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PubMed1991

Statistical analysis for single-case designs. Evaluating outcome of imaginal exposure treatment of chronic PTSD.

A recently developed statistical method for single-case subject designs based on classical test theory was used to examine the efficacy of imaginal exposure treatment for posttraumatic stress disorder (PTSD) in four Vietnam veterans. The method was sensitive to intraindividual changes across different outcome measures even when relatively few data points were available. Two veterans clearly improved from exposure and maintained their gains at 3- and 15-month follow-ups. One veteran improved marginally, whereas one veteran's symptoms worsened. Changes in heart rate monitored over the first two imaginal exposures indicated that veterans with greater heart-rate habituation responded better to exposure than did veterans with less or no habituation. The results suggest that the statistical method illustrated here has some advantages over other methods (e.g., visual inspection, time-series analysis) for examining clinical interventions in single-case designs.

Adult↗

PubMedDate not supplied

[Group psychotherapy in the treatment of post-traumatic stress disorder].

Working with psychotraumatized war veterans we perceived their extremely regressive position, which is accompanied by several destructive and autodestructive compulsions. Facing the multiple traumatic experiences which they lived through, a certain degree of regression has been appearing, since even a satisfying "nourishing-indulgence of their needs" cannot completely make up for their pre-war position. In this way occurred the splitting between ideal (introjected) object and real object, in which were projected all bad experiences, and which is still persecuting and wants to destroy. Through interactions between all group members of traumatized patients we analyzed the phenomena and the specificities of these groups-particularly their regressive position. The aim of the group psychotherapy was to enable progressive overcoming of regressive position and transition into a more mature stage of development, thus creating a favorable climate for growing up and independence.

Combat Disorders↗

PubMed2000

Relationships among trauma exposure, chronic posttraumatic stress disorder symptoms, and self-reported health in women: replication and extension.

Fifty-two women who served during the Vietnam era were assessed for war-zone exposure, traumatic life events, post-traumatic stress disorder (PTSD), and self-reported health status. Symptoms of PTSD were examined as mediators in the relationship between traumatic exposure and subsequent reports of health problems. Results showed that PTSD symptoms accounted significantly for variance in health problems reported by women with prior traumatic stressor exposure. When the cardinal symptom domains of PTSD (re-experiencing, numbing, avoidance, hyper-arousal) were analyzed separately, the symptom cluster representing hyper-arousal accounted uniquely for the variance associated with health complaints, beyond that contributed by other symptom clusters. Discussion of the results focuses on mechanisms underlying the relationship between specific symptoms of PTSD and self-reported health. Implications for intervention within the medical system are also considered.

Adult↗

PubMed1995

Healing the warrior: admission of two American Indian war-veteran cohort groups to a specialized inpatient PTSD unit.

The American Lake VA Post-Traumatic Stress Disorder (PTSD) Treatment Program provides intensive inpatient treatment for war-related PTSD and associated conditions. As part of a substantial outreach effort to American Indians (AI) in the Northwest U.S., the program significantly modified its admission criteria and treatment to be more clinically and culturally relevant. An all-AI cohort, and then a group that was 50% AI, were admitted. Highlighted are lessons learned regarding: treating "traditional" versus more "assimilated" AI veterans; culture-specific additions of building and utilizing a sweatlodge on the hospital grounds, hiring an AI spiritual leader as a clinical advisor, and promoting attendance at weekend Pow-Wows; the relevance of the "regular" treatment components; and the need for regular debriefings about counter-transference dynamics among staff.

Cohort Studies↗

PubMed2005

Chronic PTSD patients' functioning before and after the September 11 attacks.

This study examined how treatment-seeking veterans with preexisting posttraumatic stress disorder (PTSD) (n = 178) were affected by vicarious exposure to the September 11 terrorist attacks. Participants were surveyed 0 to 5 months prior to 9/11 and resurveyed 6 months after the attacks. Half the patients reported that thoughts and feelings about 9/11 impaired their functioning some (37%) or most or all of the time (13%). However, there was little evidence that vicarious exposure to 9/11 altered the course of these patients' functioning. Mean symptom, substance use, and role functioning outcomes were unchanged from pre-9/11 levels. Time spent following media coverage of 9/11 events was weakly associated (r = .17 to .18, p < .05) with only two of eight functioning outcomes.

Adaptation, Psychological↗

PubMed1994

Development and validation of the computerized clinician administered post-traumatic stress disorder scale-1-revised.

A computer administered version of the clinician administered post-traumatic stress disorder (PTSD) scale-1 was developed to assess PTSD in subjects presenting with psychological symptoms following exposure to a traumatic event. Both forms were administered to 40 subjects who met the Diagnostic and Statistical Manual, third edition, revised (DSM-III-R) criteria for exposure to a significantly traumatic stressor. Inter-observer reliability was demonstrated with a kappa statistic of 0.90. The computer version had a sensitivity of 0.95 and a specificity 0.95. A correlation of 0.95 was found between the two versions and the mean score difference was non-significant. The computer form demonstrated adequate internal reliability and test-retest reliability. Overall results suggest the computer version is a valid and reliable measure of PTSD.

