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Results for “Stress Disorders, Traumatic”

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PubMed1991

Delayed emergence of post-traumatic stress disorder.

Post-traumatic Stress Disorder (PTSD) is the development of characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. A Chinese male with a delayed onset, non-combat post-traumatic stress disorder is described and discussed. This is an unusual case because the symptoms were reexperienced four years after a life threatening vehicular accident. The patient responded to a combination of antidepressant treatment and individual psychotherapy. He remained well on follow up one year later.

Accidents, Traffic↗

PubMed1993

Use of thioridazine in post-traumatic stress disorder.

Post-traumatic stress disorder is a condition that develops in persons who have experienced emotional or physical stress of sufficient magnitude to be extremely traumatic for virtually anyone. This may include natural catastrophes, combat experiences, rape, or other such horrifying events. The three major features of the disorder are reexperiencing the trauma through dreams, emotional numbing, and autonomic instability. To date, several treatment modalities have been used, usually consisting of a combination of psychotherapy and drug treatment. Although controversy exists, antidepressants and monoamine oxidase inhibitors are used most commonly, while other drugs such as lithium, carbamazepine, and antipsychotic drugs may be useful. We have reported a case involving a 44-year-old combat veteran who experienced severe flashbacks of his time spent in Vietnam. His symptoms and general state of mind improved significantly while taking the antipsychotic drug thioridazine.

Adult↗

PubMed2005

Misdiagnosis of post-traumatic stress disorder following severe traumatic brain injury.

BACKGROUND: The incidence of post-traumatic stress disorder (PTSD) after traumatic brain injury is unclear. One issue involves the validity of diagnosis using self-report questionnaires. AIMS: To compare PTSD'caseness' arising from questionnaire self-report and structured interview. METHOD: Participants (n=34) with traumatic brain injury were recruited. Screening measures and self-report questionnaires were administered, followed by the structured interview. RESULTS: Using questionnaires, 59% fulfilled criteria for PTSD on the Post-traumatic Diagnostic Scale and 44% on the Impact of Events Scale, whereas using structured interview (Clinician-Administered PTSD Scale) only 3% were 'cases'. This discrepancy may arise from confusions between effects of PTSD and traumatic brain injury. CONCLUSIONS: After traumatic brain injury, PTSD self-report measures might be used for screening but not diagnosis.

Adult↗

PubMed2006

Cortical/hippocampal monoamines, HPA-axis changes and aversive behavior following stress and restress in an animal model of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is characterized by monoaminergic and hypothalamic-pituitary-adrenal (HPA)-axis abnormalities. Understanding monoamine-HPA-axis responses following stress and restress may provide a greater understanding of the neurobiology of PTSD and of its treatment. Hippocampal and frontal cortex serotonin, noradrenaline and dopamine, plasma corticosterone and aversive behavior were studied in rats on day 1 and day 7 post acute stress (AS = sequential restraint stress, swim stress and halothane exposure), and on day 1 and day 7 post restress (RS = swim stress). After AS, there was an early increase in both avoidant behavior and corticosterone (1 h after stress), with subsequent normalisation (day 7), suggesting an adequate adaptive response to the stressor. However, restress (RS) evoked a significant early HPA-axis hyporesponsiveness (1 h after RS) and a later significant increase in avoidant behavior on day 7 post RS. Hippocampal serotonin, noradrenaline and dopamine concentrations were unchanged 1 h post AS, but were significantly raised on day 7 post AS. Restress, however, reduced serotonin and noradrenaline levels 1 h after and on day 7 post RS, respectively, while dopamine was unchanged. In the frontal cortex only dopamine levels were altered, being significantly elevated 1 h after AS, and reduced on day 7 post RS. AS and RS thus differently effect the HPA-axis, evoking regional-specific brain monoamine changes that underlie maladaptive behavior and other post stress-related sequelae.

Analysis of Variance↗

PubMed2000

Coping style and post-traumatic stress disorder following severe traumatic brain injury.

There is increasing evidence that a proportion of severe traumatically brain injured (TBI) patients do suffer post-traumatic stress disorder (PTSD). The aim of this study was to investigate the predictors of PTSD following severe TBI in a sample of 96 patients who sustained a severe TBI, of whom 27% satisfied diagnostic criteria for PTSD. The Post-traumatic Stress Disorder Interview, the Coping Style Questionnaire, and the Functional Assessment Measure was administered to these patients 6 months after hospital discharge. Avoidant coping style, behavioural coping style, and a history of prior unemployment were the significant predictors of PTSD severity. These findings indicate that reduction of PTSD and management of severe TBI may be facilitated by teaching patients more adaptive coping strategies.

