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PubMed1998

Posttraumatic stress disorder in veterans with spinal cord injury: trauma-related risk factors.

Trauma-related risk factors for posttraumatic stress disorder (PTSD) were examined in a sample of 125 veterans with spinal cord injury. Category of injury was found to be the most consistent predictor of PTSD diagnosis and symptom severity with paraplegia predicting more PTSD symptoms than quadriplegia. The occurrence of a head injury at the time of the trauma was found to predict PTSD symptom severity measures, but not PTSD diagnosis. Trauma recency consistently predicted Impact of Event score (IES) and was found to be related to current PTSD severity and lifetime PTSD diagnosis in multiple but not simple regression models. Trauma severity was found to be significantly related to self-reported PTSD symptoms and lifetime PTSD diagnosis in simple but not in multiple regression analyses. Type of trauma, alcohol or other drug (AOD) use during the trauma and loss of consciousness (LOC) during the trauma were not consistently associated with PTSD symptom severity or diagnosis.

Adult↗

PubMed2003

Racial disparities in VA service connection for posttraumatic stress disorder disability.

BACKGROUND: "Service connected" veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, service connection represents the difference between access to VA health care facilities and no access. OBJECTIVES: To determine whether there are racial discrepancies in the granting of service connection for posttraumatic stress disorder (PTSD) by the Department of Veterans Affairs and, if so, to determine whether these discrepancies could be attributed to appropriate subject characteristics, such as differences in PTSD symptom severity or functional status. RESEARCH DESIGN: Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample. SETTING AND SUBJECTS: The study comprised 2700 men and 2700 women randomly selected from all veterans filing PTSD disability claims between January 1, 1994 and December 31, 1998. RESULTS: A total of 3337 veterans returned usable surveys, of which 17% were black. Only 16% of respondents carried private health insurance, and 44% reported incomes of 20,000 US dollars or less. After adjusting for respondents' sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons' rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003). CONCLUSION: Black persons' rates of service connection for PTSD were substantially lower than other veterans even after adjusting for differences in PTSD severity and functional status.

Adult↗

PubMed2005

Posttraumatic stress disorder among Israeli ex-prisoners of war 18 and 30 years after release.

BACKGROUND: The psychological responses to captivity were measured in a sample of former prisoners of war (POWs) 18 and 30 years after release from captivity. METHOD: 209 Israeli veterans of the 1973 Yom Kippur War (103 ex-POWs and 106 controls) who had taken part in a previous study conducted in 1991 participated in the current study conducted in 2003. The study assessed current rates of posttraumatic stress disorder (PTSD), changes in PTSD over time, and the contribution of captivity severity (objective and subjective), sociode-mographic variables, and psychological appraisal and coping with captivity to predicting PTSD using standardized self-report questionnaires. RESULTS: Twenty-three percent of the ex-POWs met PTSD criteria and were 10 times more likely than controls to experience deterioration in their psychological condition in the 12-year interval between the 2 assessments. Almost 20% of ex-POWs who did not meet PTSD criteria in 1991 met criteria in the current assessment, in comparison to almost 1% of the controls. Current PTSD was predicted by younger age at the time of captivity, by loss of emotional control and higher subjective appraisal of suffering in captivity, and by a greater number of PTSD symptoms in the 1991 assessment. CONCLUSION: It is important to follow up and offer treatment to former POWs. Special attention should be paid to those who lost emotional control in captivity and to those who felt that the conditions of their captivity were severe.

Adaptation, Psychological↗

PubMed2000

Medical-care costs associated with posttraumatic stress disorder in Vietnam veterans.

OBJECTIVE: This study examined the relationship between medical-care costs of Vietnam veterans and predictor factors, including posttraumatic stress disorder (PTSD). METHOD: We merged medical-care cost data from the Department of Veterans' Affairs and the Health Insurance Commission with data from an epidemiological study of 641 Australian Vietnam veterans. Posttraumatic stress disorder and other factors were examined as predictors of medical-care cost using regression analysis. RESULTS: We found that a diagnosis of PTSD was associated with medical costs 60% higher than average. Those costs appeared to be partly associated with higher treatment costs for physical conditions in those with PTSD and also related mental health comorbidities. Major predictors of medical-care cost were age ($137 per year for each 5-year increase in age) and number of diagnoses reported ($81 to $112 per year for each diagnosis). Mental health factors such as depression ($14 per year for each symptom reported) and anxiety ($27 per year for each symptom reported) were also important predictors. CONCLUSIONS: The findings indicate that, however they are incurred, high healthcare and, presumably, also economic and personal costs are associated with PTSD. There is an important social obligation as well as substantial economic reasons to deal with these problems. From both perspectives, continued efforts to identify and implement effective prevention and treatment programs are warranted.

