Clin Psychol Rev. 2009 Feb;29(1):87-100. Epub 2008 Oct 20.

Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model.

Elwood LS, Hahn KS, Olatunji BO, Williams NL.

Center for Trauma Recovery, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 63121, USA. elwoodls@umsl.edu

While some individuals develop PTSD subsequent to traumatic experiences, many individuals resume prior functioning naturally. Diathesis-stress models suggest that stable individual differences present in individuals prior to trauma may serve as vulnerability factors to symptom development. The high levels of comorbidity and symptom similarity suggest that established vulnerability factors for anxiety and depression may also serve as vulnerability factors for PTSD. The  examination of multiple vulnerability factors simultaneously may increase understanding of the etiology of PTSD and comorbid post-trauma symptomatology and account for a greater percentage of variance in PTSD symptoms. In addition, the vulnerability factors may be related to distinct sets of symptoms, with vulnerabilities predicting the PTSD symptoms most similar to their associated disorders. Research examining the relations between attributional style, rumination, anxiety sensitivity, and the looming cognitive style and the development of PTSD after trauma exposure is reviewed and suggestions for future  research are provided.

PMID: 19008028 [PubMed - in process]

 

Clin Psychol Rev. 2009 Feb;29(1):24-33. Epub 2008 Sep 30.

Posttraumatic growth in cancer: reality or illusion?

Sumalla EC, Ochoa C, Blanco I.

Fundación Privada de Gastroenterología, Dr. Francisco Vilardell, Barcelona, Spain.

Research in posttraumatic growth (PTG) among cancer patients has been triggered primarily by the inclusion of serious illnesses among the events that can lead to posttraumatic stress disorder (PTSD); increasing survival rates among cancer patients; and, attempts at encouraging a positive psychology that focuses on a patient's ability to fight adversity. The difficulties encountered in clearly defining the processes associated with this subjective feeling of growth following recovery raise doubts concerning the real or illusory nature of the phenomenon and its adaptative value. This paper explains why cancer may be different than other traumas and why PTG may interact with this ecology of circumstances in different ways. Difficulty in identifying a single stressor, the internal source of the event, cancer as a future, ongoing and chronic integration threat, and greater perceived control differences between cancer and others traumas. This review brings together the latest studies of PTG in cancer, and focuses in the debate of the real or illusory nature of the PTG and his adaptative value. The ongoing threat, uncertainty and vulnerability associated with cancer are the variables that have been related most consistently with PTG and tend to confuse the relationship between PTG and emotional well-being, too.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18996633 [PubMed - in process]

 

Int J Neuropsychopharmacol. 2009 Feb;12(1):23-31. Epub 2008 Jun 11.

Onset of activity and time to response on individual CAPS-SX17 items in patients  treated for post-traumatic stress disorder with venlafaxine ER: a pooled analysis.

Stein DJ, Pedersen R, Rothbaum BO, Baldwin DS, Ahmed S, Musgnung J, Davidson J.

University of Cape Town, Cape Town, South Africa.

This pooled analysis of data from two randomized, placebo-controlled trials of venlafaxine extended release (ER) assessed onset of activity and time to response on the 17 symptoms of post-traumatic stress disorder (PTSD) listed in DSM-IV and  measured by the 17-item Clinician-Administered PTSD Scale (CAPS-SX17). The intent-to-treat (ITT) population comprised 687 patients (placebo, n=347; venlafaxine ER, n=340). Significant (p<0.05) separation between venlafaxine ER and placebo was observed on most CAPS-SX17 items, with earliest onset of activity and response (week 2) on items 5 (physiological reactivity on exposure to cues) and 14 (irritability or anger outbursts), and (week 4) items 1 (intrusive recollections) and 4 (psychological distress at exposure to cues). Onset of activity and response occurred later (generally, weeks 6-8) on items 9 (diminished interest/participation in activities), 10 (detachment or estrangement), 11 (restricted range of affect), 12 (sense of foreshortened future), all associated with numbing, 15 (difficulty concentrating), 16 (hypervigilance), 17 (exaggerated startle response), associated with hyperarousal, and 6 (avoidance of thoughts/feelings or conversations). Significant differences between venlafaxine ER and placebo were largely absent throughout the treatment period and at the primary week-12 end-point for items 2  (distressing dreams), 7 (avoidance of activities, places or people), 8 (inability to recall important aspect of trauma) and 13 (difficulty falling/staying asleep). These results indicate that symptoms of physiological reactivity and psychological distress in response to cues, and irritability/anger outbursts show early and robust improvement with venlafaxine ER treatment, while symptoms of numbing and hyperarousal take longer. The early and persistent effect of venlafaxine ER over placebo on anger/irritability is noteworthy in view of the clinical significance of these symptoms in PTSD.

