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Results for “Stress Disorders, Traumatic”

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PubMed1997

Persistent changes in corticotropin-releasing factor systems due to early life stress: relationship to the pathophysiology of major depression and post-traumatic stress disorder.

In addition to a genetic contribution to the vulnerability for mood and anxiety disorders, such as major depressive disorder (MDD) and post-traumatic stress disorder (PTSD), a preeminent role of early adverse life events in the pathogenesis of these disorders has been postulated. Corticotropin releasing factor (CRF), which has been conclusively documented to be the major regulator of the mammalian stress response, may be the seminal neurobiological substrate mediating the effects of early life stress on subsequent psychopathology. Central administration of CRF produces many of the physiological and behavioral effects of stress and of anxiety and depression. Clinical studies have provided evidence for increased activation of CRF neuronal systems in both MDD and PTSD. Similar hyperactivity of CRF neurons and sensitization of the pituitary-adrenal stress response has been observed in adult animals exposed to stress early in life. We propose that early adverse life events might render the human individual vulnerable to the effects of stress later in life, resulting in an increased risk for developing psychopathology via long-lived alterations in CRF-containing neural circuits. Based on these findings, new therapies including early intervention can now be developed to treat individuals exposed to severe stress early in life.

Adult↗
PubMed2003

Sexually abused children suffering from post-traumatic stress disorder: assessment and treatment strategies.

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.

Journal Article↗
PubMed2000

Comorbidity of substance use and post-traumatic stress disorders in a community sample of adolescents.

A study of 384 18-year-old adolescents living in the community demonstrated a frequent co-occurrence of substance use disorders and post-traumatic stress disorder. Multiple pathways appeared to lead to this comorbidity, which was associated with widespread psychological impairment that might have serious developmental consequences. Implications for research and practice are discussed.

Adolescent↗
PubMed2005

Childhood post-traumatic stress disorder: an overview.

This article presents an overview of post-traumatic stress disorder (PTSD) as it relates to children and adolescents. The authors provide a critical review of the pediatric PTSD literature regarding the definition, epidemiology, clinical presentation, assessment, neurobiologic foundation, and treatment of PTSD. The importance of developmental and neurobiologic factors and the uniqueness of these factors to children are emphasized.

Child↗
PubMed1987

Conducting applied research on Vietnam combat-related post-traumatic stress disorder.

A paradigmatic shift in post-traumatic stress disorder (PTSD) research is underway. Formistic and mechanistic research designs, characterized by single-category, single-cause, single-effect models, gradually are being replaced by contextual and organistic research designs that feature multi-category, multi-cause, and multi-effect interactional models. Such changes in diagnostic and treatment outcome research require solving many methodological issues in such areas as: measuring types of traumas and stressors; measuring PTSD symptoms and subtypes; measuring subject dispositional characteristics (such as ethnic differences); assessing concurrent and/or pre-existing psychiatric (Axis I) disorders; classifying personality styles and concurrent and/or pre-existing personality (Axis II) disorders; evaluating phase in the development of PTSD as a disorder; measuring current environmental stresses and interpersonal interactions; and assessing secondary gains and readiness for treatment. These and other methodological problems must be addressed as research on PTSD shifts to longitudinal measurement of subjects randomly assigned to treatment conditions.

Humans↗
PubMed2004

Olanzapine versus fluphenazine in an open trial in patients with psychotic combat-related post-traumatic stress disorder.

RATIONALE: Combat-related post-traumatic stress disorder (PTSD) is often complicated with other psychiatric comorbidities, and is refractory to treatment. OBJECTIVE: The aim of an open, comparative 6-week study was to compare olanzapine and fluphenazine, as a monotherapy, for treating psychotic combat-related PTSD. METHOD: Fifty-five male war veterans with psychotic PTSD (DSM-IV criteria) were treated for 6 weeks with olanzapine (n=28) or fluphenazine (n=27) in a 5-10 mg/day dose range, once or twice daily. Patients were evaluated at baseline, and after 3 and 6 weeks of treatment, using Watson's PTSD scale, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity Scale (CGI-S), Clinical Global Impression Improvement Scale (CGI-I), Patient Global Impression Improvement Scale (PGI-I) and Drug Induced Extra-Pyramidal Symptoms Scale (DIEPSS). RESULTS: At baseline, patient's data (age, duration of combat experience and scores in all measurement instruments) did not differ. After 3 and 6 weeks of treatment, olanzapine was significantly more efficacious than fluphenazine in reducing symptoms in PANSS (negative, general psychopathology subscale, supplementary items), Watson's PTSD (avoidance, increased arousal) subscales, CGI-S, CGI-I, and PGI-I scale. Both treatments affected similarly the symptoms listed in PANSS positive and Watson's trauma re-experiencing subscales. Fluphenazine induced more extrapyramidal symptoms. Prolongation of the treatment for 3 additional weeks did not affect the efficacy of either drug. CONCLUSIONS: Our data indicate that both fluphenazine and olanzapine were effective for particular symptom profile in psychotic combat-related PTSD. Olanzapine was better than fluphenazine in reducing most of the psychotic and PTSD symptoms, and was better tolerated in psychotic PTSD patients.

