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PubMedDate not supplied

Clinical assessment for post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is an increasingly fashionable diagnosis used to describe an individual who experiences psychological problems following his/her involvement in a traumatic event. However, PTSD can prove difficult to assess accurately owing to the unique problems of co-morbidity with other psychological disorders or the late onset of symptoms. Paradoxically, PTSD may be misdiagnosed by a healthcare professional which may result in inappropriate therapeutic intervention. This article introduces a simple five-stage assessment that is designed to help the clinician determine whether the client's distress is caused by PTSD or another disorder. These guidelines are structured and explore the five stages of PTSD assessment: collecting background information; initial contact with the client; correctly identifying the problem; general assessment; and summary. Finally, some recommended structured clinical assessment guidelines and psychometric rating scales are outlined.

Adult↗
PubMed2004

Noradrenergic mechanisms in the pathophysiology of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a serious psychiatric illness that may develop in individuals after exposure to a traumatic event. Recent data suggest that trauma and/or long-term stressors can cause alterations in the functioning of neuroanatomical structures and neural networks throughout the central nervous system. Specifically, dysregulation in central and perhaps, peripheral noradrenergic neural networks has been implicated as the cause of specific symptom clusters in the pathophysiology of PTSD. In this review, both clinical and preclinical data are presented to highlight types of noradrenergic dysfunction observed in individuals with PTSD. Additionally, the role of noradrenaline dysregulation in the acquisition/initiation, and maintenance of hyperarousal and reexperiencing symptom clusters in PTSD will be addressed.

Animals↗
PubMed1991

A new technique for treating post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) symptoms are notoriously difficult to treat. The need for a simple, easily reproducible technique, that could inactivate the repetitive intrusive imagery of the traumatic event, prompted the trial of a technique originally devised for phobias. Nineteen members of the West Midlands Police Force, who qualified as PTSD sufferers, were offered the 're-wind' technique. On average only three therapeutic sessions were required per patient. During a two-year follow-up, all victims remained free of intrusive images and resumed their occupations. It is hoped that such a consistently rapid and effective technique will open the way for more victims to be treated and for controlled trials to be facilitated.

Association↗
PubMed2004

Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder.

Post-traumatic stress disorder (PTSD) affects about 20-30% of exposed individuals. Clinical studies of PTSD generally employ stringent criteria for inclusion in study populations, and yet in animal studies the data collection and analysis are generally expressed as a function of exposed vs nonexposed populations, regardless of individual variation in response. Prior data support an approach to animal models analogous to inclusion criteria in clinical studies. This series of studies sought to assess prevalence rates of maladaptive vs adaptive responses determined according to a more stringent approach to the concept of inclusion/exclusion criteria (cutoff behavioral criteria-CBC), consisting of two successive behavioral tests (elevated plus maze and acoustic startle response tests). The rats were exposed to stressors in two different paradigms; exposure to a predator and underwater trauma. The prevalence rates of maladaptive responses to stress in these two distinct models dropped over time from 90% in the acute phase to 25% enduring/maladaptive response at 7 days, to remain constant over 30 days. As setting the affected individuals apart from the unaffected approximates clinical studies, it might also help to clarify some of the pending issues in PTSD research.

Acoustic Stimulation↗
PubMed2002

Lower cortisol levels in depressed patients with comorbid post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is often comorbid with major depressive episodes (MDEs) and both conditions carry a higher rate of suicidal behavior. Hypothalamic-pituitary-adrenal (HPA) axis and serotonin abnormalities are associated with both conditions and suicidal behavior, but their inter-relation is not known. We determined cortisol response to placebo or fenfluramine in MDE, MDE and PTSD (MDE+PTSD), and healthy volunteers (HVs) and examined the relation of cortisol responses to suicidal behavior. A total of 58 medication-free patients with MDE (13 had MDE+PTSD) and 24 HVs were studied. They received placebo on the first day and fenfluramine on the second day. Cortisol levels were drawn before challenge and for 5 h thereafter. The MDE+PTSD group had the lowest plasma cortisol, the MDE group had the highest, and HVs had intermediate levels. There were no group differences in cortisol response to fenfluramine. Suicidal behavior, sex, and childhood history of abuse were not predictors of baseline or postchallenge plasma cortisol. Cortisol levels increased with age. This study finds elevated cortisol levels in MDE and is the first report of lower cortisol levels in MDE+PTSD. The findings underscore the impact of comorbidity of PTSD with MDE and highlight the importance of considering comorbidity in psychobiology.