PMID: 18544181 [PubMed - in process]

 

J Interpers Violence. 2009 Feb;24(2):231-58. Epub 2008 May 8.

Deployment stressors of the iraq war: insights from the mainstream media.

La Bash HA, Vogt DS, King LA, King DW.

National Center for PTSD and VA Boston Healthcare System. hlabash@unr.edu.

A comprehensive understanding of the stressors of the Iraq War is needed to ensure appropriate postdeployment assessments and to inform empirical inquiries.  Yet we are unaware of any published studies that address the range of stressors experienced by this cohort. Thus, in the present study, we report the results of  an interpretive literature review of mainstream media reports published from the  beginning of the Iraq War in March 2003 to March 2005. This literature revealed a combination of stressors associated with traditional combat, insurgency warfare,  and peacekeeping operations. The increasing deployment of National Guard/Reservist personnel, older soldiers, and women highlights additional stressors associated with sexual harassment and assault, preparedness and training, and life and family disruptions. This is a cause for concern as war-zone stressors have been implicated in postdeployment health outcomes, including intimate partner violence and child maltreatment, immediate physical and mental health, and long-term adjustment.

PMID: 18467690 [PubMed - in process]

 

J Interpers Violence. 2009 Feb;24(2):349-60. Epub 2008 Apr 1.

MMPI-2 Profiles in Civilian PTSD: An Examination of Differential Responses Between Victims of Crime and Industrial Accidents.

Shercliffe RJ, Colotla V.

Luther College. regan.shercliffe@uregina.ca.

The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with  chronic pain (N = 40). Significant differences were seen in profiles between the  PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different kinds of traumatic incidents: industrial accidents or criminal events. They found differences in profile elevations based  on the type of event: The level of distress and fear is greater in PTSD victims of crime, and the results also suggest that victims of crime are more suspicious  and guarded compared with accident victims. Theoretically based reasons for the differences in profile elevations between the two PTSD groups are discussed.

PMID: 18381973 [PubMed - in process]

 

Psychiatry Res. 2009 Jan 30;171(1):44-53. Epub 2008 Dec 11.

Increased activation of the left hippocampus region in Complex PTSD during encoding and recognition of emotional words: A pilot study.

Thomaes K, Dorrepaal E, Draijer NP, de Ruiter MB, Elzinga BM, van Balkom AJ, Smoor PL, Smit J, Veltman DJ.

GGZ Buitenamstel, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.

To gain insight into memory disturbances in Complex Posttraumatic Stress Disorder (Complex PTSD), we investigated declarative memory function and medial temporal lobe activity in patients and healthy non-traumatized controls. A case-control study was performed in nine patients with Complex PTSD and nine controls. All respondents performed a declarative memory task with neutral and emotional, negative words during functional magnetic resonance imaging. Memory performance of neutral words was impaired in Complex PTSD with a relative conservation of recall of negative words. Deep encoding of later remembered negative words, as well as correct recognition of negative words and false alarms, was associated with an enhanced Blood Oxygenation Level Dependent (BOLD) response in the left hippocampus extending into the parahippocampal gyrus of Complex PTSD patients compared with controls. Post-hoc volumetric comparisons did not reveal significant anatomical differences in the medial temporal lobe between Complex PTSD patients and controls. We conclude that in Complex PTSD preferential recall  of negative words is associated with increased activation in the left hippocampus and parahippocampal gyrus during both successful and false recall. These findings support a model of an abnormally functioning hippocampus in Complex PTSD.

PMID: 19081708 [PubMed - in process]

 

Psychiatry Res. 2009 Jan 30;165(1-2):68-77. Epub 2008 Dec 5.

Verbal learning and memory impairments in posttraumatic stress disorder: The role of encoding strategies.

Johnsen GE, Asbjørnsen AE.

University of Bergen, Bergen, Norway.

