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PubMed2006

[Pain processing in patients with borderline personality disorder, fibromyalgia, and post-traumatic stress disorder].

The authors review relevant experimental studies on pain perception and processing in psychiatric disorders with traumatic stress as an etiological factor. In borderline personality disorder, post-traumatic stress disorder, and fibromyalgia neurophysiological and neuropsychological patterns of pain processing appear to be different. Experimental studies in borderline patients show a desensitization of pain thresholds whereas patients with fibromyalgia show an opposite pattern, which could be explained by a central augmentation of pain processing. Furthermore, the authors outline methods to assess pain perception (peripheral and central) and describe the neurobiological mechanisms of pain processing, particularly the distinction between the sensory-discriminative lateral system and the affective-motivational medial system. Finally, suggestions for further research and implications for therapy are proposed.

Central Nervous System↗

PubMed2005

Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study.

BACKGROUND: Post-traumatic stress disorder (PTSD) is the only psychiatric condition that requires a specific event to have occurred for its diagnosis. AIMS: To gather evidence from the adult general population on whether life events (e.g. divorce, unemployment) generate as many symptoms of post-traumatic stress as traumatic events (e.g. accidents, abuse). METHOD: Data on demographic characteristics and history of stressful events were collected through a written questionnaire sent to a random sample of 2997 adults. Respondents also filled out a PTSD symptom checklist, keeping in mind their worst event. Mean PTSD scores were compared, controlling for differences between the two groups. Differences in item scores and in the distribution of the total PTSD scores were analysed. RESULTS: Of the 1498 respondents, 832 were eligible for inclusion in our analysis. For events from the past 30 years the PTSD scores were higher after life events than after traumatic events; for earlier events the scores were the same for both types of events. These findings could not be explained by differences in demographics, history of stressful events, individual item scores, or the distribution of the total PTSD scores. CONCLUSIONS: Life events can generate at least as many PTSD symptoms as traumatic events. Our findings call for further studies on the specificity of traumatic events as a cause of PTSD.

Adult↗

PubMed2006

Pharmacotherapy for disordered sleep in post-traumatic stress disorder: a systematic review.

Sleep disorders, such as insomnia and nightmares, are common problems in post-traumatic stress disorder (PTSD), exert a strong negative influence on the quality of life and are a great challenge for clinical psychiatry. Several studies have reported on the efficacy of drugs for the treatment of PTSD-related sleep disorders. These studies have not been systematically reviewed. This is the first review on the effectiveness of sleep medication in PTSD. We performed a Medline, EMBASE and Cochrane Library Indexed search, using the keywords: PTSD, pharmacotherapy, therapy, sleep, nightmares, insomnia and review. From this database, English-language, human subject, data driven papers published after 1980 were selected. Forty eight articles are discussed. Open-label and case studies suggest efficacy for some antidepressants, anticonvulsants and atypical antipsychotics. Only a few placebo-controlled studies have been published. They show promising results for the atypical antipsychotic olanzapine, and the alpha1-adrenoceptor antagonist prazosin. In comparison to the incidence and impact of sleep complaints in PTSD, the pharmacotherapeutic armamentarium for PTSD-related sleep complaints remains poorly investigated. Some recent studies show promising results, especially for alpha1-adrenoceptor and 5-HT2 receptor antagonists. However, randomized controlled trials with larger populations need to be conducted.

Adrenergic alpha-1 Receptor Antagonists↗

PubMedDate not supplied

Developing a traditional chinese medicine diagnostic structure for post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought. METHODS: Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations. RESULTS: The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation-Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire-and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems. CONCLUSIONS: The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.

Anxiety↗

PubMed1999

Variceal haemorrhage and post-traumatic stress disorder.

OBJECTIVE: Post-traumatic Stress Disorder (PTSD) is thought to be relatively common following extremely distressing life-threatening events. Patients with liver cirrhosis can experience severe brisk variceal haemorrhage during which they vomit litres of blood and may exsanguinate. We predicted that a significant proportion of survivors would suffer from PTSD. DESIGN: PTSD assessment of 30 patients who had a haematemesis of more than four units of blood secondary to variceal bleeding and were fully conscious at the time of the bleed. METHOD: Structured Clinical Diagnostic Interview (SCID-DSM-III-R) and self-report measures. RESULTS: Most found the experience distressing, but only 1 out of 30 patients fulfilled DSM-III-R diagnostic criteria for PTSD. CONCLUSIONS: PTSD in a sample of patients who survived life-threatening variceal haemorrhage is much rarer than might reasonably have been anticipated. Possible reasons for this low prevalence of PTSD are discussed.

