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PubMedDate not supplied

[The role of day care hospitals in psychosocial rehabilitation of patients with psychiatric war injuries].

The integrative therapy with the aim of psychosocial rehabilitation of the patients with war psychotraumas, treated in the Day-time hospital in the period 1992-1996, was described and analysed in this study. There were 209 patients (175 males and 34 females)--133 (63.6%) war veterans and 76 (36.4%) refugees. All patients had posttraumatic mental disorders caused by strong war stressors. Diagnostic estimation was carried out in accordance with DSM-III-R classification and standardized PTSD interview. The most frequent were adaptation disorders and posttraumatic stress disorder. Eclectically oriented therapy which consisted of pharmacotherapy, psychotherapy, sociotherapy, occupational and recreational therapy was applied. The results of therapy and specially group therapy and social support, were positive; 182 (67.1%) patients were pronounced capable and 27 (12.9%) uncapable for work, but in almost all of them the social functioning and adaptation were improved. It could be said that the Day-time hospital was the optimal place for psychosocial rehabilitation of patients with war psychotraumas, because hospitalization and stigmatisation was omitted, with favourable conditions for keeping and renewal of the social network.

Adolescent↗

PubMed1999

Elevated lipid levels in Vietnam veterans with chronic posttraumatic stress disorder.

BACKGROUND: Elevated cholesterol levels have been reported in panic disorder and anger attacks, but not major depression. No data have been reported in posttraumatic stress disorder (PTSD). METHODS: Seventy-three male Vietnam veterans with chronic (PTSD) had serum lipid screening upon entry to a 90-day inpatient program. RESULTS: Elevated cholesterol, low-density lipoprotein, triglycerides, and reduced high-density lipoprotein, were frequent in Vietnam veterans with chronic PTSD and are significant risk factors for coronary artery disease. CONCLUSIONS: Routine lipid screening may be warranted in this at-risk population. Altered lipid levels may result from activation of the noradrenergic system.

Adult↗

PubMed2002

Exposure therapy for posttraumatic stress disorder.

Exposure therapy is a well-established treatment for Posttraumatic Stress Disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Exposure methods include confrontation with frightening, yet realistically safe, stimuli that continues until anxiety is reduced. A review of the literature on exposure therapy indicates strong support from well-controlled studies applied across trauma populations. However, there are many misconceptions about exposure therapy that may interfere with its widespread use. These myths and clinical guidelines are addressed. It is concluded that exposure therapy is a safe and effective treatment for PTSD when applied as directed by experienced therapists.

Adult↗

PubMed1996

A dual representation theory of posttraumatic stress disorder.

A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.

Adaptation, Psychological↗

PubMed2000

War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.

Adaptation, Psychological↗

PubMed1994

An eclectic inpatient treatment model for Vietnam and Desert Storm veterans suffering from posttraumatic stress disorder.

This paper describes the therapeutic components of an eclectic, intensive inpatient treatment strategy for Vietnam and Desert Storm veterans with posttraumatic stress disorder. A specific treatment model was devised by this author. The procedure was a collaborative effort: the staff and the patients participated in this preparatory phase treatment program at the Tripler Posttraumatic Stress Unit, Tripler Army Medical Center, Honolulu, Hawaii. The basic treatment is based on group therapy, utilizing educational, cognitive-behavioral therapy, gestalt therapy, and individualized psychotherapy, and eye movement desensitization strategies. The timing and sequencing of these treatments are a critical part of the model, and we have come to refer to it as the layered model because the treatments are layered, much like the delicious parfait dessert.

Adaptation, Psychological↗

PubMed1994

Eye movement desensitization and reprocessing in posttraumatic stress disorder: a pilot study using assessment measures.

Spectacular claims have been made regarding the efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of posttraumatic stress disorder (PTSD), but almost entirely on the basis of patients' reports and without objective criteria. This study reports on the treatment of eight patients with a diagnosis of PTSD who received EMDR treatment over four sessions. Assessment measures included two structured interviews, three self-report inventories, and the electromyogram (EMG). Assessments were conducted pre and posttreatment, and at 3-month follow-up. Despite some residual pathology at posttreatment and follow-up, significant improvements were obtained on all measures and across all PTSD symptom clusters. Compared with other treatments of PTSD, change was achieved in far fewer sessions.

Adaptation, Psychological↗

PubMedDate not supplied

Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder.