Adolescent↗

PubMed1997

Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder.

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.

Adaptation, Psychological↗

PubMed1999

Assessing quality of care: administrative indicators and clinical outcomes in posttraumatic stress disorder.

BACKGROUND: Although the use of quality of care indicators based on data collected for administrative purposes has become widespread, the relationship between those measures and clinical outcomes has yet to be evaluated. RESEARCH DESIGN: This study used hierarchical linear modeling to examine the relationship between 12 performance indicators derived from administrative data sets and 6 clinical outcome measures addressing symptoms, substance abuse, and social functions. SUBJECTS: Patient interviews were conducted with 4,165 veterans 4 months after their discharge from 62 specialized VA inpatient programs for treatment of Posttraumatic Stress disorder. RESULTS: Five of twelve administrative measures were significantly associated with at least one of the clinical outcome measures, which was all in the expected directions. The number of hospital readmissions during the 6 months after the index discharge was significantly related to poor outcomes on all 5 of 6 measures. Measures of readmission and post-discharge hospital use were more strongly and consistently related to outcome than to measures of access, intensity, or continuity of outpatient care. CONCLUSION: Administrative data, especially measures of hospital readmission, are significantly related to clinical outcomes. Correlations, however, are small to modest in magnitude indicating that these 2 types of performance measures assess different aspects of quality and can not be substituted for one another.

Adult↗

PubMed2006

Trauma-related and neutral false memories in war-induced Posttraumatic Stress Disorder.

Recent models of cognition in Posttraumatic Stress Disorder (PTSD) predict that trauma-related, but not neutral, processing should be differentially affected in these patients, compared to trauma-exposed controls. This study compared a group of 50 patients with PTSD related to the war in Bosnia and a group of 50 controls without PTSD but exposed to trauma from the war, using the DRM method to induce false memories for war-related and neutral critical lures. While the groups were equally susceptible to neutral critical lures, the PTSD group mistakenly recalled more war-related lures. Both false and correct recall were related more to depression than to self-rated trauma. Implications for accounts of false memories in terms of source-monitoring are discussed.

Adult↗

PubMed1999

An intensive treatment program for chronic posttraumatic stress disorder: 2-year outcome data.

OBJECTIVE: The present study evaluates the efficacy of a closed-cohort treatment program for chronic posttraumatic stress disorder (PTSD). METHOD: The treatment orientation was a combined approach involving cognitive behaviour therapy and pharmacotherapy. Treatment involved an inpatient phase of 4 weeks, with group and individual follow-up sessions of at least 6-month duration. The treatment population consisted largely of Australian Vietnam veterans. Standardised psychometric measures were obtained pre-treatment, on completion of the residential phase; and at 6, 12 and 24 months post discharge from the residential program. RESULTS: The results obtained from 64 patients demonstrate significant reductions in depression, anxiety and PTSD symptoms, maintained at 2 years post discharge from the residential phase of the treatment program. CONCLUSIONS: This paper presents encouraging findings for treatment with this troubled population.

Adult↗

PubMed2004

The Hawaii Vietnam Veterans Project: is minority status a risk factor for posttraumatic stress disorder?

The Hawaii Vietnam Veterans Project (HVVP) was congressionally mandated as a follow-up to the National Vietnam Veterans Readjustment Study (NVVRS) to assess current and lifetime prevalence of posttraumatic stress disorder (PTSD). The Hawaii Vietnam Veterans Project used the original two-stage NVVRS design in which a lay interview, conducted with a large sample, was followed by a clinical interview with a smaller subsample. Reported results are from the clinical subsample consisting of 100 Native Hawaiian and 102 American of Japanese ancestry veterans compared with white veterans from the NVVRS cohort. The major finding is that veterans of Japanese ancestry exhibited significantly lower prevalence of current full, current partial, and lifetime full PTSD than white veterans. Adjustment for age and war zone exposure did not eliminate most of these differences. These results indicate that minority status per se is not a risk factor for PTSD.

Adaptation, Psychological↗

PubMed2006

Posttraumatic stress disorder part I: historical development of the concept.

TOPIC: Posttraumatic Stress Disorder (PTSD) is a significant health problem, characterized by high rates of chronicity and comorbidity. PURPOSE: This is the first of three articles examining the sufficiency of the current PTSD construct to articulate the spectrum of human responses to trauma, in particular as it relates to women and interpersonal trauma. This paper reviews the conceptual history of PTSD from the nineteenth century up to its inclusion in the DSM-III (American Psychiatric Association, 1980). SOURCES OF INFORMATION: Existing bodies of theoretical and research literature related to the effects of trauma. CONCLUSION: Although there is strong evidence that gender plays a role in responses to stress and trauma, gender specificity is not well-incorporated into clinical services or research in the area of PTSD.