Adult↗
PubMed1993

Borderline disorder and post-traumatic stress disorder: an equivalence?

This paper draws attention to various similarities between Borderline Personality Disorder and Post-traumatic Stress Disorder. It is argued that the former may be considered to be an equivalent of the latter, with the difference that the trauma has either undergone repression or, having been suffered before the establishment of speech, has not been registered in verbal form. The criteria for Borderline Personality Disorder are presented in terms of symptoms of failed attachment consistent with early trauma, and various research papers linking these concepts are considered. Other research in infant attachment suggests intergenerational links between disorganised attachment patterns in infancy and parents with unresolved problems with their own parents. Research concerning the biochemical underpinning of emotional responses is quoted to link these conditions more securely, and may offer a conceptual framework in which to understand the need of these patients for a therapeutic milieu in which early developmental needs may be understood.

Arousal↗
PubMed2006

Hypothalamic-pituitary-adrenal axis function in dissociative disorders, post-traumatic stress disorder, and healthy volunteers.

BACKGROUND: This study investigated basal and stress-induced hypothalamic-pituitary-adrenal (HPA)-axis alterations in dissociative disorders (DDs). METHODS: Forty-six subjects with DD without lifetime post-traumatic stress disorder (PTSD), 35 subjects with PTSD, and 58 healthy comparison (HC) subjects, free of current major depression, were studied as inpatients. After a 24-hour urine collection and hourly blood sampling for ambient cortisol determination, a low-dose dexamethasone suppression test was administered, followed by the Trier Social Stress Test. RESULTS: The DD group had significantly elevated urinary cortisol compared with the HC group, which was more pronounced in the absence of lifetime major depression, whereas the PTSD and HC groups did not differ. The DD group demonstrated significantly greater resistance to, and faster escape from, dexamethasone suppression compared with the HC group, whereas the PTSD and HC groups did not differ. The three groups did not differ in cortisol stress reactivity, but both psychiatric groups demonstrated a significant inverse correlation between dissociation severity and cortisol reactivity, after controlling for all other symptomatology. The PTSD subgroup with comorbid DD tended to have blunted stress reactivity compared with the HC group. CONCLUSIONS: The study demonstrates a distinct pattern of HPA-axis dysregulation in DDs, emphasizing the importance of further study of stress-response systems in dissociative psychopathology.

Adult↗
PubMedDate not supplied

[Post-traumatic stress disorder].

A traumatic experience outside the scope of the usual human experience (flood, earthquake, industrial disaster, fire, road accident, death camp, torture and bombing) results in a certain number of people in a traumatic disorder which was described for the first time in 1980. The third edition of the Diagnostic and Statistical Manual (DSM-III) of mental illnesses published by the American Psychiatric Society gave a definition of post-traumatic stress disorder which was amended in 1987 in the revised edition of the same manual. The same definition has been accepted by the International Classification of Diseases and Causes of Death (ICD-10). The disorder is observed in 30-80% of the survivors of catastrophic events, in 18-54% of the war veterans, in 17-67% of the prisoners of war, and the prevalence in the course of life is 9.2%. The symptoms include reliving the experience of the traumatic event, avoidance of stimuli related to the trauma, generally dulled reactions and a lack of alertness. PTSD etiology comprises the following: stressor (strength, duration and circumstances of occurrence), personality (age, personality traits, previous experience, genetic predisposition, and available social support) and organic factors (effects of autonomic nervous system and neurobiological changes in the brain). The etiology of the understanding of the disorder is supported by the psychoanalytical theories (primary and secondary gain, anxiety neurosis and conflict neurosis) together with the behavioural cognitive theories based on conditioning and the theory of learning.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed2006

Pharmacotherapy for post traumatic stress disorder (PTSD).