The present study examined mechanisms underlying verbal memory impairments in patients with posttraumatic stress disorder (PTSD). Earlier studies have reported that the verbal learning and memory alterations in PTSD are related to impaired encoding, but the use of encoding and organizational strategies in patients with  PTSD has not been fully explored. This study examined organizational strategies in 21 refugees/immigrants exposed to war and political violence who fulfilled DSM-IV criteria for chronic PTSD compared with a control sample of 21 refugees/immigrants with similar exposure, but without PTSD. The California Verbal Learning Test was administered to examine differences in organizational strategies and memory. The semantic clustering score was slightly reduced in both groups, but the serial cluster score was significantly impaired in the PTSD group and they also reported more items from the recency region of the list. In addition, intrusive errors were significantly increased in the PTSD group. The data support an assumption of changed memory strategies in patients with PTSD associated with a specific impairment in executive control. However, memory impairment and the use of ineffective learning strategies may not be related to PTSD symptomatology only, but also to self-reported symptoms of depression and general distress.

PMID: 19058857 [PubMed - in process]

 

J Clin Psychiatry. 2009 Jan 17. pii: ej07m03828. [Epub ahead of print]

Treatment of Posttraumatic Stress Disorder in Postwar Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial.

Gordon JS, Staples JK, Blyta A, Bytyqi M, Wilson AT.

From The Center for Mind-Body Medicine, Washington, D.C., USA. jgordon@cmbm.org.

OBJECTIVE: To determine whether participation in a mind-body skills group program based on psychological self-care, mind-body techniques, and self-expression decreases symptoms of posttraumatic stress disorder (PTSD). METHOD: Eighty-two adolescents meeting criteria for PTSD according to the Harvard Trauma Questionnaire (which corresponds with 16 of the 17 diagnostic criteria for PTSD in DSM-IV) were randomly assigned to a 12-session mind-body group program or a wait-list control group. The program was conducted by high school teachers in consultation with psychiatrists and psychologists and included meditation, guided imagery, and breathing techniques; self-expression through words, drawings, and movement; autogenic training and biofeedback; and genograms. Changes in PTSD symptoms were measured using the Harvard Trauma Questionnaire. The study was conducted from September 2004 to May 2005 by The Center for Mind-Body Medicine at a high school in the Suhareka region of Kosovo. RESULTS: Students in the immediate intervention group had significantly lower PTSD symptom scores following the intervention than those in the wait-list control group (F = 29.8, df = 1,76; p < .001). Preintervention and postintervention scores (mean [SD]) for the intervention group were 2.5 (0.3) and 2.0 (0.3), respectively, and for the control group, 2.5 (0.3) and 2.4 (0.4), respectively. The decreased PTSD symptom  scores were maintained in the initial intervention group at 3-month follow-up. After the wait-list control group received the intervention, there was a significant decrease (p < .001) in PTSD symptom scores compared to the preintervention scores. CONCLUSIONS: Mind-body skills groups can reduce PTSD symptoms in war-traumatized high school students and can be effectively led by trained and supervised schoolteachers. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00136357.

PMID: 18945398 [PubMed - as supplied by publisher]

 

Acta Paediatr. 2009 Jan;98(1):17-22. Epub 2008 Sep 14.

Children and adolescents injured in traffic--associated psychological consequences: a literature review.

Olofsson E, Bunketorp O, Andersson AL.

Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden. eva.m.olofsson@vgregion.se

AIM: To identify the prevalence of post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS) among children and adolescents injured in traffic, and to assess  predictors of such post-traumatic stress. METHODS: Studies identified from electronic databases were reviewed. RESULTS: Based on a review of 12 studies, fulfilling specified criteria, the prevalence of PTSS was estimated at 30% within 1 month and 13% at 3-6 months. The prevalence of PTSD was almost 30% at 1-2 months and decreased to the same level as PTSS at 3-6 months. Perceived threat and high levels of distress, anxiety symptoms and being female were significantly associated with PTSD and PTSS. Injury severity was positively related to the number of PTSD symptoms in one of eight studies. Types of accident, age and socioeconomic status were not related to the development of PTSD/PTSS. CONCLUSION: Any child will be at risk of PTSD/PTSS, not just those with severe injuries. Trauma care should include procedures that could identify and prevent stress reactions in order to minimize the risk of associated psychological consequences.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18795910 [PubMed - in process]

 

Am J Prev Med. 2009 Jan;36(1):1-8. Epub 2008 Oct 31.

Posttraumatic stress disorder and obesity: evidence for a risk association.

Perkonigg A, Owashi T, Stein MB, Kirschbaum C, Wittchen HU.

Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany. axelp11@gmx.net

BACKGROUND: There is evidence from cross-sectional studies that posttraumatic stress disorder (PTSD) may be associated with obesity. The aim of this study was  to examine prospective longitudinal associations between PTSD and obesity in a community sample. METHODS: A prospective, longitudinal, epidemiologic study with  a representative community sample of adolescents and young adults (N=3021, aged 14-24 years at baseline) was conducted in Munich, Germany. Participants were assessed four times between 1995 and 2005 with the Munich-Composite International Diagnostic Interview. Associations between obesity (BMI > or =30) and DSM-IV PTSD were evaluated in 2007, using cross-sectional and prospective data during young adulthood. RESULTS: The cumulative lifetime incidence of obesity in the sample at 10-year follow-up during young adulthood was 4.3% (women, 4.6%; men, 4.0%). Among women but not among men, obesity was associated with a lifetime history of PTSD (OR=3.8; 95% CI=1.4, 10.7) in the cross-sectional analyses. Prospective longitudinal analyses from 4-year follow-up to 10-year follow-up confirmed that obesity was predicted by antecedent subthreshold and full PTSD (OR=3.0; 95% CI=1.3, 7.0) among women but not among men. There were no associations between other mental disorders and obesity in the prospective analyses. CONCLUSIONS: The  findings indicate a possible causal pathway for the onset of obesity in females with PTSD symptoms. These findings need replication with regard to the pathophysiologic and behavioral mechanisms underlying this relationship.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18976880 [PubMed - in process]

 

Anxiety Stress Coping. 2009 Jan;22(1):27-37.

The Experience of Intrusions Scale: a preliminary examination.

Salters-Pedneault K, Vine V, Mills MA, Park C, Litz BT.

National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. kristalyn.salters@ va.gov

Intrusive thoughts (i.e., unwelcome, distressing, involuntary thoughts) are prevalent in a variety of clinical conditions and are increasingly a focus of translational research. The goal of this study was to develop and preliminarily examine a brief self-report measure designed to assess clinically relevant aspects of the experience of intrusive thoughts related to a particular target. The Experience of Intrusions Scale (EIS) is a five-item measure that assesses the frequency, unpredictability, and unwantedness of intrusive thoughts, as well as the interference and distress caused by the intrusions, each on a five-point Likert-type scale. Five times over a four-] period, female undergraduates (N=160) completed the EIS in response to intrusive thoughts regarding a film clip depicting a sexual assault. On the first and last days, participants completed the EIS five minutes after watching the clip. In between film clip viewings, participants completed the EIS once per day. The EIS demonstrated good internal consistency, good to excellent test-retest reliability using both immediate post-stimulus and 24-hour time intervals, and convergent validity with two existing measures of intrusive phenomena: the White Bear Suppression Inventory (Wegner & Zanakos, 1994) and the Post-traumatic Stress Disorder Checklist-Civilian Version (Weathers, Litz, Herman, Huska, & Keane, 1993).

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18937103 [PubMed - in process]

 

Anxiety Stress Coping. 2009 Jan;22(1):117-27.

Proactive coping, gratitude, and posttraumatic stress disorder in college women.

Vernon LL, Dillon JM, Steiner AR.

Florida Atlantic University, Jupiter, FL, USA. lvernon@fau.edu

This study investigated relationships among proactive coping, positive emotions,  and posttraumatic stress disorder (PTSD) symptom severity for 182 undergraduate women with trauma histories. Participants were administered the Life Events Checklist (LEC), PTSD Checklist, Proactive Coping Inventory, Proactive Attitude Scale, General Perceived Self-Efficacy Scale, and measures of posttrauma gratitude and emotional growth. An Exploratory Factor Analysis (EFA) with proactive coping, proactive attitude, and self-efficacy items indicated a one-factor solution. The proactive coping style factor and posttrauma gratitude were independently negatively associated with current PTSD symptom level, above and beyond the effects of trauma severity, trauma history, and time elapsed since the trauma. The implications of these results for future research and understanding of the development of PTSD and its treatment are discussed.

PMID: 18791902 [PubMed - in process]

 

Aust N Z J Psychiatry. 2009 Jan;43(1):80-6.

Complex post-traumatic stress disorder in patients with somatization disorder.

Spitzer C, Barnow S, Wingenfeld K, Rose M, Löwe B, Grabe HJ.

