, 95-db, 0-rise-time pure-tone stimuli, administered to both ears. The subjects' heart-rate, skin-conductance, and orbicularis-oculi-electromyogram responses to the tones were measured. Blind subjects did not differ from controls in the magnitude and in the habituation-rate of their responses. Results were interpreted as showing that blind persons' capacity for discriminative learning and for regulation of arousal is unimpaired. Task-related anxiety of blind persons should be differentiated from stimulus-related anxiety.

Acoustic Stimulation↗
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↗