Adult↗

PubMed1998

The structure of posttraumatic stress symptoms.

Posttraumatic stress disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. and 4th ed.; American Psychiatric Association, 1987, 1994, respectively), is characterized by 17 symptoms, descriptively clustered into 3 groups: (a) intrusions, (b) hyperarousal, and (c) avoidance and numbing. The present study sought to identify the basic dimensions (factors) that underlie these symptoms. Two samples were assessed: 103 victims of motor vehicle accidents and 419 United Nations peacekeepers deployed in Bosnia. A principal axis factor analysis was conducted for each sample. In each sample, 2 correlated factors were obtained, which were very similar across samples. Factor 1 was labeled Intrusions and Avoidance, and Factor 2 represented Hyperarousal and Numbing. These factors loaded on a single higher order factor. The higher order factor accounted for 13% to 38% of variance in symptom severity, and the lower order factors accounted for an additional 8% to 9% of variance. If the authors assume that each factor corresponds to a distinct mechanism (R. B. Cattell, 1978), then the results suggest that posttraumatic stress reactions arise from a general mechanism, with contributions from 2 specific mechanisms.

Adult↗

PubMed2000

Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas.

Current posttraumatic stress disorder (PTSD) associated with participation in secret military tests of mustard gas during World War II was assessed in 363 male military veterans who were randomly sampled from a registry developed by the Department of Veterans Affairs. Current prevalence was 32% for full PTSD and 10% for partial PTSD. Prevalence of PTSD varied as a function of risk and protective factors, including volunteering, physical symptoms during the tests, and prohibited disclosure. Prediction of partial PTSD was weaker than prediction of full PTSD. Veterans with full PTSD reported poorer physical health, a higher likelihood of several chronic illnesses and health-related disability, greater functional impairment, and higher likelihood of health care use than those with no PTSD. Veterans with partial PTSD also had poorer outcomes than did veterans with no PTSD in a subset of these domains. There is discussion of the traumatic elements of experimental mustard gas exposure, vulnerability to PTSD, and the relevance of these findings to understanding the broad range of outcomes associated with PTSD.

Aged↗

PubMed2003

The neuroendocrinology of posttraumatic stress disorder: new directions.

Studies of the hypothalamic-pituitary-adrenal (HPA) axis in persons with posttraumatic stress disorder (PTSD) have produced variable findings. This review focuses on the factors likely to have affected the outcome of these studies, including population characteristics and experimental design. Also discussed is a possible role for the adrenal neurosteroid dehydroepiandrosterone (DHEA) as a mediator of HPA axis adaptation to extreme stress and the psychiatric symptoms associated with PTSD. The antiglucocorticoid properties of DHEA may contribute to an upregulation of HPA axis responses as well as mitigate possible deleterious effects of high cortisol levels on the brain in some PTSD subpopulations. The neuromodulatory effects of DHEA and its metabolite DHEAS at gamma-aminobutyric acid and N-methyl-D-aspartate receptors in the brain may contribute to psychiatric symptoms associated with PTSD. The possible importance of other neurohormone systems in modulating HPA axis and symptom responses to traumatic stress is also discussed. Understanding the complex interactions of these stress-responsive neurosteroid and peptide systems may help explain the variability in patterns of HPA axis adaptation, brain changes, and psychiatric symptoms observed in PTSD and lead to better targeting of preventive and therapeutic interventions.

Adaptation, Psychological↗

PubMed2001

Living with post-traumatic stress disorder: the wives'/female partners' perspective.

AIM OF THE STUDY: This phenomenological study examined what it was like for the wives/female partners to live with a Vietnam veteran who suffers from post-traumatic stress disorder (PTSD). PROCEDURE: Audio-taped interviews were conducted with 10 women and data were examined from three overlapping phases of the veteran/partner relationship: the early phase, the middle phase and the later phase. FINDINGS: The early phase was conceptualized as a period of adjustment in which three themes were identified: (1) attractors, (2) feelings and (3) communication. The middle phase, one of enmeshment, was characterized by six themes: (1) dealing with veteran PTSD symptoms, (2) substance abuse, (3) physical and/or emotional abuse, (4) roles, (5) feelings and (6) coping techniques. Three themes depicted the later phase of resolution/healing: (1) stress related symptoms, (2) staying or leaving and (3) activities that promoted an ongoing process of resolution/healing. CONCLUSIONS: The central meaning statement that best described the experience of wives/female partners who live with a Vietnam veteran with PTSD is that the experience is a gradual process of becoming enmeshed in the veteran's pathology, with all energies being directed at minimizing the effect on self and family, culminating in intermittent movement towards resolution/healing. This study has implications for practitioners who treat Vietnam PTSD veterans and their wives or female partners.