University Department of Psychosomatic Medicine and Psychotherapy, University Clinic Hamburg-Eppendorf and Klinikum Eilbek (Schön Kliniken), Hamburg, Germany.  c.spitzer@uke.uni-hamburg.de

OBJECTIVE: Given the association between severe childhood trauma, adult somatization and complex post-traumatic stress disorder (cPTSD), the purpose of the present paper was to assess this syndrome and its clinical correlates in patients with somatization disorder (SD). METHODS: A total of 28 patients (82% women, mean age = 41.7+/-10.1 years) meeting DSM-IV criteria for SD as confirmed  by the Structured Clinical Interview for DSM-IV, Axis I were compared to 28 age-  and gender-matched patients with major depression, but without a lifetime diagnosis of SD. They completed the Structured Interview for Disorders of Extreme Stress, the Brief Symptom Inventory, the Inventory of Interpersonal Problems-Circumplex Scales, and the SF-36 Health Survey. RESULTS: Compared to the control group, SD patients had higher risks for current and lifetime diagnoses of cPTSD (odds ratio (OR) = 15.0, 95% confidence interval (CI) = 1.76-127.54; and OR = 8.33, 95%CI = 2.04-34.07, respectively). SD subjects with cPTSD had more psychological distress, more interpersonal problems and worse psychosocial functioning than those without the syndrome. CONCLUSION: The concept of complex PTSD may hold clinical utility when applied to SD patients because it identifies  a distinct subgroup characterized by severe psychosocial impairment. The diagnostic and therapeutic implications of the present findings are discussed.

PMID: 19085532 [PubMed - in process]

 

Behav Med. 2009 Winter;34(4):125-32.

Hypertension in relation to posttraumatic stress disorder and depression in the US National Comorbidity Survey.

Kibler JL, Joshi K, Ma M.

Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale,  FL.

The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 19064371 [PubMed - in process]

 

Behav Modif. 2009 Jan;33(1):66-81. Epub 2008 Aug 22.

Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies.

Frueh BC, Grubaugh AL, Cusack KJ, Elhai JD.

The Menninger Clinic and Baylor College of Medicine, Houston, TX 77080, USA.

Posttraumatic stress disorder (PTSD) remains largely untreated among adults with  severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes  precedence in the care of adults with SMI. Such oversight is problematic in that  PTSD in SMI populations is common (19%-43%), contributes a significant illness burden, and hinders mental health care. Yet few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the article is to describe strategies and efforts to disseminate trauma-focused empirically based practices in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are to set clear goals, nurture broad-based organizational commitment and key stakeholder involvement, implement specialty training efforts to provide information and change attitudes, provide ongoing supervision, conduct fidelity monitoring, and ensure accountability to the extent possible.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18723837 [PubMed - in process]

 

Behav Res Ther. 2009 Jan;47(1):60-5. Epub 2008 Oct 17.

Psychosocial predictors of chronic Post-Traumatic Stress Disorder in Sri Lankan tsunami survivors.

Lommen MJ, Sanders AJ, Buck N, Arntz A.

Department of Clinical Psychological Science, Maastricht University, Maastricht,  The Netherlands.

This study aimed to determine whether psychological factors associated with Post-Traumatic Stress Disorder (PTSD) identified in Western samples generalize to low Social-Economical-Status (SES) populations in an underdeveloped Asian country. The study included 113 survivors of the 2004-tsunami on the south coast  of Sri Lanka, recruited from 4 preschools and 10 villages for displaced persons.  With logistic regressions the relations between interview-based PTSD diagnosis and psychological factors were assessed, controlling for putative confounders. Fifteen months post-trauma the prevalence of PTSD was 52.2%. Multivariate analyses indicated that negative interpretation of tsunami-memories was significantly (P<0.005) related to PTSD. Of the putative confounders, gender and  (non-replaced) lost work equipment were related to current PTSD (P<0.05). The results indicate that the relation between negative interpretation of trauma memories and PTSD is quite universal, suggesting that interventions focusing on this factor may be important in treatment of tsunami survivors who are suffering  from chronic PTSD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19013551 [PubMed - in process]

 

Behav Res Ther. 2009 Jan;47(1):6-12. Epub 2008 Oct 17.

A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder.

Bugg A, Turpin G, Mason S, Scholes C.

