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Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder.

Caregiver burden in 58 partners of Vietnam veterans with posttraumatic stress disorder (PTSD) was examined. The relationship between patient PTSD severity and caregiver burden, as well as the effect of several caregiver and patient variables on caregiver psychological status, was evaluated twice, an average of 8 months apart. Patient symptom severity was positively correlated with caregiver burden. Time 1 cross-sectional analysis indicated that greater caregiver burden was associated with greater caregiver psychological distress, dysphoria, and anxiety. Patient symptom severity also contributed to caregiver psychological distress; financial stress contributed to caregiver dysphoria and trait anxiety. Time 2 cross-sectional analyses essentially replicated the Time 1 findings. A third set of analyses examining change scores indicated that changes in caregiver burden for individuals in the sample positively predicted individual changes in caregiver psychological distress, dysphoria, and state anxiety.

Adult↗

Clonazepam-related sexual dysfunction in male veterans with PTSD.

Medication-induced sexual dysfunction can significantly interfere with patients' quality of life and lead to poor compliance. This retrospective study examined the records of 100 male veterans with post-traumatic stress disorder (PTSD) selected in alphabetical order from an active treatment file of 230 patients. Forty-two patients had received clonazepam (mean maximum dose: 3.4 +/- 1.6 mg/day) at some point during their treatment. Of these, 18 (42.9%) complained of significant sexual dysfunction (primarily erectile dysfunction). Eighty-four patients received diazepam (mean maximum dose: 52.1 +/- 29.7 mg/day), nine received alprazolam (mean maximum dose: 5.2 +/- 2.8 mg/day) and eight received lorazepam (mean maximum dose: 3.8 +/- 2.4 mg/day). None of these patients complained of sexual dysfunction during treatment with these three other benzodiazepines. Our findings suggest that benzodiazepines, particularly clonazepam in the current study, can be a cause of sexual dysfunction in many male patients. Prospective studies comparing the overall clinical utility of various benzodiazepines are indicated in this and other clinic populations.

Adult↗

Effect of darkness on acoustic startle in Vietnam veterans with PTSD.

OBJECTIVE: Exaggerated startle is a symptom of posttraumatic stress disorder (PTSD), but empirical studies have not consistently documented elevated baseline startle in PTSD. The authors proposed in a previous study that Vietnam veterans with PTSD exhibit exaggerated startle only under stressful conditions. They reported that darkness facilitated startle in humans, suggesting that the startle reflex is sensitive to the aversive nature of darkness. In the present study they tested the hypothesis that the magnitude of facilitation of startle by darkness would be greater in Vietnam veterans with PTSD than in comparison groups of subjects without PTSD. Prepulse inhibition was also investigated. METHOD: The magnitude of startle and prepulse inhibition were assessed in alternating periods of darkness and light in 19 nonmedicated Vietnam veterans with PTSD, 13 Vietnam veterans without PTSD, and 20 civilians without PTSD. RESULTS: The overall startle level was higher in the veterans with PTSD than in either of the two groups of subjects without PTSD. Startle was facilitated by darkness, and the magnitude of this facilitation was greater in the veterans with PTSD than in the civilians without PTSD, but it was not greater in the veterans without PTSD. Prepulse inhibition was not affected by darkness and did not significantly differ among groups. CONCLUSIONS: Contrary to the hypothesis, elevated sensitivity to darkness was specific to individuals with combat experience, not to individuals with PTSD, perhaps because veterans had become aversively conditioned to darkness during their combat experiences. The more general increase in startle reactivity in the veterans with PTSD is consistent with clinical observations and descriptions of symptoms in DSM-IV.

Acoustic Stimulation↗

Basal sympathoadrenal function in posttraumatic distress disorder.

Research has consistently shown that patients with posttraumatic stress disorder (PTSD) manifest greater changes in heart rate, blood pressure, and plasma epinephrine than controls when exposed to trauma-related laboratory stressors. However, findings are equivocal as to whether PTSD subjects differ from controls on basal, or tonic, measures of autonomic activity. In this study, PTSD patients (n = 11) and asymptomatic controls (n = 11) were compared on measures of basal sympathoadrenal function, including plasma norepinephrine and epinephrine as well as heart rate and blood pressure. Results showed that PTSD patients were not significantly different from control subjects on any measure. Although phasic alterations in autonomic function in PTSD have been consistently found in previous research, this study suggests that tonic sympathetic nervous system activity in PTSD patients may not differ from that of healthy controls.