Adult↗
PubMed1995

Eye movement and electrodermal responses to threat stimuli in post-traumatic stress disorder.

A core feature of post-traumatic stress disorder (PTSD) is hypervigilence to threatening material. This study measured processing of threat material in PTSD with simultaneously acquired initial eye movements and electrodermal activity, following presentation of threatening and neutral words. Ten PTSD subjects and 10 controls were presented with 4 words in parafoveal range. On trials in which a threat word was present, PTSD subjects demonstrated initial eye fixations on the threat word more than controls. PTSD subjects also demonstrated more orienting responses on all trials than controls. These results suggest that processing of threat information in PTSD can be usefully investigated with convergent psychophysiological methodologies.

Adult↗
PubMed2004

Age effects on cortisol levels in depressed patients with and without comorbid post-traumatic stress disorder, and healthy volunteers.

BACKGROUND: Post-traumatic stress disorder (PTSD) and major depression are frequently comorbid. Age and major depression are associated with higher cortisol levels and dexamethasone resistance, whereas PTSD is associated with lower cortisol and dexamethasone supersensitivity. Therefore, we examined the effect of age on the hypothalamic-pituitary-adrenal (HPA) system in depressed patients with and without PTSD. METHODS: Thirty-one depressed patients without PTSD, 12 depressed patients with PTSD, and 23 healthy volunteers were studied on 2 days. Subjects received single-blind placebo on day 1 and fenfluramine on day 2. Cortisol levels were drawn before challenge and for 5 h thereafter. RESULTS: Cortisol levels increase with age in depressed patients without PTSD but not in depressed patients with PTSD or in healthy volunteers. Number of previous major depressive episodes was a predictor of the cortisol response to fenfluramine administration in depressed patients without PTSD. CONCLUSIONS: The results of our study highlight the importance of considering age in psychobiology. Further research is needed to fully delineate the role of age in abnormalities of the HPA axis found in major depression and PTSD.

Adult↗
PubMed2000

Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks.

Power spectral analysis (PSA) of heart rate variability (HRV) offers reliable assessment of cardiovascular autonomic responses, providing a 'window' onto the interaction of peripheral sympathetic and parasympathetic tone. Alterations in HRV are associated with various physiological and pathophysiological processes, and may contribute to morbidity and mortality. Previous studies of posttraumatic stress disorder (PTSD) found lower resting HRV in patients compared to controls, suggesting increased sympathetic and decreased parasympathetic tone. This article describes the analysis of HRV at rest and after psychological stress in panic disorder (PD) patients, in an enlarged sample of PTSD patients, and in healthy control subjects. Standardized heart rate (HR) analysis was carried out in 14 PTSD patients, 11 PD patients and 25 matched controls. ECG recordings were made while subjects were resting ('rest 1'), while recalling the trauma implicated in PTSD, or the circumstances of a severe panic attack, as appropriate ('recall'), and again while resting ('rest 2'). Controls were asked to recall a stressful life event during recall. While both patient groups had elevated HR and low frequency (LF) components of HRV at baseline (suggesting increased sympathetic activity), PTSD patients, unlike PD patients and controls, failed to respond to the recall stress with increases in HR and LF. HRV analysis demonstrates significant differences in autonomic regulation of PTSD and PD patients compared to each other and to control subjects. HRV analysis may augment biochemical studies of peripheral measures in these disorders.

Adult↗
PubMedDate not supplied

Family and past history of mental illness as predisposing factors in post-traumatic stress disorder.

BACKGROUND: Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. Identifying predisposing factors in PTSD compared to anxiety disorders may help to clarify the classification of PTSD as a diagnostic entity. METHOD: Retrospective case note study of 87 PTSD patients who participated in an RCT, and 51 PTSD patients and 87 agoraphobics treated routinely in outpatients. RESULTS: Compared to agoraphobics, PTSD patients had significantly less family history of anxiety disorder but not mental illness in general. They also had significantly less personal history of mental illness prior to the index episode. CONCLUSIONS: Trauma precipitated PTSD in subjects who had significantly fewer premorbid predisposing factors than did agoraphobics. Such factors may predispose agoraphobics to become psychiatrically ill after more minor trauma. Research is needed to systematically compare the events which precipitate PTSD as opposed to agoraphobia and other anxiety disorders.

Adult↗
PubMed1991

Post-traumatic stress disorder and severe head injury.