Adaptation, Psychological↗

PubMed1988

Elevation of urinary norepinephrine/cortisol ratio in posttraumatic stress disorder.

We have previously reported the unusual combination of low urinary free cortisol levels with high urinary norepinephrine excretion in posttraumatic stress disorder (PTSD) patients in comparison with four other patient groups: major depressive disorder, endogenous type; bipolar I, manic; paranoid schizophrenia; undifferentiated schizophrenia. Cortisol levels alone did not distinguish PTSD from paranoid schizophrenia patients and norepinephrine levels alone did not distinguish PTSD from bipolar I, manic, patients. In further consideration of these findings, we have found that combining the values for the two systems in a norepinephrine/cortisol (N/C) ratio provides a measure that significantly distinguishes PTSD from all the other patient groups throughout the hospitalization period. The N/C ratio was more than twice as high in the PTSD group than in all the other patient groups in the first sample following hospital admission, in the mean sample during hospitalization, and in the last sample before discharge. The mean N/C ratio for the PTSD group was 2.54, compared with a mean of .99 for the other four groups, which ranged from .81 to 1.18. The diagnostic sensitivity was 78% and the specificity was 94% for correct classification of PTSD in our sample. These preliminary findings yield further encouragement for exploring multivariate strategies, using hormonal ratios or profiles, in an effort to increase the diagnostic sensitivity of neuroendocrine criteria in the assessment of psychiatric patients.

Combat Disorders↗

PubMed2002

Double-blind placebo-controlled pilot study of sertraline in military veterans with posttraumatic stress disorder.

The efficacy of sertraline in the treatment of civilian posttraumatic stress disorder (PTSD) has been established by two large placebo-controlled trials. The purpose of the current pilot study was to obtain preliminary evidence of the efficacy of sertraline in military veterans suffering from PTSD. Outpatient Israeli military veterans with a DSM-III-R diagnosis of PTSD were randomized to 10 weeks of double-blind treatment with sertraline (50-200 mg/day; N = 23, 83% male, mean age = 41 years) or placebo (N = 19, 95% male, mean age = 38 years). Efficacy was evaluated by the Clinician-Administered PTSD Scale (CAPS-2) and by Clinical Global Impression Scale-Severity (CGI-S) and -Improvement (CGI-I) ratings. Consensus responder criteria consisted of a 30% or greater reduction in the CAPS-2 total severity score and a CGI-I rating of "much" or "very much" improved. The baseline CAPS-2 total severity score was 94.3 +/- 12.9 for sertraline patients, which is notably higher than that reported for most studies of civilian PTSD. On an intent-to-treat endpoint analysis, sertraline showed a numeric but not statistically significant advantage compared with placebo on the CAPS-2 total severity and symptom cluster scores. In the study completer analysis, the mean CGI-I score was 2.4 +/- 0.3 for sertraline and 3.4 +/- 0.3 for placebo (t = 2.55, df = 30, p = 0.016), CGI-I responder rates were 53% for sertraline and 20% for placebo (chi2 = 3.62, df = 1, p = 0.057), and combined CGI-I and CAPS-2 responder rates (>or=30% reduction in baseline CAPS-2 score) were 41% for sertraline and 20% for placebo (chi2 = 1.39, df = 1, p = 0.238). Sertraline treatment was well tolerated, with a 13% discontinuation rate as a result of adverse events. This pilot study suggests that sertraline may be an effective treatment in patients with predominantly combat-induced PTSD, although the effect size seems to be somewhat smaller than what has been reported in civilian PTSD studies. Adequately powered studies are needed to confirm these results and to assess whether continued treatment maintains or further improves response.

Adult↗

PubMed1990

Post traumatic stress disorder: an eclectic approach.

A number of victims of post traumatic stress disorder, apart from the rest of their symptom constellation, suffer flashbacks. These flashbacks occur during the waking state and frequently are very disabling. From among this group of patients, we have identified a few who demonstrate epileptiform discharge emanating from temporal lobe foci. We have postulated that indeed the flashbacks might represent an amalgam of abnormal neuronal firing along with the expression of a dynamically charged event. Eight cases are documented which illustrate this pattern. In all eight cases, the flashbacks were completely controlled through the use of anticonvulsant medication (carbamazepine and one case of valproate). Other symptoms were treated more traditionally. A modification to a conventional psychotherapeutic approach is introduced which does not merely foster abreaction but also introduces a process of desensitization to the highly charged events. The sessions during which the patient relives the precipitant to the syndrome are audiotaped. Following the experience of working through in therapy, the patient is encouraged to replay the tape(s) repeatedly over several months to facilitate flooding/desensitization. The two case summaries which are presented illustrate the integration of pharmacotherapeutic intervention, a focal short-term dynamic approach, and a behavioral model.