Adaptation, Psychological↗

PubMed1996

Effect of repeated visual traumatic stimuli on the event related P3 brain potential in post-traumatic stress disorder.

Post-Traumatic Stress Disorder (PTSD) patients are characterized by a hypersensitivity to traumatic stimuli which may be expressed as an automatic and involuntary cognitive response. Electrophysiologically this can be recorded as an augmented visual P3 (P300) event related potential (ERP). This study examined P3 changes in response to repeated traumatic pictorial stimuli presented in the form of a visual discrimination oddball paradigm to 40 Israeli combat veterans with and without PTSD. Subjects were asked to press a button when target stimuli (domestic animal pictures) appeared, and to ignore all non-target stimuli (irrelevant pictures of furnishings/flowers and traumatic combat related pictures). On average, P3 in response to combat related pictures was earlier and approximately 5 times greater in amplitude for the PTSD patients as compared to the controls. Repeated combat related pictures stimuli presentation resulted in a rapid and appreciable P3 amplitude reduction and latency prolongation. This effect was not observed for the target stimuli. These findings suggest that a gradually reduced amount of attentional resource is required and allocated to the processing of repeated CRP stimuli. This may occur as a consequence of the activation of an inhibitory mechanism related to the cognitive processing of traumatic stimuli.

Adult↗

PubMed1998

[The epidemiology of post-traumatic stress disorders].

Post-traumatic stress disorder (PTSD) has been subjected to several epidemiological studies during the last 10 years. Large differences in prevalence between different studies can only partly be explained by differences in methodology, impact of the trauma and populations. Changes in diagnostic criteria, the stressor criteria, general mentality over time and cultural differences may account for some of the differences. In general populations a lifetime prevalence of PTSD of between 1% and 9% has been found. In unselected traumatized populations 20-45% will develop PTSD after exposure to significant traumas. Among soldiers who have participated in battles of war a PTSD prevalence of 15-20% has been found. After exposure to lesser traumas and among well-trained corps 5-10% develop PTSD. Over long periods the point prevalence of PTSD in a given traumatized population diminishes. Predictive factors related to PTSD are complex.

Combat Disorders↗

PubMed1993

Uncontrolled pain following physical injury as the core-trauma in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a psychiatric diagnostic category characterized by "the development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience". Research shows that the prevalence of PTSD among injured survivors of stressful events is higher than that of survivors without physical injury, thus suggesting that secondary stressors (e.g., severe uncontrolled pain, a prolonged state of acute anxiety, uncertainty regarding the immediate future, loss of control, and inability to monitor contact with the environment) may play an important role in the formation of PTSD. However, pain has never been suggested or recognized as a direct cause of PTSD. We present the case of a patient who lost an eye under traumatic circumstances and was later diagnosed as suffering from PTSD. Upon evaluation in a psychophysiological laboratory, this patient's core-trauma was discovered to be 7 h of severe uncontrolled pain while waiting for surgery, rather than the moment when he lost his eye during military service. The case suggests that pain, although not "generally outside the range of usual human experience", may be a strong enough stressor in traumatic circumstances to cause the development of PTSD, thus highlighting the importance of prompt and adequate pain management in hospitalized survivors of traumatic injury.