Stratford Locality, Mental Health Services, Building 2, 2nd Floor Arden Street, Stratford-upon-Avon, United Kingdom. ali_bugg@hotmail.com

The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A & E), were screened for Acute Stress Disorder and randomised to an information control group (n=36) or a writing and information group (n=31). Participants in both groups received an information booklet one-month post-injury. Participants in the writing group also wrote about emotional aspects of their trauma during three 20-min sessions, five to six weeks post-injury. Psychological assessments were completed within one month and at three and six months post-injury. There were significant improvements on measures of anxiety, depression and PTSD over time. Differences between groups on these measures were  not statistically significant. However, subjective ratings of the usefulness of writing were high. In conclusion, the results do not currently support the use of writing as a targeted early intervention technique for traumatic injury patients  at risk of developing PTSD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19012880 [PubMed - in process]

 

Brain Dev. 2009 Jan;31(1):15-9. Epub 2008 Jun 16.

Psychiatric disorders and behavioral problems in children and adolescents with Tourette syndrome.

Ghanizadeh A, Mosallaei S.

Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran. ghanizad@sina.tums.ac.ir

OBJECTIVE: Many previous studies have surveyed associations between Tourette syndrome (TS) and co-morbid psychiatric disorders, but they usually did not include oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). METHOD: The subjects were children and adolescents with TS who visited a child and adolescent psychiatric clinic, and who were interviewed using DSM-IV diagnostic criteria. Characteristics of their tics were examined by the Yale-Global Tic Severity Scale (Y-GTSS). Behavioral problems were surveyed by the Child Behavior Checklist (CBCL) filled in by the parents. RESULTS: About 87.9% of the subjects were boys.  The mean age of the subjects was 11.8 years. The most common psychiatric disorders were attention deficit hyperactivity disorder (ADHD), ODD, nail biting, and obsessive compulsive disorder (OCD). Only one subject was affected by TS without co-morbidities. Among TS patients with co-morbidities, those with disruptive behavioral disorders (DBD) have significantly higher mean scores than  patients without DBD on the Externalizing scale, Social problems, Attention problems, Delinquent and Aggression scales. Co-morbidity of anxiety disorders was not related to the CBCL scores. CONCLUSION: Many of our results were similar to those reported in studies conducted in other parts of the world. TS is more common in boys and nearly all of them had at least one co-morbid disorder. The most common co-morbidity was ADHD. Behavioral problems in TS are related to the co-morbidity with the DBD, and possibly not to the anxiety disorders.

PMID: 18558469 [PubMed - in process]

 

Clin Child Psychol Psychiatry. 2009 Jan;14(1):71-83.

Guilt and posttraumatic stress symptoms in child victims of interpersonal violence.

Kletter H, Weems CF, Carrion VG.

Stanford University School of Medicine, California, USA.

Our objective was to examine the relationship between guilt and posttraumatic stress disorder (PTSD) symptoms in children with a history of interpersonal violence. Eighty-seven children between the ages of 5 and 16 years (mean age = 11.70 years) were administered the Clinician-Administered PTSD Scale for Children and Adolescents to assess for PTSD symptoms and associated features. Multiple regression analysis found that guilt over acts of commission or omission (behaviors the child performed or failed to perform during the event or to prevent it) was highly associated with PTSD severity. Derealization and changes in attachment were also significantly related to PTSD symptoms. Findings suggest  that it may be important for clinicians to assess for associated features in traumatized children as these are associated with greater PTSD severity. Posttraumatic interventions may benefit from targeting these symptoms.

PMID: 19103706 [PubMed - in process]

 

Drug Alcohol Depend. 2009 Jan 1;99(1-3):169-75. Epub 2008 Oct 8.

Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans.

Dickerson DL, O'Malley SS, Canive J, Thuras P, Westermeyer J.

Yale University, 1 Long Wharf Drive, Box 18, New Haven, CT 06511, USA; University of California, Los Angeles (UCLA), Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, USA.

BACKGROUND: American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. METHODS: This study analyzes the co-occurrence of current and  lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans. RESULTS: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder. CONCLUSIONS: Substantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.

PMID: 18845405 [PubMed - in process]

 

Int Clin Psychopharmacol. 2009 Jan;24(1):29-33.

Pregabalin augmentation of antidepressants in patients with accident-related posttraumatic stress disorder: an open label pilot study.

Pae CU, Marks DM, Han C, Masand PS, Patkar AA.

aDepartment of Psychiatry, The Catholic University of Korea College of Medicine bDepartment of Psychiatry, The Korea University, Seoul, South Korea cDepartment of Psychiatry and Behavioral Medicines, Duke University Medical Center, Durham, North Carolina dDepartment of Psychiatry and Behavioral Sciences, SUNY Upstate Medical Center at Syracuse, New York, USA.

