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Post-traumatic stress disorder evolved from the concepts of shell shock and traumatic war neurosis. In Vietnam veterans, the disorder is associated with unemployment, marital discord, alcoholism and increased autonomic system response to perceived symbols of war trauma. A combination of psychotherapy and pharmacotherapy is the recommended treatment.
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The onset of post-traumatic stress disorders in a group of firefighters who had an intense exposure to a bushfire disaster was investigated using a longitudinal research design. Contrary to expectation, the intensity of exposure, the perceived threat, and the losses sustained in the disaster, when considered independently, were not predictors of post-traumatic stress disorder. By contrast, introversion, neuroticism, and a past history and family history of psychiatric disorder were premorbid factors significantly associated with the development of chronic post-traumatic stress disorders.
Traditional monoamine oxidase inhibitors have shown efficacy in the treatment of post-traumatic stress disorder, but their use is limited by some serious drug and food interactions. Moclobemide, which is a reversible inhibitor of monoamine oxidase-A, is relatively free of these limitations and is therefore potentially useful in the treatment of post-traumatic stress disorder. Twenty patients who met Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) criteria for post-traumatic stress disorder were entered into a 12-week open study with moclobemide. Assessments were completed every 4 weeks. Eleven participants no longer met DSM-III-R criteria for post-traumatic stress disorder by week 12. The severity of post-traumatic stress disorder reduced by 2.09 SD (95% confidence interval 1.49-2.69; p < 0.001) and functional impairment improved by 1.08 SD (95% confidence interval 0.46-1.69; p < 0.01). Adverse events were minimal. Controlled, double-blind studies should be considered to confirm these findings.
Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder frequently found in psychiatric clinic and in the population of victims of traumatic events. PTSD, characterized by an intense fear, helplessness or horror, resulting from exposure to a traumatic event, is clinically manifested with three main syndromes: reexperiencing, avoidance behavior and numbing of emotion, and physiological hyperarousal. The Post-Traumatic Checklist Scale (PCLS) is a brief and self-report questionnaire for evaluating the severity of three main syndromes of PTSD. The scale can be divided into three sub-scores corresponding to the three main syndromes of the disorder: reexperiencing (items 1-5), avoidance (items 6-12) and hyperarousal (items 13-17). The validation studies in English version (Weathers et al., 1993, Blanchard et al., 1996) and French version (Ventureyra et al., 2001) showed that the PCLS possesses good psychometric properties. But the discriminating validation with another pathological group and the sensitivity of the scale to change of treatment have not yet been studied up to now. The aim of this study is the validation of the French version of the PCLS in Post-Traumatic Stress Disorder (PTSD) subjects compared with subjects suffering from other anxiety disorders and non-clinical subjects. The sensitivity of the PCLS after a cognitive behavioral therapy (CBT) for PTSD was studied for the first time. Fifty-seven outpatients suffering from PTSD according to DSM IV criteria, 23 patients suffering from other anxiety disorders and 28 non-clinical subjects were included in this study. All subjects were assessed with the PCLS. The Beck Depression Inventory--13 items (BDI-13) and the Fear Questionnaire (FQ) were used for the two groups of patients. Fifty-five PTSD patients were administered the PCLS twice over an interval of one to two weeks without any intervention in order to determine the test-retest reliability of the PCLS. And 24 PTSD patients were reassessed with the PCLS after 16 sessions of cognitive behavioral therapy (CBT) in order to study the sensitivity to treatment of the PCLS. The CBT technique for PTSD consisted of relaxation, exposition, recital, cognitive restructuration and stress management. The total score and the subscores on the PCLS were found to be significantly higher in PTSD patients than in two control groups: suffering from other anxiety disorders subjects (61.2/41.4, p<0.0001) and non-clinical subjects (61.2/28.8, p<0.0001). The correlation between the PCLS total score and the others measures showed that the PCLS correlated significantly with the depression measure, the BDI-13 (p<0.001), and the sub-scores of Fear Questionnaire (agoraphobia: p<0.001; anxiety-depression: p<0.001; distress: p<0.001), but not with the social phobia sub-score of the FQ. The PCLS showed a satisfactory test-retest reliability in 55 patients (the total score: r=0.75, p<0.0001; the sub-score of reexperiencing: r=0.844, p<0.0001; the sub-score of avoidance: r=0.702, p<0.0001; the sub-score of hyperarousal: r=0.712, p<0.0001). The t-test showed that the total score of the PCLS was significantly reduced in 24 patients after 16 sessions of CBT (the mean gain=13.1, t=5.63, p<0.0001). The results of our study confirm that the PCLS possesses good empirical and discriminating validity and a good sensitivity. The fact that the PTSD patients reported significantly higher total scores on the PCLS and its three subscores than other anxiety disorder subjects and non-clinical subjects indicates that the PCLS differentiates well the patients presenting PTSD from other anxiety disorder subjects and non-clinical subjects. The PCLS total score also correlates significantly with the other measures of psychopathology used in the study, such as measures of phobia (the Fear Questionnaire agoraphobia subscale), depression (the Beck Depression Inventory -13) and distress (the Fear Questionnaire distress subscale). This may be explained by the fact that some PTSD symptoms overlap with those of depression and of anxiety or phobia. The PCLS showed anxiety or phobia. The PCLS showed a satisfactory test-retest reliability. The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in clinical practice and research in psychiatry.