BACKGROUND: Post traumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment. OBJECTIVES: To assess the effects of medication for post traumatic stress disorder. SEARCH STRATEGY: We searched the Cochrane Depression, Anxiety and Neurosis Group specialised register (CCDANCTR-Studies) on 18 August 2005, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 4, 2004), MEDLINE (January 1966 to December 2004), PsycINFO (1966 to 2004), and the National PTSD Center Pilots database. Reference lists of retrieved articles were searched for additional studies. SELECTION CRITERIA: All randomised controlled trials (RCTs) of pharmacotherapy for PTSD. DATA COLLECTION AND ANALYSIS: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. MAIN RESULTS: 35 short-term (14 weeks or less) RCTs were included in the analysis (4597 participants). Symptom severity for 17 trials was significantly reduced in the medication groups, relative to placebo (weighted mean difference -5.76, 95% confidence intervals (CI) -8.16 to -3.36, number of participants (N) = 2507). Similarly, summary statistics for responder status from 13 trials demonstrated overall superiority of a variety of medication agents to placebo (relative risk 1.49, 95% CI 1.28 to 1.73, number needed to treat = 4.85, 95% CI 3.85 to 6.25, N = 1272). Medication and placebo response occurred in 59.1% (N = 644) and 38.5% (628) of patients, respectively. Of the medication classes, evidence of treatment efficacy was most convincing for the SSRIs. Medication was superior to placebo in reducing the severity of PTSD symptom clusters, comorbid depression and disability. Medication was also less well tolerated than placebo. A narrative review of 3 maintenance trials suggested that long term medication may be required in treating PTSD. AUTHORS' CONCLUSIONS: Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability. The findings of this review support the status of SSRIs as first line agents in the pharmacotherapy of PTSD, as well as their value in long-term treatment. However, there remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.

Antidepressive Agents↗
PubMed2002

[Is the borderline personality disorder a complex post-traumatic stress disorder? - The state of research].

Regarding the high prevalence of traumatic experiences in patients with borderline personality disorders (BPD), we review the available literature focussing on the hypothesis that BPD is a subtype of trauma associated disorders. The criteria of BPD, of complex post-traumatic stress disorders (PTSD), and of disorders of extreme stress not otherwise specified (DESNOS) substantially overlap. Research of the long-term course of BPD and PTSD, trauma research, and research of vulnerability in both disorders yielded converging results. Neuropsychological deficits in BPD and PTSD as well as psychoendocrinological and neuroimaging studies in BPD und PTSD also revealed common features. A pathogenetic specificity of individual etiologic factors does not appear to exist, however the assumption of a diathesis-stress model with traumatisation as a necessary but etiologically insufficient condition seems justified. Further research will have to prove BPD as a complex and early-onset post-traumatic stress disorder after multiple and/or chronic (type II) traumatic experiences during childhood and/or youth. Definitive conclusions require further research efforts.

Adolescent↗
PubMedDate not supplied

Does comorbid anxiety or depression affect clinical outcomes in patients with post-traumatic stress disorder and alcohol use disorders?

Post-traumatic stress disorder (PTSD) is commonly comorbid with other psychiatric disorders, including substance use disorders. In spite of this, pharmacologic treatment trials for PTSD often exclude individuals with significant psychiatric comorbidity. This study is a post hoc analysis of a 12-week double-blind placebo-controlled trial investigating sertraline in the treatment of patients with comorbid PTSD and an alcohol use disorder. Individuals with additional anxiety and affective disorders were included. Patients (N = 93) were stratified into four groups depending on presence or absence of additional anxiety or depressive disorders and evaluated for the effects of comorbidity on PTSD symptoms, depressive symptoms, and drinking behaviors. We hypothesized that additional comorbidity would be associated with poorer outcomes. Patients in all four subgroups showed marked and clinically significant improvement in alcohol drinking behaviors over the course of the study. For the entire sample, over the course of the 12 weeks, mean drinks per drinking day fell from 13.0 +/- 8.4 (SD) to 3.0 +/- 5.0 (SD); t = 10.2, df = 92, P <.000. There were, however, no significant differences among groups. Patients in all four groups showed moderate improvement in Hamilton Depression Rating Scale (HAMD) scores and Clinician-Administered PTSD scale (CAPS) scores at endpoint. For the entire sample, mean CAPS scores fell from 59.3 +/- 19.4 (SD) to 40.8 +/- 26.0, t = 8.9, df = 92, P <.000. Mean HAMD scores fell from 17. 9 +/- 6.7 (SD) at baseline to 11.8 +/- 9.4 (SD) at endpoint; t = 6.7, df = 92, P <.000. There were, however, no significant differences among groups for change in HAM-D or CAPS scores. Hence, contrary to our hypothesis, having additional anxiety or mood disorder comorbidity did not decrease treatment response in individuals with comorbid PTSD and an alcohol use disorder.