Post-traumatic stress disorder (PTSD) is described following a road traffic accident in which the patient suffered a severe head injury. The stress reaction was associated with intrusive thoughts and avoidance of cognitive and physical events associated with consequences of the accident. The condition was successfully treated by behavioural intervention. It seems clear that PTSD can occur even where there is loss of consciousness and organic amnesia for the event and its immediate sequelae.

Adolescent↗
PubMed2004

SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations.

Post-traumatic stress disorder (PTSD) is a highly prevalent (7.8% lifetime rate) anxiety disorder with impairment in daily functioning, frequent suicidal behaviour and high rates of co-morbidity. Fortunately, PTSD is responsive to pharmacotherapy and psychotherapy. The selective serotonin reuptake inhibitors (SSRIs) are the most studied medications for PTSD, with the largest number of double-blind, placebo-controlled trials. Of the SSRIs, sertraline, paroxetine and fluoxetine have been the most extensively studied, with sertraline and paroxetine being US FDA-approved for PTSD. These studies have demonstrated that SSRIs are effective in short-term trials (6-12 weeks). Furthermore, continuation and maintenance treatment for 6-12 months decrease relapse rates. Besides being the most studied and effective drugs for PTSD, SSRIs have a favourable adverse effect profile, making them the first-line treatment for PTSD. If SSRIs are not tolerated or are ineffective, non-SSRIs should be considered. Serotonin-potentiating non-SSRIs, such as venlafaxine, nefazodone, trazodone and mirtazapine, have been evaluated in PTSD only in open-label and case studies. Because of their promising results and relatively good safety profile, they should be considered as second-line treatment. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) have both been evaluated in a small number of double-blind, placebo-controlled studies. The results have been inconsistent but promising. In the limited comparative studies, MAOIs appeared superior to TCAs but patients continued to have residual symptoms. These drugs have significant adverse effects, such as cardiovascular complications, and safety issues, such as ease of overdose. Therefore, TCAs and MAOIs should be considered as third-line treatment. Anticonvulsants have been evaluated in PTSD in open-label studies and results have been positive for carbamazepine, valproic acid, topiramate and gabapentin. A small double-blind, placebo-controlled study demonstrated efficacy of lamotrigine for PTSD. Anticonvulsants should be considered where co-morbidity of bipolar disorder exists, and where impulsivity and anger predominate. Bupropion (amfebutamone), a predominantly noradrenergic reuptake inhibitor, was ineffective in PTSD in an open-label study. Benzodiazepines were ineffective in a double-blind, placebo-controlled study despite encouraging case reports. They should be avoided or used only short term because of potential depressogenic effects, and the possibility that they may promote or worsen PTSD. Buspirone, a non-benzodiazepine anxiolytic, was found to be effective in PTSD only in open-label studies. Recently, atypical antipsychotics were as effective as monotherapy and as an augmenter to SSRIs in open-label/case studies and small double-blind, placebo-controlled trials; atypical antipsychotics should be considered in PTSD where paranoia or flashbacks are prominent and in potentiating SSRIs in refractory cases.

Anti-Anxiety Agents↗
PubMedDate not supplied

Post-traumatic stress disorders; psychophysiological and medical aspects.

Post-traumatic stress disorder (PTSD) is a psychobiological concept. Distressing events outside the range of usual human experience produce several somatovegetative and especially several psychic disturbances. The psychoneuroendocrine mechanisms of PTSD concern the impact of cognitive factors, a disorder of arousal and alterations of the central sympathoadrenal system and of the noradrenergic mediation. The authors exhibited the influence of stressful events (uprising of December 1989 in Romania) on the intestinal and noncoronary cardiovascular complains and analysed five cases of PTSD, treated in the last three years.

Adrenal Glands↗
PubMedDate not supplied

Drug treatment in post-traumatic stress disorder.

As our knowledge of post-traumatic stress disorder grows, so new treatment strategies develop. This article evaluates the benefits and limitations of drug treatment, with reference to underlying neurobiological changes seen in the condition. Drug treatment has a beneficial role if used as part of a flexible, client-centred approach.

Alprazolam↗
PubMedDate not supplied

Road to recovery. Post-traumatic stress disorder: the hidden victim.

1. Post-traumatic stress disorder (PTSD) is characterized by the development of a set of specific symptoms following a psychologically distressing event that is outside the range of usual human experience. 2. Recovery does not seem to feel as difficult or overwhelming if it is approached "one day at a time." 3. The psychologic damage that occurs in PTSD is due primarily to holding the experiences inside, "stuffing" them down through various psychodynamics, or keeping the experiences subdued through addictive behaviors. 4. PTSD among Vietnam veterans is not a mental illness; it is a reaction to extreme stress and a reaction to keeping memories stuffed down and not allowed to surface.

Alcoholism↗
PubMed2000

The assessment and treatment of Post-traumatic Stress Disorder in children and adolescents.

Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re-experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents.

Adaptation, Psychological↗