This study evaluated the efficacy of pregabalin augmentation of antidepressant treatment in patients with posttraumatic stress disorder (PTSD). Nine patients meeting Diagnostic and Statistical Manual, fourth edition criteria for PTSD who were on stable doses of antidepressants were treated open label with flexibly dosed pregabalin for 6 weeks. All patients were assessed with the Short PTSD Rating Interview, Montgomery-Asberg Depression Rating Scale, Patient Global Impression-severity, Visual Analog Scale-pain, and Sheehan Disability Scale at baseline and weeks 2, 4, and 6. Significant reductions were observed in all effectiveness measures from week 4 to the end of the study. In particular, the numerical improvement of the Visual Analog Scale-pain score was most robust (-53.4%, P=0.007). Pregabalin augmentation was effective and well tolerated during the study. Our findings warrant adequately powered, placebo-controlled clinical trials to confirm the usefulness of pregabalin augmentation of antidepressants in patients with PTSD.

PMID: 19060720 [PubMed - as supplied by publisher]

 

J Affect Disord. 2009 Jan;112(1-3):81-4. Epub 2008 Jun 10.

Depression and PTSD symptoms among bereaved adolescents 6(1/2) years after the 1988 spitak earthquake.

Goenjian AK, Walling D, Steinberg AM, Roussos A, Goenjian HA, Pynoos RS.

UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Collaborative Neuroscience Network, Garden Grove, CA 92845.

OBJECTIVE: To compare depression and PTSD symptoms of parentally bereaved adolescents and a comparison group after a catastrophic natural disaster. METHOD: Six and a half years after the Spitak earthquake, 48 parentally bereaved adolescents and a comparison group of 44 subjects with no parental loss were evaluated using the Depression Self - Rating Scale (DSRS) and Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI). RESULTS: Orphans scored significantly  higher on depression than those who lost a father (Mean DSRS scores: 20.2+/-3.3 vs. 16.6+/-5.2; p<0.001), who in turn scored significantly higher than those who  lost a mother (Mean DSRS scores: 16.6+/-5.2 vs. 12.7+/-4.1; p<0.002). Depression  scores for orphans fell above the cut-off for clinical depression, while those who lost a father scored slightly below. PTSD scores within each group fell in the moderate range of severity, with girls scoring higher than boys (Mean CPTSD-RI scores: 35.9+/-11.3 vs. 29.3+/-10.1; p<0.04). LIMITATION: As self-report instruments were used, responses may have been over- or under- reported. Participants belonged to the same ethnic group and therefore the results may not  be generalizable to other populations. CONCLUSION: Loss of both parents and, to a lesser degree, loss of a father is a significant risk factor for depression, but  not for PTSD. This study extends prior findings documenting post-disaster chronicity of depression and PTSD among bereaved adolescents, and underscores the need for post-disaster mental health and social programs, especially for those who suffer the loss of both parents.

PMID: 18547646 [PubMed - in process]

 

J Affect Disord. 2009 Jan;112(1-3):144-50. Epub 2008 Jun 6.

Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder.

Romero S, Birmaher B, Axelson D, Goldstein T, Goldstein BI, Gill MK, Iosif AM, Strober MA, Hunt J, Esposito-Smythers C, Ryan ND, Leonard H, Keller M.

University of Pittsburgh Medical Center. Western Psychiatric Institute Clinic, United States; Institute Clinic of Neuroscience, Hospital Clinic Universitari of  Barcelona, Spain.

OBJECTIVE: Adult bipolar disorder (BP) has been associated with lifetime history  of physical and sexual abuse. However, there are no reports of the prevalence of  abuse in BP youth. The objective of this study was to examine the prevalence and  correlates of physical and/or sexual abuse among youth with BP spectrum disorders. METHODS: Four hundred forty-six youths, ages 7 to 17 years (12.7+/-3.2), meeting DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized definition of BP-NOS (n=154) were assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime version (K-SADS-PL). Abuse was ascertained using the K-SADS. RESULTS: Twenty percent of the sample experienced physical and/or sexual abuse. The most robust correlates of any abuse history were living with a non-intact family (OR=2.6), lifetime history of posttraumatic stress disorder (PTSD) (OR=8.8), psychosis (OR=2.1), conduct disorder (CD) (OR=2.3), and first-degree family history of mood disorder (OR=2.2). After adjusting for confounding demographic factors, physical abuse was associated with longer duration of BP illness, non-intact family, PTSD, psychosis, and first-degree family history of mood disorder. Sexual abuse was associated with PTSD. Subjects with both types of abuse were older, with longer illness duration, non-intact family, and greater prevalence of PTSD and CD as compared with the non-abused group. LIMITATIONS: Retrospective data. Also, since this is a cross-sectional study, no inferences regarding causality can be made. CONCLUSION: Sexual and/or physical abuse is common in youth with BP particularly in subjects with comorbid PTSD, psychosis, or CD. Prompt identification and treatment of these youth is warranted.

