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PubMed1994

The development of the Self-Rating Inventory for Posttraumatic Stress Disorder.

In this study a newly developed Self-rating Inventory for Posttraumatic Stress Disorder (PTSD) is presented. The instrument consists of 47 items, reflecting DSM-III-R criteria, associated features and items corresponding to the disorder of extreme stress not otherwise specified. All items are phrased in a trauma-independent way and are measured on an intensity scale. The instrument was validated on 76 subjects with war-related trauma and 59 psychiatric outpatients, one third of whom were traumatized. Test-retest for the scale was 0.90. The coefficient alpha appeared to be 0.96 for the 47-items scale and 0.92 for the 22 DSM-III-R subscale. The scale correlated significantly with the Clinician Administered PTSD Scale, the Mississippi Scale for Combat-related PTSD, the MMPI PTSD subscale and the Impact of Event Scale. The overall efficiency of the Self-rating Inventory for PTSD was comparable to the overall efficiency of the Mississippi Scale and superior to the MMPI PTSD subscale. Factor analysis on the 22 DSM-III-R items showed 4 factors, representing numbing, intrusion, avoidance and sleeping problems. It is concluded that the Self-rating Inventory for PTSD is a powerful instrument for diagnosing PTSD in survey research. The instrument appears to be capable of differentiating not only between PTSD and non-PTSD subjects but also between traumatized non-PTSD subjects and non-traumatized psychiatric patients.

Adult↗

PubMedDate not supplied

Seasonal pattern of posttraumatic stress disorder admissions.

Seasonal influences in some psychiatric disorders have been reported. Therefore, we examined whether a seasonal variation exists in posttraumatic stress disorder (PTSD). Charts of Vietnam veterans with PTSD (N = 160) admitted to a Veterans Administration Medical Center during a 3-year period were reviewed for season of admission. We found that admissions for PTSD were significantly more frequent in spring and summer. These preliminary results suggest the possibility that seasonal factors may influence PTSD.

Combat Disorders↗

PubMed1989

Delayed onset PTSD among Israeli veterans of the 1982 Lebanon War.

This is an exploratory study of the nature, course and rates of delayed post-traumatic stress disorder (PTSD). We reviewed 150 medical files of Israeli soldiers who sought help between 6 months and 5 years after the 1982 Lebanon War. Results indicated that only 10% of the cases were truly examples of delayed PTSD; in a large proportion of the cases, help-seeking rather than onset was delayed.

Adult↗

PubMedDate not supplied

Reviewing Frankl's Will to meaning and its implications for psychotherapy dealing with post-traumatic stress disorder.

Recent research has shown that people who have gone through war experiences in one way or the other tend to manifest reactions classified as post-traumatic stress disorder. Viktor Frankl, the founder of logotherapy, manifested PTSD reactions when he was in a concentration camp. This paper attempts to sketch how he lived through his traumatic experiences by relying on the principle of Will to Meaning as his survival mechanism. Two implications will be outlined derived from this principle for psychotherapies dealing with disaster survivors.

Behavior Therapy↗

PubMed1994

Legal aspects of post-traumatic stress disorder.

The legal requirements for compensable injury in civil law gradually has loosened over the years from the physical effects of direct injury to include the emotional effects of direct injury, the emotional effects of witnessing injury to others, the emotional effects of knowing of injury to others, and a person's fear that he or she may become ill at a later date. Although a psychiatric diagnosis is not required to bring action, post-traumatic stress disorder (PTSD) has become the favored diagnosis in cases of emotional distress. Also, in criminal law, defenses based on PTSD have become increasingly common, being used as the standard defense in selected situations. The limits of the use of PTSD as a defense remain to be clarified; differing judgments have been made in similar cases by different courts.

Adult↗

PubMed1982

Use of a feeding procedure in the treatment of a stress-related anxiety disorder.

A feeding procedure was used with a Vietnam veteran who became highly anxious when near a springhouse that resembled the site where he had been wounded in Vietnam. After 36-hr of food deprivation, the patient ate his favorite meal while sitting next to the springhouse. Treatment successfully reduced both anxiety and avoidance behavior. Results of a 10-month follow-up showed no relapse.

Adult↗

PubMed1997

Antidepressant treatment, posttraumatic stress disorder, survivor guilt, and spiritual awakening.

A patient with posttraumatic stress disorder (PTSD) had a major depressive episode that was responsive to treatment with the antidepressant fluoxetine. In contrast to the remission of other symptoms of depression, the associated feature of survivor guilt became more dramatically obvious. Individualized treatment of survivor guilt may be needed for patients with PTSD and major depression.

Alcoholism↗

PubMed1991

PTSD and the Vietnam veteran: the battle for treatment.

1. Patients with post-traumatic stress disorder (PTSD) often encounter treatment that is complicated by professional bias, personal issues, countertransference, and pathological staff dynamics. 2. Treatment is further complicated by diagnostic confusion, the dual diagnoses of substance abuse or depression, and symptoms that mimic personality disorders or psychosis. 3. The special circumstances of the Vietnam conflict that contributed to the susceptibility and etiology of PTSD are the individual characteristics of those who served, the special nature of the war itself and the military strategies used, and the psychosocial and cultural milieu in which it occurred.