Adrenal Glands↗

Treatment of female veterans with posttraumatic stress disorder: the role of comfort in a predominantly male environment.

This study examines the role of women's comfort in coming for treatment of posttraumatic stress disorder in a predominantly male environment. Consecutive admissions (N = 224) to the Department of Veterans Affairs (VA)'s Women's Stress Disorder Treatment Teams were enrolled in an outcome study from July 1998 through June 2000. Women reported that they were somewhat comfortable in coming to the VA for their mental health care. For women who had no prior experience with the VA, comfort increased with their exposure to the treatment program. Further, for this group of women, comfort level was related significantly to their commitment to working in therapy and the regularity of their attendance in treatment over time. There were no significant changes in comfort level for women who had prior contact with the VA. Comfort level was unrelated to satisfaction and only minimally related to clinical outcomes. The primary role of women's comfort level, therefore, appeared to be as a facilitator of their participation in the therapeutic process.

Adaptation, Psychological↗

Employment outcomes and PTSD symptom severity.

A diagnosis of chronic war-related posttraumatic stress disorder (PTSD) has been linked consistently to poor employment outcomes. This study investigates the relation further, analyzing how symptom severity correlates with work status, occupation type, and earnings. Study participants were male Vietnam veterans with severe or very severe PTSD who received treatment in the Department of Veterans Affairs system (N = 325). Veterans with more severe symptoms were more likely to work part-time or not at all. Among workers, more severe symptoms were weakly associated with having a sales or clerical position. Conditional on employment and occupation category, there was no significant relation between PTSD symptom level and earnings. Alternative PTSD symptom measures produced similar results. Our findings suggest that even modest reductions in PTSD symptoms may lead to employment gains, even if the overall symptom level remains severe.

Adult↗

Posttraumatic stress disorder and retrospectively reported stressor exposure: a longitudinal prediction model.

There has been recent concern about the degree to which posttraumatic stress disorder (PTSD) symptomatology influences reports of prior exposure to highly stressful life events. In this longitudinal study of 2,942 male and female Gulf War veterans, the authors documented change in stressor reporting across 2 occasions and the association between change and PTSD symptom severity. A regression-based cross-lagged analysis was used to examine the relationship between PTSD symptom severity and later reported stressor exposure. Shifts in reporting over time were modestly associated with PTSD symptom severity. The cross-lagged analysis revealed a marginal association between Time 1 PTSD symptom severity and Time 2 reported stressor exposure for men and suggested that later reports of stressor exposure are primarily accounted for by earlier reports and less so by earlier PTSD symptomatology.

Adult↗

Posttraumatic stress disorder and late-onset smoking in the Vietnam era twin registry.

Epidemiological and clinical studies have consistently reported associations between smoking and posttraumatic stress disorder (PTSD). This study analyzed diagnostic interview data on 6,744 members of the Vietnam Era Twin Registry to clarify the PTSD-smoking relation and to examine whether genetic liability for smoking moderated this relation. Preexisting active (unremitted) PTSD increased risk of late-onset daily smoking. Remitted PTSD decreased risk. Active PTSD increased risk of smoking at all levels of genetic liability; the effect was strongest for those with least genetic liability. This suggests PTSD represents a nongenetic pathway to late-onset smoking among individuals who were nonsmokers prior to developing PTSD. If replicated, these results identify PTSD as a risk factor for smoking that should lead to early tobacco control treatment in this population.

Adult↗

[The epidemiology of post-traumatic stress disorders].