BACKGROUND: Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism, the effect of these medications on alcohol use outcomes and on psychiatric symptoms is still unknown in patients with co-occurring disorders post-traumatic stress disorder (PTSD). METHODS: Patients (n = 254) with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in a medication study at three Veterans Administration outpatient clinics. Randomization included (1) open randomization to disulfiram or no disulfiram; and (2) double-blind randomization to naltrexone or placebo. This resulted in four groups: (1) naltrexone alone; (2) placebo alone; (3) disulfiram and naltrexone; or (4) disulfiram and placebo. Outcomes were measures of alcohol use, PTSD symptoms, alcohol craving, GGT levels and adverse events. RESULTS: 93 individuals (36.6%) met DSM-IV criteria for PTSD. Subjects with PTSD had better alcohol outcomes with active medication (naltrexone, disulfiram or the combination) than they did on placebo; overall psychiatric symptoms of PTSD improved. Individuals with PTSD were more likely to report some side effects when treated with the combination. CONCLUSIONS: The results of this study suggest that disulfiram and naltrexone are effective and safe for individuals with PTSD and comorbid alcohol dependence.
Vietnam veterans with post-traumatic stress disorder are frequently encountered in the dental office. They are often anxious, hostile, depressed, withdrawn, or resistant to treatment. Their psychological set and relatively high incidence of alcohol and drug-related problems frequently require modification of their dental therapy. An attractive and biologically sound restoration of the orofacial structures may improve long-term rehabilitation by enhancing self-esteem and social interactions.
Post Traumatic Stress Disorder (PTSD) was first recognised by psychiatric international classification systems in 1980 and a wealth of research and treatment literature has developed since. This paper provides a review of PTSD and Spinal Cord Injuries. A brief history of the disorder is provided before descriptions of the defining characteristics, assessment and differential diagnoses. The paper provides an overview of the incidence and prevalence of PTSD and risk factors within the general population, before considering both veteran and non-veteran research within spinal cord injuries. Pharmacological and psychological approaches to the treatment of PTSD are also discussed. The review closes with recommendations for future research into the prevalence and treatment of PTSD in spinal cord injuries.
While awareness of post-traumatic stress disorder (PTSD) and sexual abuse continues to grow, it has only been during the past few years that the military has realized the prevalence and impact of sexual abuse inflicted upon women while on active military duty. Though Veteran Administration (VA) agencies throughout the United States have given concerted attention to this problem, published resources specific to PTSD and military sexual abuse have been limited. In this article the authors present the results of a 2(1/2)-year endeavor to address the problem of PTSD and military sexual abuse at the Tulsa VA Outpatient Clinic. The project started with a research study and the subsequent initiation of a PTSD women veterans support group, and culminated in the development of resource manuals for both professional staff and women veterans.
Chronic pain and post-traumatic stress disorder (PTSD) are frequently observed within the Department of Veterans Affairs healthcare system and are often associated with a significant level of affective distress and physical disability. Clinical practice and research suggest that these two conditions co-occur at a high rate and may interact in such a way as to negatively impact the course of either disorder; however, relatively little research has been conducted in this area. This review summarizes the current literature pertaining to the prevalence and development of chronic pain and PTSD. Research describing the comorbidity of both conditions is reviewed, and several theoretical models are presented to explain the mechanisms by which these two disorders may be maintained. Future directions for research and clinical implications are discussed.
The appearance of post-traumatic stress disorder (PTSD) is presented and discussed. Three case reports of patients concerned by an accident demonstrate, that not diagnosed PTSD may be the reason of the lack of response to rehabilitation interventions.
Post-traumatic stress disorder (PTSD) is one of the anxiety disorders recently included in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III).(1) The disorder refers to the psychological sequelae that may follow a significant stressor. The military has previously referred to PTSD as "war neurosis," "shell shock," and "combat neurosis."PTSD has recently gained attention as a means of legal defense. As a defense, it may exist separately from "innocence by reason of insanity." The authors review the literature, provide case vignettes exemplifying the clinical features, and present three additional cases that gained local and national notoriety because of their defense motions. The senior author served as an expert witness in these cases. Recommendations are given to readers who may in the future serve as expert witnesses or consultants in similar cases.
Post Traumatic Stress Disorder (PTSD) is still a diagnosis which is frequently missed even by psychiatric professionals. Each doctor needs to maintain a high level of awareness that patients may have experienced trauma; that PTSD can often occur for a variety of common symptoms; and that it may also be at the root of a persisting treatment-resistant depressive or anxiety state. This case demonstrates that occupational accidents may result in this condition.
Trauma-related exposure therapy is a useful but not universally effective treatment for post-traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post-traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma-related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale, a self-report measure of post-traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post-traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1- and 3-month follow-up. Symptoms of anxiety sensitivity and post-traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post-traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma-related exposure therapy as a means of boosting treatment efficacy.
Post-traumatic stress disorder (PTSD) is frequently associated with other psychiatric diagnoses, being substance use disorder (SUD) one of the most prevailing. Comorbid disorders in general and SUD in particular frequently complicate the course and outcome of PTSD, and vice versa. As with other dual disorders, comorbidity of PTSD and SUD is complex, having been proposed different theoretical models to explain it that will be discussed in the present paper, the first of a series of two. In addition, the present paper reviews data from epidemiological studies, as well as the clinical characteristics, the relevance of stressful life events as a vulnerability factor to PTSD as well as to SUD and the neurobiological basis of the association of both disorders with the aim of gaining a better understanding of this comorbidity, so that the treatment of this dual disorder will be discussed in the second part.
Studies concerning the development of a post-traumatic stress disorder related to severe illness are scarce. The confrontation with myocardial infarction may be a very stressful event. Twenty-three patients consecutively admitted for first myocardial infarction were studied. After two years 1 of 18 survivors had been suffering from a partial post-traumatic stress disorder. Similarities and differences in the psychological reactions following potential traumatic events are discussed.