Attitude of Health Personnel↗

PubMedDate not supplied

Posttraumatic stress disorder and self-reported physical health status among U.S. Military personnel serving during the Gulf War period: a population-based study.

The objective of this study was to investigate the relation between posttraumatic stress disorder (PTSD) and perceived physical health. Participants included 3,682 Gulf War veterans and control subjects of the same era who completed a telephone survey about their health status. PTSD was assessed using the PTSD Checklist-Military Version. Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life. The results of this study are consistent with studies of other combat veterans and provide further support for an association between PTSD and adverse physical health outcomes. Stressful or traumatic life events, such as those encountered during a rapid military deployment and conflict, are associated with a variety of adverse health effects. These health effects may manifest themselves in both psychological and physical outcomes. Health care providers must be attentive to recognize and evaluate both of these dimensions.

Adult↗

PubMed2004

Global-local visual processing in posttraumatic stress disorder.

The purpose of this study was to examine a behavioral index of hemispheric asymmetry (i.e., visual hierarchical attention) in posttraumatic stress disorder (PTSD), a disorder characterized by anxiety and other emotional symptoms. A reaction time based, computerized, global-local visual paradigm was administered to 26 PTSD-diagnosed and 22 psychopathology-free right-handed, male Vietnam War zone veterans. Results indicated that PTSD-diagnosed veterans displayed slower reaction times to all targets than the no-mental disorders comparison sample. However, findings also revealed a Group x Target location interaction in which the PTSD group was slower than the no-disorders comparison sample to respond to local, but not global, targets. Moreover, relative global bias was greater among PTSD-diagnosed veterans than their no-diagnosis counterparts. Findings provide partial support for the hypothesis that PTSD may be associated with a functional cerebral asymmetry favoring the right hemisphere.

Analysis of Variance↗

PubMed1992

The prevalence of posttraumatic psychopathology in the general and the clinical population.

Since the beginning of psychiatry, there has been a controversy about the consequences of traumatic events. Although there is no real dispute about human suffering caused by extreme stress events, social scientists have wondered whether traumatic events could lead to lasting psychopathology. This dispute was very strong in the first two versions of the the diagnostic and statistical manual of the American Psychiatric Association, which came out in 1952 and 1968. In DSM I (1), trauma could only lead to "gross stress reactions", which were part of "transient situational personality disorders". Extreme stress events were thought to lead only to a transient/temporary disturbance and if there was more disturbance than that, another diagnostic label had to be found. This attitude towards trauma has changed over the years and from 1980, in DSM III, there emerged the Posttraumatic Stress Disorder, a disorder which can be lasting or transient (2). In the past years, it has become clear that posttraumatic stress disorders are not the only form of psychopathology that follows after traumatic events. Major depressive episodes and dissociative disorders can also follow traumatic events. In this article, the results of two studies are reviewed. The first is a survey of the major studies into the prevalence of disorders after traumatic events. The main conclusion of this study shows that about 20% of the people that go through severely distressing events develop severe disorders. The second study focuses on the prevalence of disorders in the process of coping with traumatic events in a psychiatric outpatient clinic. Results of this study showed that clinically significant signs of these disorders were found to be present in 18% of the psychiatric outpatient referrals. In the discussion, the conclusion is drawn that posttraumatic psychopathology is a phenomenon that every clinician is confronted with on a regular basis. We might then wonder why specific treatment for posttraumatic psychopathology is still such a neglected area in psychiatry and psychotherapy.

Adaptation, Psychological↗

PubMedDate not supplied

Posttraumatic stress disorder and platelet serotonin measures.

The role of serotonin (5HT) in the pathophysiology of posttraumatic stress disorder (PTSD) has been suggested by the overlap in clinical symptoms between PTSD and psychiatric conditions in which a serotonin dysfunction is implicated, as well as by the therapeutic efficiency of 5HT-related drugs (antidepressants, selective serotonin reuptake inhibitors and monoamine oxidase inhibitors) in alleviating symptoms in PTSD. In the present study, the blood platelet, which has been proposed as a peripheral model for the central serotonergic neurons, has been used to search for alterations in 5HT mechanisms in PTSD. Platelet serotonin level and kinetics of serotonin transporter and monoamine oxidase (MAO-B) were assessed in 63 combat-related PTSD patients and 43 sex and age-matched control subjects. A significant reduction in maximal velocity of platelet MAO-B (approx. 30%), with no changes in the enzyme affinity was observed in our patient sample. Conversely, no alterations in kinetic parameters (V(max), K(m)) of platelet serotonin transporter, as well as in platelet 5HT level, were found in the PTSD group.

Adult↗

PubMed2003

Social anxiety, depression, and PTSD in Vietnam veterans.