Abreaction↗

PubMed2006

Psychosocial therapy for posttraumatic stress disorder.

Immediately after experiencing a traumatic event, many people have symptoms of posttraumatic stress disorder (PTSD). If trauma victims restrict their routine and systematically avoid reminders of the incident, symptoms of PTSD are more likely to become chronic. Several clinical studies have shown that programs of cognitive-behavioral therapy (CBT) can be effective in the management of patients with PTSD. Prolonged exposure (PE) therapy-a specific form of exposure therapy-can provide benefits, as can stress inoculation training (SIT) and cognitive therapy (CT). PE is not enhanced by the addition of SIT or CT. PE therapy is a safe treatment that is accepted by patients, and benefits remain apparent after treatment programs have finished. Nonspecialists can be taught to practice effective CBT. For the treatment of large numbers of patients, or for use in centers where CBT has not been routinely employed previously, appropriate training of mental health professionals should be performed. Methods used for the dissemination of CBT to nonspecialists need to be modified to meet the requirements of countries affected by the Asian tsunami. This will entail the use of culturally sensitive materials and the adaptation of training methods to enable large numbers of mental health professionals to be trained together.

Allied Health Personnel↗

PubMed2004

Effects of trauma exposure on the cortisol response to dexamethasone administration in PTSD and major depressive disorder.

OBJECTIVE: To evaluate cortisol suppression following 0.5 mg of dexamethasone (DEX) in trauma survivors (N=52) with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), both, or neither disorder, and in subjects never exposed to trauma (N=10), in order to examine interactions between diagnosis and trauma history on cortisol negative feedback inhibition. METHOD: Lifetime trauma exposure and psychiatric diagnoses were assessed and blood samples were obtained at 8:00 a.m. for the determination of baseline cortisol. Participants ingested 0.5 mg of DEX at 11:00 p.m. and blood samples for determination of cortisol and DEX were obtained at 8:00 a.m. the following day. RESULTS: PTSD was associated with enhanced cortisol suppression in response to DEX. Among trauma survivors, the presence of a traumatic event prior to the "focal" trauma had a substantial impact on cortisol suppression in subjects with MDD. Such subjects were more likely to show cortisol alterations similar to those associated with PTSD, whereas subjects with MDD with no prior trauma were more likely to show alterations in the opposite direction, i.e. relative non-suppression. CONCLUSIONS: Cortisol hypersuppression in PTSD appears not to be dependent on the presence of traumatic events prior to the focal trauma. However, prior trauma exposure may affect cortisol suppression in MDD. This finding may have implications for understanding why only some depressed patients show non-suppression on the DST.

Adolescent↗

PubMed2004

Evaluation of psychiatric disability in PTSD of military origin.

BACKGROUND: Israeli veterans suffering from post-traumatic stress disorder (PTSD) filed claims for recognition of their mental disability and for compensation underwent thorough psychiatric evaluations conducted by an interdisciplinary team. OBJECTIVE: To study the clinical features and functional impairment of PTSD veterans who filed claims for psychiatric disability. To evaluate possible relationships among severity of PTSD, psychiatric comorbidity and level of disability. METHOD: Subjects were 294 veterans with PTSD. Evaluation included a semi-structured psychiatric interview; self report questionnaires of PTSD, psychiatric symptoms and assessment of functional impairments (in self-care in daily living, interpersonal--familial and social, and occupational functioning). Upon completion of the various assessments the psychiatrist determined a global disability score. RESULTS: 156/294 (53%) of the PTSD subjects had psychiatric comorbidity, mainly depression (31%) and anxiety (15%). PTSD casualties suffered significant functional impairments, more in occupational functioning than interpersonal and activities of daily living, respectively. A number of PTSD symptoms were positively correlated with functional impairments in the occupational and interpersonal areas and with the global disability score, while psychiatric comorbidity was not. CONCLUSION: PTSD veterans who file for psychiatric disability report severe mental distress and functional impairment, and probably constitute the more severe PTSD casualties. Systematic assessment of functional impairment in addition to clinical examination is needed for valid evaluation of disability and for determining disability score.

Activities of Daily Living↗

PubMed2000

Nefazodone treatment for chronic posttraumatic stress disorder: an open trial.