Adult↗

PubMed2006

The auditory startle response in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) patients are considered to have excessive EMG responses in the orbicularis oculi (OO) muscle and excessive autonomic responses to startling stimuli. The aim of the present study was to gain more insight into the pattern of the generalized auditory startle reflex (ASR). Reflex EMG responses to auditory startling stimuli in seven muscles rather than the EMG response of the OO alone as well as the psychogalvanic reflex (PGR) were studied in PTSD patients and healthy controls. Ten subjects with chronic PTSD (>3 months) and a history of excessive startling and 11 healthy controls were included. Latency, amplitude and duration of the EMG responses and the amplitude of the PGR to 10 auditory stimuli of 110 dB SPL were investigated in seven left-sided muscles. The size of the startle reflex, defined by the number of muscles activated by the acoustic stimulus and by the amplitude of the EMG response of the OO muscle as well, did not differ significantly between patients and controls. Median latencies of activity in the sternocleidomastoid (SC) (patients 80 ms; controls 54 ms) and the deltoid (DE) muscles (patients 113 ms; controls 69 ms) were prolonged significantly in PTSD compared to controls (P < 0.05). In the OO muscle, a late response (median latency in patients 308 ms; in controls 522 ms), probably the orienting reflex, was more frequently present in patients (56%) than in controls (12%). In patients, the mean PGR was enlarged compared to controls (P < 0.05). The size of the ASR response is not enlarged in PTSD patients. EMG latencies in the PTSD patients are prolonged in SC and DE muscles. The presence of a late response in the OO muscle discriminates between groups of PTSD patients with a history of startling and healthy controls. In addition, the autonomic response, i.e. the enlarged amplitude of the PGR can discriminate between these groups.

Acoustic Stimulation↗

PubMed2006

Sensitivity to carbon dioxide in drug-naïve subjects with post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is currently classified as an anxiety disorder in DSM-IV, and as a neurosis or stress-related disorder in ICD-10. It shares many features with depression. Sensitivity to carbon dioxide (CO2), a classic provocation agent in the proto-typical anxiety disorder, panic disorder, has not been tested in PTSD. Twenty rigorously ascertained drug-naïve subjects with PTSD inhaled a single vital capacity inhalation of 35% CO2; before and after the inhalation they completed measures of PTSD and panic anxiety, and were rated for the presence of a panic attack. These results were retrospectively compared with those of 39 healthy volunteers and 17 patients with panic disorder previously studied by the same research group. PTSD symptoms were not exacerbated by CO2. Two out of twenty PTSD subjects panicked. PTSD subjects' responses were indistinguishable from those of healthy volunteers, and differed from those of subjects with panic disorder. The lack of sensitivity to carbon dioxide in PTSD subjects in the present study adds to the literature on the differences between PTSD and other anxiety disorders, and to that on the specificity of the CO2 challenge in panic disorder.

Adult↗

PubMed2005

Glucocorticoid receptor polymorphisms and post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is reported in some studies to be associated with increased glucocorticoid (GC) sensitivity. Two common glucocorticoid receptor (GR) polymorphisms (N363S and BclI) appear to contribute to the population variance in GC sensitivity. There is some evidence that there may be a genetic predisposition to PTSD. Hence we studied 118 Vietnam war veterans with PTSD for (i) GR polymorphisms, particularly the N363S and the BclI polymorphisms which are thought to be GC sensitising, and (ii) two measures of GC sensitivity, the low-dose 0.25 mg dexamethasone suppression test (LD-DST) and the dermal vasoconstrictor assay (DVVA). The DST and GR polymorphisms were also performed in 42 combat exposed Vietnam war veterans without PTSD. Basal plasma cortisol levels were not significantly different in PTSD (399.5+/-19.2 nmol/L, N=75) and controls (348.6+/-23.0 nmol/L, N=33) and the LD-DST resulted in similar cortisol suppression in both groups (45.6+/-3.2 vs. 40.8+/-4.1%). The cortisol suppression in PTSD patients does not correlate with Clinician Administered PTSD Scores (CAPS), however there was a significant association between the BclI GG genotype and low basal cortisol levels in PTSD (P=0.048). The response to the DVVA was similar to controls (945+/-122, N=106 vs. 730+/-236, N=28, P=0.42). PTSD patients with the GG genotype, however, tended to be more responsive to DVVA and in this group the DVVA correlated with higher CAPS scores. The only exon 2 GR polymorphisms detected were the R23K and N363S. Heterozygosity for the N363S variant in PTSD, at 5.1% was not more prevalent than in other population studies of the N363S polymorphism in Caucasians (6.0-14.8%). The GG genotype of the BclI polymorphism found to be associated with increased GC sensitivity in many studies showed a tendency towards increased response with DVVA and correlated with higher CAPS scores. In conclusion, the N363S and BclI GR polymorphisms were not more frequent in PTSD patients than controls and reported population frequencies. Our PTSD group did not display GC hypersensitivity, as measured by the LD-DST and DVVA. In a subset of PTSD patients with the BclI GG genotype, CAPS scores and basal cortisol levels were negatively correlated.