Many Vietnam veterans with PTSD report a high level of social anxiety and avoidance. Many traumatized individuals also suffer from symptoms of depression, which is often associated with significant problems in social functioning. In order to explore the relationship between social anxiety, depression, and PTSD, we recruited a group of Vietnam veterans with PTSD (n = 27), veterans with other mental disorders (n = 20), and veterans with no mental disorders (n = 35). Participants were administered diagnostic interviews and some of the most commonly used social anxiety instruments. Although the groups did not differ in their rates of social phobia, veterans with PTSD scored highest in most social anxiety measures. Veterans with PTSD were also more likely to be clinically depressed than veterans without PTSD at the time of the assessment. When controlling for the level of depression, the three groups no longer differed in any of the social anxiety measures. Furthermore, level of depression was the best predictor for group membership. These findings suggest that social anxiety in Vietnam combat veterans with PTSD is closely associated with mood disturbance, social withdrawal, and isolation associated with depression.

Combat Disorders↗

PubMed2006

Marital relations among former prisoners of war: contribution of posttraumatic stress disorder, aggression, and sexual satisfaction.

In this study, the authors examined the marital adjustment, spousal aggression, and sexual satisfaction of prisoners of war (POWs) 3 decades after their release. More specifically, the authors examined the extent to which impaired marital relations among former POWs are an outcome of their captivity or of the posttraumatic stress disorder (PTSD) that some of them developed. The authors compared 25 former POWs with PTSD, 85 former POWs without PTSD, and 104 control veterans. The findings reveal that the marital problems of former POWs are more related to PTSD than to their captivity. PTSD is related to decreased marital satisfaction, increased verbal aggression, and heightened sexual dissatisfaction among former POWs.

Adaptation, Psychological↗

PubMed1999

Course and predictors of posttraumatic stress disorder among Gulf War veterans: a prospective analysis.

Rates and predictors of posttraumatic stress disorder (PTSD) over time are not well understood. This study is the first to look at the rates of PTSD immediately following war and 2 years later using a large cohort (N = 2,949) of Gulf War veterans. Using a cut score to indicate presumptive PTSD, 3% of participants exceeded the cutoff at Time 1 compared with 8% at Time 2. Those who exceeded the cutpoint at Time 1 were up to 20 times more likely to exceed the cutpoint at Time 2 than those who did not exceed the cutpoint at Time 1. Women and those with high levels of combat exposure were at increased risk for PTSD at both times. Being young, being single, and having previous combat experience were associated with increased risk at Time 1 only, whereas reservists and enlisted personnel were at increased risk at Time 2 only. These findings indicate that, although low initially, rates of PTSD increased substantially over time.

Adult↗

PubMed2006

Dissemination of evidence-based mental health interventions: importance to the trauma field.

Randomized controlled trials have established the efficacy of psychotherapy and medication treatments for posttraumatic stress disorder (PTSD). Despite these advancements, many individuals do not receive guideline-concordant PTSD care. In an effort to advance dissemination of evidence-based PTSD treatments, the authors review several examples of dissemination efforts of mental health interventions. The first examples describe the dissemination of multifaceted collaborative care interventions for patients with depressive disorders and evidence-based interventions for patients with severe mental illness. The final example explores evolving efforts to adapt and disseminate interventions to acutely injured trauma survivors. For each example, the authors describe the problem with prior clinical approaches, the program to be disseminated, the barriers and levers to implementation and the progress in overcoming these barriers.

Case Management↗

PubMed1994

Race-related PTSD: the Asian American Vietnam veteran.

This article presents a conceptual framework by which to understand race-related post-traumatic stress disorder (PTSD) for the Asian American Vietnam veteran. The framework draws from cognitive schema theory, social behaviorism, the notion of cumulative racism as trauma, and the assumption that bifurcation and negation of one's bicultural identity is injurious. Classifications of race-related stress or trauma that may be experienced by Asian American Vietnam veterans, with exemplifying clinical case material, are presented. These types of stressors include being mistaken for Vietnamese, verbal and physical assaults that are race-related, death and near-death experiences that are race-related, racial stigmatization, dissociation from one's Asian identity, and marginalization. As studies of combat trauma and sexual assault forced the psychological stresses attendant to war and sexist oppression into public consciousness, so this article addresses psychological stress and trauma attendant to racism.

Adaptation, Psychological↗

PubMed1989

Multiple diagnosis in posttraumatic stress disorder. The role of war stressors.

Prior studies have shown that posttraumatic stress disorder (PTSD) in Vietnam veterans is associated with various aspects of war stressors and that other diagnoses often co-occur with PTSD in this population. The present report examines the prediction of other diagnoses, in combination with PTSD, from a variety of war stressor experiences in a broad sample of veterans recruited from clinical and nonclinical sources. The results show that PTSD with panic disorder is better explained by war stressors than other diagnostic combinations and that high-risk assignments and exposure to grotesque deaths were more salient than other stressor experiences in accounting for different diagnostic combinations. Implications of the findings for PTSD's placement in the DSM-III-R and for psychological and pharmacological treatments were discussed.

Adult↗