Post-traumatic stress disorder (PTSD) has been subjected to several epidemiological studies during the last 10 years. Large differences in prevalence between different studies can only partly be explained by differences in methodology, impact of the trauma and populations. Changes in diagnostic criteria, the stressor criteria, general mentality over time and cultural differences may account for some of the differences. In general populations a lifetime prevalence of PTSD of between 1% and 9% has been found. In unselected traumatized populations 20-45% will develop PTSD after exposure to significant traumas. Among soldiers who have participated in battles of war a PTSD prevalence of 15-20% has been found. After exposure to lesser traumas and among well-trained corps 5-10% develop PTSD. Over long periods the point prevalence of PTSD in a given traumatized population diminishes. Predictive factors related to PTSD are complex.

Combat Disorders↗

Characteristics of posttraumatic stress disorder-alcohol abuse comorbidity in women.

Trauma characteristics and symptoms were examined in 12 women diagnosed with posttraumatic stress disorder (PTSD) and alcohol abuse (AA), 13 women with PTSD only, and 22 controls. Participants served during the Vietnam era. Women completed diagnostic interviews and a questionnaire battery. Results showed that PTSD-AA women reported more childhood sexual abuse and sexual victimization during wartime service than the other two groups. Groups did not differ on other childhood trauma variables, nor on adult physical assault and traditional wartime stressor exposure. PTSD-AA women reported more PTSD, dissociation, and borderline personality traits than the other two groups. These results suggest that trauma type, specifically sexual victimization across the life span, is an important factor in dual diagnosis in women, and that women with PTSD-AA have a particularly severe level of symptoms relative to women with only PTSD and controls.

Adult↗

Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam War veterans.

Previous studies have identified traumatic exposure and posttraumatic stress disorder (PTSD) as predictors of physical health complaints without considering the relationship between exposure and PTSD. This study examined the unique associations of war-zone exposure and PTSD with perceived physical health outcomes in a nontreatment-seeking sample of 109 female veterans of the Vietnam War who responded to a series of psychological, exposure, and health questionnaires. Both PTSD and exposure were associated with reports of negative health outcomes when each variable was not adjusted for the other. The effects associated with exposure decreased when PTSD was controlled for, whereas the effects associated with PTSD remained when exposure was controlled for. Results suggest that effects of traumatic exposure on perceived health are partially mediated by increases in PTSD after exposure, supporting studies on the effects of stress on health.

Adult↗

Traumatic war stressors and psychiatric symptoms among World War II, Korean, and Vietnam War veterans.

Three hypotheses regarding symptoms of war-related posttraumatic stress disorder and general psychiatric distress were tested: that symptoms are more severe the more severe the traumatic exposure, regardless of the war in question; that symptoms are less severe the older the veterans' age; and that symptom levels differ across sociocultural cohorts. A total of 5,138 war zone veterans who were seeking treatment from specialized Veterans Affairs outpatient clinical teams made up the sample: 320 World War II, 199 Korean War, and 4,619 Vietnam War veterans. All hypotheses were supported significantly. The similarity of relationships between traumatic exposure and symptoms across wars testifies to the generality of these experiences. Furthermore, the results suggest the operation of significant effects due both to aging and to cohort differences in sociocultural attitudes toward the stigma of mental illness and the popularity of the wars.

Adult↗

Secondary traumatization among wives of PTSD and post-concussion casualties: distress, caregiver burden and psychological separation.

This study has two aims. First, it assesses the implication of husbands' post-traumatic stress disorder (PTSD) and post-concussion syndrome (PC) on their wives' sense of burden and emotional distress. The second aim was to examine the implication of the women's separation-individuation on their adjustment. Sixty women participated in study: 20 women married to war veterans diagnosed as suffering to PTSD, 20 women married to war veterans suffering from PC, and 20 women married to healthy controls. Data was collected using self report questionnaires assessing psychiatric symptomatology, caregiver burden and psychological separation-individuation. Results indicate that women from both research groups suffer from higher levels of burden and distress than controls. The level of separation-individuation was found to be correlated to levels of burden and distress. The complex implications of living with a traumatized spouse are discussed.

Adaptation, Psychological↗

[A historical medical study of post-traumatic stress disorders in World War I soldiers].