Attitude to Death↗

PubMed2003

Diagnosis and management of post-traumatic stress disorder.

Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to 9 percent, and approximately 25 to 30 percent of victims of significant trauma develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: re-experiencing the trauma, marked avoidance of usual activities, and increased symptoms of arousal. Before a diagnosis of PTSD can be made, the patient's symptoms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment.

Humans↗

PubMed2000

Acute and post-traumatic stress disorder after spontaneous abortion.

When a spontaneous abortion is followed by complicated bereavement, the primary care physician may not consider the diagnosis of acute stress disorder or post-traumatic stress disorder. The major difference between these two conditions is that, in acute stress disorder, symptoms such as dissociation, reliving the trauma, avoiding stimuli associated with the trauma and increased arousal are present for at least two days but not longer than four weeks. When the symptoms persist beyond four weeks, the patient may have post-traumatic stress disorder. The symptoms of distress response after spontaneous abortion include psychologic, physical, cognitive and behavioral effects; however, patients with distress response after spontaneous abortion often do not meet the criteria for acute or post-traumatic stress disorder. After spontaneous abortion, as many as 10 percent of women may have acute stress disorder and up to 1 percent may have post-traumatic stress disorder. Critical incident stress debriefing, which may be administered by trained family physicians or mental health practitioners, may help patients who are having a stress disorder after a spontaneous abortion.

Abortion, Spontaneous↗

PubMed2005

Child maltreatment and HPA axis dysregulation: relationship to major depressive disorder and post traumatic stress disorder in females.

A history of child maltreatment increases the vulnerability to the development of Major Depressive Disorder (MDD) and/or Posttraumatic Stress Disorder (PTSD), especially in females. Both MDD and PTSD are associated with a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Dysregulation of the HPA axis may be an important etiological link between child maltreatment and subsequent psychiatric disorder, yet little is known about the relationship between exposure and outcome. The aim of this review is to explore the role of HPA axis dysregulation in the link between child maltreatment and MDD/PTSD among women. Studies of females with MDD frequently indicate a hyperactivity of the HPA axis, and contribute to our understanding of the underlying mechanisms involved in mood dysregulation. Evidence for HPA axis dysregulation in PTSD is less convincing and suggests that timing of the stressful experience as well as the type of the trauma may influence the outcome. The strongest evidence to date suggesting that the development of the HPA axis may be affected by early life stressful experiences comes from pre-clinical animal studies. Together these studies add to our understanding of the role of the HPA axis in psychiatric disorders in relation to stress. The literature on HPA axis function in both children and adults following child maltreatment further highlights the potential relevance of early stress to later onset of major psychiatric disorders. Such knowledge may also contribute to the development of early interventions targeted at primary prevention.

Adolescent↗

PubMed2000

The use of stimulants in the treatment of post traumatic stress disorder: case report.

Post Traumatic Stress disorder (PTSD) is a condition where the individual suffers re-experiencing phenomena, avoidance behaviour or emotional numbing and hyperarousal following a major traumatic event. Psychological treatments, primarily behavioural, and psychopharmacological interventions have been shown to be of considerable benefit. This case report describes an individual suffering from PTSD who experienced almost complete remission of her symptoms following the prescription of a centrally acting stimulant for unrelated reasons. The actions of centrally acting stimulants and the current knowledge about the neurophysiology of PTSD may help to explain the patient's recovery. Further investigation of amphetamine-like substances and related compounds in PTSD is required. Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗

PubMed2000

Elevated circulatory level of GABA(A)--antagonistic neurosteroids in patients with combat-related post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a multisystem neurobiological disorder with chronic alterations in various neurochemical systems. Levels of the GABA(A)--antagonistic neurosteroids plasma dehydroepiandrosterone (DHEA) and its sulphate derivate, dehydroepiandrosterone sulphate (DHEAS) may be relevant to depressive and anxiety disorders, including PTSD. METHODS: We assessed the circulatory levels of morning plasma DHEA and DHEAS in 21 male outpatients with untreated chronic combat-related PTSD (CR-PTSD), and 18 healthy control male subjects. RESULTS: Compared with the control subjects, the PTSD patients showed significantly higher plasma DHEA and DHEAS levels. CONCLUSIONS: Chronic CR-PTSD may be associated with increased circulatory level of neuroactive steroids with inhibitory activity at the GABA(A) receptors. Neurosteroid-induced decreased GABAergic tone may be relevant to the symptomatology and pathophysiology of chronic PTSD, as well as to the frequent co-morbidity of PTSD with depression and anxiety disorders.

Adult↗

PubMed2002

Brief report: prevalence of post-traumatic stress disorder symptoms after severe traumatic brain injury in a representative community sample.

PRIMARY OBJECTIVE: In this study, the authors investigated the prevalence of symptoms of post-traumatic stress disorder (PTSD) in a community sample of 66 survivors of severe traumatic brain injury (TBI). RESEARCH DESIGN, METHODS AND PROCEDURES: A representative sample of survivors of TBI were selected on the basis of having suffered significant disturbance in consciousness following their trauma event in the form of coma and/or post-traumatic amnesia. Neuropsychological testing confirmed that participants had suffered cognitive deficits consistent with severe brain injury. Participants were administered the Impact of Events inventory for symptoms of PTSD. MAIN OUTCOMES AND RESULTS: The authors found a prevalence rate of 18% for moderate-to-severe PTSD symptoms. CONCLUSIONS: PTSD symptoms are common following severe TBI. Further research is needed to establish protective and predictive factors for PTSD in TBI groups.

Adolescent↗

PubMed1992

Noise-induced psychogenic tremor associated with post-traumatic stress disorder.

Tremors in post-traumatic stress disorders have not been previously well characterized. A 67-year-old man has a 46-year history of a noise-induced exaggerated startle reflex followed by a large amplitude rest, postural and kinetic tremor that may persist for up to 3 days. This tremor is superimposed on a continuous mild organic postural/kinetic tremor whose electrophysiological characteristics are different from those of the overlying tremor. We attribute the exaggerated startle reflex and the noise-induced tremor to Post-Traumatic Stress Disorder (PTSD) and postulate a psychogenic origin for the noise-induced tremor. The patient also believes the noise-induced tremor to be psychologically based and to be produced by the fear and anxiety he experiences when he hears loud, unexpected noises. The sudden onset of the noise-induced tremor, its intermittent character, its temporary disappearance on distraction despite the patient's inability to suppress it, inconsistencies in handwriting and figure drawing, and the fact that the noise-induced tremor is stimulus specific and persists long after the offending stimulus (noise) is no longer present all suggest a tremor of psychogenic origin.

Accidents↗

PubMed2004

Client-centred therapy, post-traumatic stress disorder and post-traumatic growth: theoretical perspectives and practical implications.

In practice it is not unusual for client-centred therapists to work with people who have experienced traumatic events. However, client-centred therapy is not usually considered within texts on traumatic stress and questions have been raised over the appropriateness of client-centred therapy with trauma survivors. The present study shows how, although he was writing well before the introduction of the term 'post-traumatic stress disorder', Carl Rogers provided a theory of therapy and personality that contains an account of threat-related psychological processes largely consistent with contemporary trauma theory. Rogers' theory provides the conceptual underpinnings to the client-centred and experiential ways of working with traumatized people. Furthermore, Rogers' theory provides an understanding of post-traumatic growth processes, and encourages therapists to adopt a more positive psychological perspective to their understanding of how people adjust to traumatic events.

Humans↗

PubMedDate not supplied

Post-traumatic stress disorder due to childbirth: the aftermath.