A study was conducted to investigate smoking patterns in 445 Vietnam veterans with and without posttraumatic stress disorder (PTSD). Combat veterans with PTSD reported similar occurrence of smoking (53%) compared to combat veterans without PTSD (45%). For those who smoked, combat veterans with PTSD reported a significantly higher rate of heavy smoking (> or = 25 cigarettes daily): 28% of combat veterans without PTSD were heavy smokers and 48% of combat veterans with PTSD were heavy smokers. PTSD diagnosis and heavy smoking status were independently and differentially related to motives for smoking. In combat veterans with PTSD, heavy smoking status was positively related to total health complaints, lifetime health complaints, health complaints in the past year, negative health behaviors, total PTSD symptoms, DSM-IV C cluster (avoidance and numbing) and D cluster (hyperarousal) PTSD symptoms. Heavy smoking status was also associated with fewer positive health behaviors.

Age Factors↗

PubMed2004

Post-war syndromes: illustrating the impact of the social psyche on notions of risk, responsibility, reason, and remedy.

The 20th century offered many examples of post-war syndromes such as Da Costa's syndrome, irritable heart, shell shock, effort syndrome, medical evacuation syndrome, post-traumatic stress disorder, and Gulf War syndrome. These post-war syndromes occur under conditions of substantial medical and scientific uncertainty, conditions that potentially magnify the impact of social context on clinical care for these syndromes. This article reviews the social circumstances surrounding four post-war syndromes. The case is made that social context has significantly impacted professional and lay perceptions of causal mediators, relevant risk factors, defining symptoms, and appropriate therapies for these syndromes. Furthermore, it is argued that social context influences what parties are held responsible for post-war syndromes, and what clinical disciplines are ultimately deemed appropriate to provide legitimate post-war illness care.

Combat Disorders↗

PubMed1992

Post-traumatic stress disorders and European war veterans.

After tracing the history of PTSD as a diagnosis and exemplifying its use among non-European war veteran groups, this review article documents the size and characteristics of European war veteran populations and the known psychological, social and medical sequelae of war experience since 1918. Models of psychopathology vary markedly over time and between countries. Treatment practices owe more to sociopolitical and military expediency than systematic assessment of European veterans' needs and treatment outcomes. PTSD has not yet attained the pivotal status it enjoys in studies of American war veterans. Reasons for this are offered along with a proposal that recent European studies rightly highlight a broad spectrum of post-war adjustment difficulties in which PTSD emerges as a process phenomenon with implications for prognosis and future care planning.

Adult↗

PubMed1988

Biological mechanisms in posttraumatic stress disorder. Relevance for substance abuse.

Recent studies suggest a significant biological contribution to posttraumatic stress disorder (PTSD). In particular, central catecholamine and endogenous opioid systems have been implicated both in this syndrome and in substance abuse. We review relevant animal and human studies that support these hypotheses and suggest that this overlap may contribute to the incidence of substance abuse in PTSD. The animal studies have primarily employed the learned helpless and conditioned emotional response models and have included assessments of brain catecholamines, locus ceruleus activity, and behavioral correlates in rodents and nonhuman primates. Human studies have used only indirect measures to assess these variables. However, both therapeutic approaches and attempts at self-medication for PTSD have supported this hypothesis.

Animals↗

PubMed1986

A population-based survey of loss and psychological distress during war.

Research on the psychological effects of war has been conducted on a limited number of population groups and has generally failed to study the experience of particular losses while warfare was still in progress. This paper presents the results of a household surveillance study of 5788 displaced and non-displaced civilians conducted during the summer 1982 war in Lebanon. In order to determine demographic differences in the psychological response to war and help identify population groups possibly at-risk for mental disorder, an interview checklist of symptoms of psychological distress was developed and administered to a key informant in each household. The occurrence of psychological distress symptoms varied significantly by age, sex, nationality, socio-economic status, loss of physical health and economic loss. A more detailed analysis of the psychological effect of displacement or loss of one's home during war is presented. Displacement group differentials suggest that psychological distress may be more frequently perceived post-war and that both social integration and social isolation may play important roles in mediating the perception of psychological distress during war.

Adolescent↗

PubMed1997

Actigraphic sleep monitoring in posttraumatic stress disorder (PTSD) patients.

Posttraumatic stress disorder (PTSD) patients frequently complain that they suffer from sleep disturbances. To date, the polysomnographic studies that have attempted to study PTSD patients' subjective complaints of sleep difficulties have produced conflicting results. The objective of the present study was to compare PTSD patients' subjective complaints of poor sleep and objective actigraphic recordings of their sleep over a period of several consecutive nights. The results indicate that PTSD patients do not suffer from poorer sleep than a control group, based on actigraphic measures, and that their subjective sleep evaluation is inconsistent with objective sleep measures. These patients fail to correctly estimate their sleep.