Adult↗
PubMed2003

Misidentification of the self in a patient with a psychotic disorder and post-traumatic stress disorder.

The central characteristic of the delusional misidentification syndromes is a delusion of personal misidentification of the self or of others. Other symptoms of psychopathology in addition to delusional misidentification may be important contributors to the misidentification of people. In this article we report the case of a man who suffered from the syndrome of subjective doubles, reverse subjective doubles associated with a psychotic disorder and post-traumatic stress disorder. The contribution of his psychiatric disorders in the genesis of delusional misidentification is explored. Capgras Syndrome was also present.

Adult↗
PubMed1993

The incident in Kure--a 40-year follow-up of post-traumatic stress disorder.

A traumatic incident involving Allied Occupation Forces in Japan in 1947 came to light in the course of pension applications by three Australian ex-servicemen. They had been present when a 'fire fight' took place between Australian and Indian soldiers based near Kure, apparently resulting in the death of two Sikhs. The emotional consequences had been suppressed, as had details of this incident, for 40 years. These cases provide a rare insight into the long-term consequences of traumatic events. The nature of chronic post-traumatic stress disorder and the necessity for evaluation of the contribution that traumatic experience can make to continuing psychopathology are discussed.

Adult↗
PubMed2004

Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors.

PURPOSE: Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. PATIENTS AND METHODS: Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. RESULTS: The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. CONCLUSION: The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.

Adult↗
PubMed1993

Autistic disorder and post-traumatic stress disorder.

The present case study examined an adolescent boy who initially was evaluated at our clinic and was found to meet DSM-III-R criteria for autistic disorder. After placement in a residential school using Daily Life Therapy for autistic disorder, the subject reported being physically abused by a staff member. Additional psychiatric evaluation revealed post-traumatic stress disorder (PTSD) including symbolic anxiety and repetition of the trauma. The diagnosis of PTSD should be considered in children with autistic disorder and other severe developmental disorders who have experienced physical and sexual abuse. Furthermore, parents, professionals, educators, and child care workers struggle with emotional reactions to children with severe developmental disorders and may have difficulty accepting the reality of the child rather than the fantasy of the "wished-for child." The disappointment of this fantasy and the equating of the child's weaknesses as one's own may lead to personal devaluation and increase the risk of abusive behavior.

Autistic Disorder↗
PubMed2004

Acute stress disorder as a predictor of post-traumatic stress disorder in physical assault victims.

The authors' objective was to examine the ability of acute stress disorder (ASD) and other trauma-related factors in a group of physical assault victims in predicting post-traumatic stress disorder (PTSD) 6 months later. Subjects included 214 victims of violence who completed a questionnaire 1 to 2 weeks after the assault, with 128 participating in the follow-up. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. Twenty-two percent met the full PTSD diagnosis and 22% a subclinical PTSD diagnosis. Previous lifetime shock due to a traumatic event happening to someone close, threats during the assault, and dissociation explained 56% of PTSD variance. Inability to express feelings, hypervigilance, impairment, and hopelessness explained another 15% of PTSD variance. The dissociative, the reexperiencing, the avoidant, and the arousal criteria of the ASD diagnosis correctly classified 79% of the subsequent PTSD cases.

Adaptation, Psychological↗