BACKGROUND: Childbirth qualifies as an extreme traumatic stressor that can result in post-traumatic stress disorder. The reported prevalence of post-traumatic stress disorder after childbirth ranges from 1.5% to 6%. OBJECTIVE: The aim of this phenomenologic study was to describe the essence of mothers' experiences of post-traumatic stress disorder after childbirth. METHODS: The qualitative research design used for this study was descriptive phenomenology. The main recruitment approach was via the Internet through the help of Trauma and Birth Stress, a charitable trust in New Zealand. Purposive sampling was used and resulted in 38 mothers participating from the countries of New Zealand, the United States, Australia, and the United Kingdom. The participants were asked to describe their experiences with post-traumatic stress disorder after childbirth. Their stories were analyzed using Colaizzi's method of data analysis. RESULTS: Mothers with post-traumatic stress disorder attributable to childbirth struggle to survive each day while battling terrifying nightmares and flashbacks of the birth, anger, anxiety, depression, and painful isolation from the world of motherhood. CONCLUSIONS: This glimpse into the lives of mothers with post-traumatic stress disorder attributable to childbirth provides an impetus to increase research efforts in this neglected area.

Adaptation, Psychological↗

PubMed2001

Rem sleep behavior disorder: potential relationship to post-traumatic stress disorder.

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia in which there is enactment, often violent, of dream mentation. Although this syndrome is sometimes associated with neurologic disorders, psychiatric comorbidity is not typical. The authors present a unique series of veterans with RBD. A high incidence of comorbidity with post-traumatic stress disorder is noted. The literature on RBD is reviewed, and the coexistence of RBD and post-traumatic stress disorder is reasoned. The authors suggest that it is possible that similar neuropathologic processes are responsible for both conditions, at times in the same patient.

Adult↗

PubMed2001

A twin study of generalized anxiety disorder symptoms, panic disorder symptoms and post-traumatic stress disorder in men.

Generalized anxiety disorder (GAD), panic disorder (PD) and post-traumatic stress disorder (PTSD) often co-occur. We investigated whether and to what degree genetic and environmental contributions overlap among symptoms of GAD, symptoms of PD and PTSD. Subjects were 3327 monozygotic and dizygotic male-male twin pair members of the Vietnam Era Twin Registry who participated in a 1992 telephone administration of the Diagnostic Interview Schedule Version 3 Revised (DIS3R). Genetic model fitting was performed to estimate the magnitude of genetic and environmental contributions to the lifetime co-occurrence of GAD symptoms, PD symptoms and PTSD. The liability for GAD symptoms was due to a 37.9% additive genetic contribution common to PD symptoms and PTSD. Liability for PD symptoms was due to a 20.7% additive genetic contribution common to GAD symptoms and PTSD, and a 20.1% additive genetic influence specific to PD symptoms. Additive genetic influences common to symptoms of GAD and PD accounted for 21.3% of the genetic variance in PTSD. Additive genetic influences specific to PTSD accounted for 13.6% of the genetic variance in PTSD. Remaining variance for all three disorders was due to unique environmental factors both common and specific to each phenotype. These results suggest that these disorders each have etiologically distinct components and also have significant genetic and unique environmental contributions in common.

Adult↗

PubMed1994

Post-traumatic stress disorder in chronic post-traumatic headache patients.

The prevalence of post-traumatic stress disorder (PTSD) was examined in a sample of chronic post-traumatic headache patients. All subjects had been injured in a motor vehicle accident and had developed headache or experienced marked exacerbation of an existing headache condition as a result. Nearly 30% of the sample was diagnosed with PTSD. Depression and suppressed anger were significantly higher in subjects with PTSD compared to the rest of the sample. Those with PTSD were more likely to have a history of headache prior to the accident than subjects without PTSD. Comparisons between the PTSD and non-PTSD groups on other headache and demographic variables were non-significant. The importance of evaluating post-traumatic headache patients for the presence of PTSD is discussed.

Accidents, Traffic↗

PubMed2005

Hopelessness as a risk factor for post-traumatic stress disorder symptoms among interpersonal violence survivors.

Post-traumatic stress disorder often co-occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post-traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self-reported and interviewer-rated measures of hopelessness gathered at 2 weeks post-trauma and self-reported and interviewer-rated symptoms of post-traumatic stress disorder gathered at 2 weeks and 3 months post-trauma were examined. Hierarchical, simultaneous regression analyses that co-varied trauma type revealed that hopelessness was related to self-reported symptoms of post-traumatic stress disorder, both concurrently and prospectively. Follow-up analyses revealed that relationships between hopelessness and symptoms of post-traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer-rated symptoms of post-traumatic stress disorder.

Adolescent↗