The concept of post-traumatic stress disorder (PTSD) was to be verified considering World War I soldiers suffering from psychiatric and neurologic diseases. According to hypotheses, relevant circumstances of the case history and significance of the direct military action had to be examined. In 2002, medical histories dating from 1914 to 1921 of male soldiers in Jena, Germany, were analyzed. Statistical examination carried out by means of the chi2 test revealed mental illness more frequently in soldiers with relevant family anamnesis, previous psychiatric treatment, or degree of voluntariness than in soldiers not so characterized. The accumulation of mental illnesses was lower in soldiers involved in military actions or directly with firing weapons than in soldiers never involved in battles. These results are in accord with historical but not current literature on PTSD. The author is of the opinion that psychiatric anamnesis is not given enough consideration in the concept of PTSD.

Combat Disorders↗

The drug treatment of post-traumatic stress disorder.

Many individuals with a history of psychological trauma continue to react to current life stresses as a recurrence of the original trauma, even though they rarely make a conscious connection between present distress and past trauma. Their hyperreactivity, reliving experiences, and difficulty in modulating the intensity of their anxiety, aggression and interpersonal attachments are sources of continuing stress to both themselves and their environment. Pharmacological treatments are often necessary to blunt the intensity of their response to subsequent stressors. Our knowledge about the drug treatment of post-traumatic stress disorder (PTSD) is still very limited. Existing reports are pretty much limited to one particular population with chronic PTSD: Vietnam veterans. Even less is known about effective pharmacological management of acute PTSD. While many psychotropic agents have been proposed for the treatment of various symptoms of PTSD, carefully controlled studies are lacking to clarify the relative merits of particular psychotropic agents on the various post-traumatic symptoms. Impressions in open studies have utilized global ratings, rather than studied the effects on specific symptoms. The animal model of inescapable shock provides a good model for understanding the biological alterations produced by overwhelming trauma, and suggests a variety of pharmacological treatment interventions. Elucidation of traumatic childhood antecedents of certain forms of adult psychopathology will provide clearer links between existing knowledge about effective pharmacological management and the treatment of post-traumatic states.

Clonidine↗

Prevalence and characteristics of trauma and post-traumatic stress symptoms in operational members of the South African National Defence Force.

The prevalence of traumatic event exposure and post-traumatic stress disorder (PTSD) were surveyed in a cohort of 198 full-time operational members of the South African National Defence Force stationed in their "home" unit between deployments. Approximately 90% of members reported having experienced or witnessed trauma in their lifetime (mean number of traumatic events = 4.3 +/- 3.2), whereas 51% reported having inflicted trauma. Twenty-six percent met diagnostic criteria for PTSD on self-report with approximately 29% with PTSD also meeting diagnostic criteria for depression. Few members, however, sought help. PTSD symptom severity was best predicted by trauma type (exposure to physical assault and infliction of life-threatening injury). These findings highlight the high rates of exposure to multiple, noncombat-related trauma in military personnel, the potentially high rates of PTSD, and the role of inflicted trauma as an additional risk factor for PTSD.

Adult↗

Fluvoxamine treatment for chronic PTSD: a pilot study.

A group of 24 Dutch World War II Resistance veterans with a documented traumatic war history and a (partially) positive diagnosis of current posttraumatic stress disorder (PTSD) was studied. This special group of war victims is characterised by chronicity, suffering from intractable posttraumatic complaints for decades. They were treated with fluvoxamine (Fevarin), a selective serotonin reuptake inhibitor with antidepressive and anxiolytic properties. The study was designed as an open-ended, outpatient pilot study, with a treatment period of 12 weeks. Results of clinical examination, and questionnaires investigating PTSD, depression, sleeping problems, anxiety, and vital exhaustion indicate that a significant number of the subjects improved with respect to their PTSD symptomatology, and their symptoms of anxiety and vital exhaustion. However, at the end of the study, quantitative improvement was modest. The results indicate that treatment with fluvoxamine may offer alleviation of chronic PTSD symptoms, in particular insomnia, nightmares, anxiety, intrusive recollections, guilt feelings and tiredness.

Aged↗

Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of post-traumatic stress disorder.

BACKGROUND: The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed. METHOD: This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally. RESULTS: A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment. CONCLUSIONS: Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.

Adaptation, Psychological↗