Currently, there is no standard treatment for posttraumatic stress disorder (PTSD) because of a deficit of systematic treatment trials. The symptom overlap with other mood and anxiety disorders that respond to antidepressants and the results of a limited number of antidepressant trials indicate promise for psychopharmacologic treatment. Several open trials and one controlled trial with selective serotonin reuptake inhibitors have reported improvement in the symptomatology of PTSD. In this study, a relatively new serotonergic antidepressant, nefazodone, was tested as a treatment for PTSD. Veterans with chronic PTSD (N = 36) were enrolled in an 8-week open-label trial of nefazodone. The primary outcome measure was the Clinician-Administered PTSD Scale (CAPS). Thirty-one patients completed at least 4 weeks of treatment, which was considered to be an adequate trial, and 26 patients completed the 8-week study. During treatment, there was a significant decrease in the total CAPS score and in each of three CAPS subscale scores, with most of the improvement occurring during the first 4 weeks. Comparable improvements were also seen on the Hamilton Rating Scales for Anxiety and for Depression. Nefazodone treatment was well tolerated by this patient population, with only four patients discontinuing because of adverse effects. In summary, nefazodone treatment improved the symptoms of PTSD, including the core symptoms. Placebo-controlled studies should be undertaken to further elucidate the efficacy of nefazodone in the treatment of PTSD.

Adult↗

PubMed2004

Tattoo and personality traits in Croatian veterans.

To examine whether tattooed patients, treated for posttraumatic stress disorder (PTSD) caused by war at the Ward for Psycho-trauma of the Clinical Hospital Osijek, differ from non-tattooed patients by certain personality traits. The study was conducted on one hundred Croatian veterans who were divided into two groups with respect to the presence/ absence of tattoo. To assess the symptoms of PTSD, the Clinical Administered PTSD Scale (CAPS-2) was used for all subjects. To assess personality traits the following psychology tests were applied: Purdue non-verbal IQ test, Minnesota Multiphasic Personality Inventory (MMPI-1), and Eysenck's Personality Questionnaire (EPQ/A and EPQ/IVE). With respect to the examined pre-traumatic variables and PTSD symptoms, the two groups manifested no differences. The non-tattooed group achieved higher scores on the IQ test (IQ=100) than the tattooed group (IQ=95). EPQ test showed results either above or below the norms on all scales that were applied. The tattooed group demonstrated significantly higher levels of impulsiveness, adventurism, empathy and neuroticism than the non-tattooed one (p < 0.05). In the group of 100 Croatian veterans treated for PTSD, 33 had tattoos and 67 did not. The results indicated more impulsiveness, adventurism / risk behavior, empathy and neuroticism in the tattooed group than in the non-tattooed group, while there was no significant difference in the intensity of the PTSD symptoms.

Adult↗

PubMed2004

Reduced area of the corpus callosum in posttraumatic stress disorder.

Magnetic resonance imaging (MRI) studies have revealed decreases in the mid-sagittal area of the corpus callosum (CC) in pediatric posttraumatic stress disorder (PTSD), but at present no data are available in adult PTSD patients. We have previously reported decreased whole-brain white matter (WM) volume in adults with PTSD and now report corpus callosum area from the same sample. MRI was used to obtain whole-brain images in 12 adult patients with PTSD and 10 matched controls. Total parenchyma (white matter plus gray matter [GM]) volume, mid-sagittal area of the CC and seven sub-regions of this structure were calculated. In PTSD patients, the total CC area, absolute and normalized to total brain parenchyma, was smaller compared with control values. Several absolute and normalized CC sub-regions were also smaller in PTSD patients: genu (region 2), mid-body (region 5) and isthmus (region 6). There was also a trend for the anterior mid-body (area 4) to be smaller in PTSD patients. No differences were found in the rostrum (region 1), rostral body (region 3) or splenium (region 7). Adult patients with PTSD had decreased CC area after correcting for total brain tissue, indicating that these differences are not attributable to generalized white matter atrophy. These findings are similar to previous results in children with PTSD and suggest specific changes in the CC.

Adult↗

PubMedDate not supplied

Group therapy for partners of combat veterans with post-traumatic stress disorder.

TOPIC: An 18-month group-therapy experience with women partners of combat veterans with post-traumatic stress disorder (PTSD). PURPOSE: To describe the application of group process and feminist theory to the planning and development of a group of women partners of veterans with PTSD. SOURCE: The authors' clinical work. CONCLUSIONS: Using group psychotherapy theory and feminist theory, the group content and process involved the themes of rescuing, dissociation, and individuation. The exploration of transference and countertransference were useful in facilitating individual as well as process.

Adult↗