Adult↗

PubMed2006

Hippocampus function predicts severity of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is often accompanied by memory problems and abnormal brain structure, particularly within the hippocampus. We implemented a cross-species, hippocampal-dependent task--the virtual Morris Water task--to assess hippocampal function in people with PTSD and age-matched controls during functional magnetic resonance imaging (fMRI). Performance on the task was equivalent between the groups. However, when correlating fMRI-derived hippocampal activity during this task with PTSD severity, we observe a -0.84 correlation, indicating that those with reduced hippocampal activity show more severe PTSD symptoms. This correlation is not explained by differences in task performance, IQ, duration since trauma, nor time with PTSD. Hence, PTSD severity is predicted by functionally assessing the hippocampus using the virtual Morris water task, suggesting that this task may be used to identify those at risk for developing PTSD following a trauma.

Brain Mapping↗

PubMed1998

Response to venlafaxine in a previously antidepressant treatment-resistant combat veteran with post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is frequently treated with antidepressant medications, especially the newer selective serotonergic antidepressants which have documented efficacy in PTSD. Analogous to depression, however, some PTSD patients may not have a satisfactory response to these agents. This case report describes a PTSD patient who did not respond to several serotonergic antidepressants, but did improve with venlafaxine which has both noradrenergic and serotonergic properties.

Antidepressive Agents, Second-Generation↗

PubMed1992

Drug therapy of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a recently introduced diagnosis. The disorder is quite common, yet often unrecognised, and leads to significant morbidity or mortality. Effective treatment often entails use of psychotropic medication. Only recently has this become apparent, and awareness of the role of drug therapy in PTSD remains limited. A number of studies have indicated efficacy for antidepressant, mood-stabilising, anticonvulsant and antianxiety medications. This review describes the role of pharmacotherapy, by examining issues of diagnosis and recognition of PTSD, the theoretical basis for drug use, goals of drug treatment, dose ranges, and clinical application of psychotropic drugs.

Animals↗

PubMedDate not supplied

Behavioural treatments in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is increasingly becoming recognised as a serious mental health problem (Department of Health, 1991). Psychological treatments for PTSD remain in their infancy, though limited research has demonstrated the efficacy of behavioural and cognitive-behavioural interventions.

Adult↗

PubMed1993

Evaluation and treatment of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a common anxiety disorder seen by general practice physicians as well as by specialists. The authors review current assessment criteria, psychotherapy procedures, and psychopharmacological management of PTSD patients.

Antidepressive Agents↗

PubMed1998

Medical negligence and post traumatic stress disorder (PTSD).

Post traumatic stress disorder (PTSD) is well recognised as a consequence of natural and man-made disasters, accidents and assaults. An increasing number of plaintiffs making claims for compensation alleging medical negligence complain of the symptoms of PTSD. Medical accidents such as anaesthetic awareness and stillbirths may be claimed as stressors and relatives may allege PTSD as a psychological injury following witnessing the death or suffering of a loved one. A series of cases will be presented. Many cases are entirely genuine but increasing media publicity has alerted potential plaintiffs and their legal advisers to the symptoms of PTSD which make evaluation of symptoms difficult for psychiatric experts. Psychometric tests exist to screen PTSD but research has shown that they can be falsified and it would be unwise to rely on such tests.

Female↗

PubMed2000

Selective serotonin reuptake inhibitors in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a complex psychiatric condition, which can be triggered by a variety of traumatic events. Lifetime prevalence rates range from 1.3% to 10.4%, with women twice as likely as men to be affected. The clinical management of this condition is complex, since PTSD is associated with high rates of comorbid psychiatric disorders, particularly major depression, other anxiety and panic disorders, substance abuse and antisocial behaviour. Broadly, there are two main approaches to treatment: pharmacotherapy and cognitive or behavioural therapy. This paper reviews available pharmacological approaches for the treatment of PTSD and comorbid disorders. Although the optimal pharmacological approach has yet to be established, there is increasing evidence to support the use of antidepressants, and particularly selective serotonin reuptake inhibitors (SSRIs), as first-line therapy. In addition to alleviating the core symptoms of PTSD, some SSRIs are also effective for the treatment of common comorbidities, such as depression, panic disorder and social anxiety disorder; a fact which would appear to have important implications for patient management.

Clinical Trials as Topic↗