Adult↗

PubMed1985

A study of post traumatic stress disorder in Vietnam veterans.

Three groups of Vietnam-era veterans were compared on the frequency of symptoms typical of the diagnostic criteria for Post Traumatic Stress Disorder (PTSD), a diagnostic category introduced in DSM III (N = 90). The three groups consisted of veterans who had experienced (a) a war-related traumatic event; (b) a non-war-related traumatic event; or (c) no traumatic event. The results indicated that the two groups who experienced a traumatic event reported significantly more symptoms than the group who never experienced a traumatic event. Furthermore, the group who experienced a war-related traumatic event reported more symptoms than the group who experienced a non-war-related traumatic event. These results support the validity of PTSD.

Adult↗

PubMed1993

Road to recovery. Post-traumatic stress disorder: the hidden victim.

1. Post-traumatic stress disorder (PTSD) is characterized by the development of a set of specific symptoms following a psychologically distressing event that is outside the range of usual human experience. 2. Recovery does not seem to feel as difficult or overwhelming if it is approached "one day at a time." 3. The psychologic damage that occurs in PTSD is due primarily to holding the experiences inside, "stuffing" them down through various psychodynamics, or keeping the experiences subdued through addictive behaviors. 4. PTSD among Vietnam veterans is not a mental illness; it is a reaction to extreme stress and a reaction to keeping memories stuffed down and not allowed to surface.

Adult↗

PubMed1996

Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design.

Six patients with combat-related posttraumatic stress disorder (PTSD) entered a multiple-baseline trial of trazodone, beginning with 50 mg/day and increasing to 400 mg/day until response was maximal. Total Clinician-Administered PTSD Scale scores decreased from a mean of 92 at baseline to 79 at end point, and self-reported PTSD symptoms as measured by the Davidson Trauma Scale paralleled these results (mean of 102 at baseline to 88 at end point). Based on clinician global improvement scores, four patients were rated as much improved and two were rated to be minimally improved. Improvement in social and occupational functioning, and depression was minimal. Available follow-up scores for PTSD symptoms indicated that gains were maintained. Sleep was the first symptom to improve at 2 to 3 months. No dropouts during the treatment period occurred, and reported side effects were quite low. These preliminary data suggest that trazodone may be effective in reducing the three primary clusters of symptoms of PTSD. These findings should be confirmed by using a larger sample in a double-blind, placebo-controlled study.

Adult↗

PubMed1990

Invited review: post-traumatic stress disorder; a new clinical entity?

Recently a spate of large scale disasters has caught public attention. Survivors of unexpected catastrophes find their lives radically changed. They may develop a characteristic pattern of symptoms in response to their exposure to overwhelming stress. Ten years ago, American psychiatrists introduced a new diagnostic category, post-traumatic stress disorder (PTSD), referring to the range of psychological symptoms survivors demonstrate after extreme trauma (Diagnostic and Statistical Manual of Mental Disorders, APA, Washington D.C.). Although the validity of this syndrome remains debatable, the term PTSD is increasingly in use, a practice likely to continue given its inclusion in the draft edition of ICD 10 (WHO, Geneva). This review looks at the evidence that PTSD describes a specific clinical entity. The historical background to the belief that individuals respond to stress is summarized. The criteria that must be fulfilled and methods of establishing a diagnosis are described. A discussion of aetiological factors and the natural history of the psychological response to stress follows, with reference to clinical management, including the provision of effective intervention for survivors to prevent a full blown stress reaction emerging.

Adult↗

PubMed2002

Neurocognitive functioning in posttraumatic stress disorder.

This paper reviews the literature on performance on standard neuropsychological tests among individuals with posttraumatic stress disorder (PTSD). Of 19 studies, 16 reported impairment of attention or immediate memory (or both); however, most of these studies included PTSD patients with significant psychiatric comorbidity, so that the extent to which the observed deficits are specifically attributable to PTSD remains unclear. Other potential confounds, including medical illness, substance abuse, and motivational factors, further preclude definitive conclusions at present. Results of structural and functional neuroimaging studies of PTSD are also summarized. Two studies have reported correlations between hippocampal volume and cognitive findings in PTSD patients; functional studies have indicated specific findings in limbic regions, although the relationship of these results to neuropsychological performance remains to be explored.

Brain↗