American Civil War↗

PubMed2002

Self-rating inventory for posttraumatic stress disorder: review of the psychometric properties of a new brief Dutch screening instrument.

The Self-rating Inventory for Posttraumatic Stress Disorder of 22 items was developed for use with populations without identified traumatic experiences. The inventory has been used extensively in survey research in The Netherlands. This paper examines the psychometric properties. In four different groups (trauma and psychiatric patients, elderly Dutch subjects, former peacekeepers, and medical students) internal consistency, test-retest reliability, concurrent and discriminant validity, and sensitivity and specificity are analyzed. The inventory showed good internal consistency, test-retest reliability, concurrent and discriminant validity, and high sensitivity and specificity. It appears to be valuable for survey research on posttraumatic stress in nonselected populations. As a screening device, high sensitivity for PTSD symptoms is evident even when the traumatic event has not been defined.

Adolescent↗

PubMed1994

Sleep disorders in the elderly: depression and post-traumatic stress disorder.

We report on two studies of sleep in the elderly. (1) One hundred and ninety-eight Spanish outpatients aged over 65 who met ICD-10 criteria for either a depressive episode, a recurrent, or a persistent mood disorder were compared with a matched population of depressives aged under 55. Factorial analysis and multiple regression showed that sleep complaints in the older group correlated less with severity of depression and had a less stable response to pharmacological treatment. (2) Post-traumatic stress disorder (PTSD) symptoms and sleep complaints were studied in 817 World War II veterans from Alsace-Lorraine who had been forcibly drafted into the Wehrmacht and subsequently detained as prisoners of war in Russia. The diagnosis of PTSD was associated with more severe wartime stressors and long internment. Eighty percent of respondants still report recurrent distressing dreams of wartime or captivity events after over 45 years. We analyzed sleep complaints in two elderly populations. Part one describes a Spanish study which compared the nosological significance and treatment response of sleep complaints in depressives aged over 65 or under 55. In part two, we study sleep complaints in former Alsatian prisoners of war (POWs) and analyze the influence of previous stressors and the aging process.

Adult↗

PubMed1988

Chronic Vietnam PTSD and acute civilian PTSD. A comparison of treatment experiences.

Many types of external trauma have been linked to the genesis of posttraumatic stress disorder (PTSD) and yet recent reports have focused almost exclusively on PTSD occurring in the Vietnam veteran (PTSD/veteran). The extent to which treatment experiences with PTSD/veteran can be generalized to other traumatized patients, for example, acute civilian populations, has not been investigated. Clinical observations comparing PTSD precipitated by a motor vehicle accident with PTSD/veteran suggested there were major differences between these two groups on the following variables: source of referral, age, sex, socioeconomic level, nature of stressor, timing of the stressor, character of the intrusive and avoidance symptoms, and treatment noncompliance behavior. These differences were of sufficient magnitude to call into question the feasibility, at this time, of constructing generalizations regarding PTSD utilizing only the PTSD/veteran population.

Adaptation, Psychological↗

PubMed1996

Type of trauma, severity of posttraumatic stress disorder core symptoms, and associated features.

Sixty-six persons with posttraumatic stress disorder (PTSD) exposed to battlefield experience, civilian terrorism, and work and traffic accidents were studied to assess the differential outcome of the various types of trauma as measured by PTSD core symptoms and associated features of depression, anxiety, interpersonal sensitivity, and somatization. The participants were assessed on a PTSD scale, Impact of Events Scale, and four Symptom Check List subscales. The results showed that the battle-experience group was more severely affected than the other groups. Time elapsed since the trauma was significantly positively correlated to PTSD core symptoms and associated features. Only the time elapsed since the trauma-not the division into type of trauma groups-was significantly correlated with severity. Education and army rank were found to be protecting variables.

Accidents, Occupational↗

PubMedDate not supplied

Pharmacologic treatment of posttraumatic stress disorder: a focus on antipsychotic use.

To review the literature on the pharmacologic treatment of posttraumatic stress disorder (PTSD), with a focus on reports of antipsychotic use for this illness. A MEDLINE search (1966-Oct 2002) for English only articles about pharmacologic treatment of PTSD. Antipsychotic medications are being used with some frequency for PTSD. There are few studies and scant evidence to recommend the traditional antipsychotics. There are a number of reports (mostly case reports and open trials) in which atypical antipsychotics improved sleep and decreased the frequency of nightmares and flashbacks. Some studies showed global improvement across symptom clusters. The newer atypical antipsychotics show promise for the treatment of PTSD, mainly ameliorating intrusive symptoms. The paucity of double-blind studies prevents firm conclusions, however, this class of medications may be useful particularly for refractory symptoms.

Antipsychotic Agents↗

PubMedDate not supplied

Integrating tobacco cessation treatment into mental health care for patients with posttraumatic stress disorder.

The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression.

Behavior Therapy↗