PMID: 18538857 [PubMed - in process]

 

J Affect Disord. 2009 Jan;112(1-3):71-80. Epub 2008 Jun 3.

Complex PTSD, interpersonal trauma and relational consequences: Findings from a treatment-receiving Northern Irish sample.

Dorahy MJ, Corry M, Shannon M, Macsherry A, Hamilton G, McRobert G, Elder R, Hanna D.

Trauma Resource Centre, North & West Belfast Area, The Belfast Health & Social Care Trust, Belfast, Northern Ireland, United Kingdom; School of Psychology, The  Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom.

BACKGROUND: The relationship between PTSD and complex PTSD remains unclear. As well as further addressing this issue, the current study aimed to assess the degree to which DESNOS (complex PTSD) was related to interpersonal trauma and had relational consequences. METHODS: Eighty one treatment-receiving participants with a history of exposure to the 'Troubles' in Northern Ireland, were assessed on various forms of interpersonal trauma, including exposure to the Troubles, and measures of interpersonal and community connectedness. RESULTS: DESNOS symptom severity was related to childhood sexual abuse and perceived psychological impact of Troubles-related exposure. A lifetime diagnosis of DESNOS was related to childhood Troubles-related experiences, while a current diagnosis of DESNOS was associated with childhood emotional neglect. PTSD avoidance predicted current DESNOS diagnosis and severity. Feeling emotionally disconnected from family and friends (i.e., interpersonal disconnectedness) was related to all three indices of DESNOS (i.e., lifetime diagnosis, current diagnosis and current symptom severity). LIMITATIONS: Sample characteristics (i.e., treatment-receiving) and size may limit the generalizability of findings. CONCLUSIONS: Complex PTSD is associated with PTSD but when present should be considered a superordinate diagnosis.

PMID: 18511130 [PubMed - in process]

 

J Anxiety Disord. 2009 Jan;23(1):77-86. Epub 2008 Apr 18.

The stressor Criterion-A1 and PTSD: A matter of opinion?

Van Hooff M, McFarlane AC, Baur J, Abraham M, Barnes DJ.

University of Adelaide, The Centre for Military and Veterans' Health, Level 2/122 Frome Street, Adelaide, South Australia 5000, Australia.

Considerable controversy exists with regard to the interpretation and definition  of the stressor "A1" criterion for Post Traumatic Stress Disorder (PTSD). At present, classifying an event as either traumatic (satisfying DSM-IV Criterion-A1 for PTSD), or non-traumatic (life event) is determined by the rater's subjective  interpretation of the diagnostic criteria. This has implications in research and  clinical practice. Utilizing a sample of 860 Australian adults, this study is the first to provide a detailed examination of the impact of event categorization on  the prevalence of trauma and PTSD. Overall, events classified as non-traumatic were associated with higher rates of PTSD. Unanimous agreement between raters occurred for 683 (79.4%) events. As predicted, the categorization method employed (single rater, multiple rater-majority, multiple rater-unanimous) substantially altered the prevalence of Criterion-A1 events and PTSD, raising doubts about the  functionality of PTSD diagnostic criteria. Factors impacting on the categorization process and suggestions for minimizing discrepancies in future research are discussed.

PMID: 18511232 [PubMed - in process]

 

J Anxiety Disord. 2009 Jan;23(1):54-9. Epub 2008 Mar 28.

Repetitive TMS combined with exposure therapy for PTSD: A preliminary study.

Osuch EA, Benson BE, Luckenbaugh DA, Geraci M, Post RM, McCann U.

Biological Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MA, United States.

Treatment for anxiety and post-traumatic stress disorder (PTSD) includes exposure therapy and medications, but some patients are refractory. Few studies of repetitive transcranial magnetic stimulation (rTMS) for anxiety or PTSD exist. In this preliminary report, rTMS was combined with exposure therapy for PTSD. Nine subjects with chronic, treatment-refractory PTSD were studied in a placebo-controlled, crossover design of imaginal exposure therapy with rTMS (1Hz) versus sham. PTSD symptoms, serum and 24h urine were obtained and analyzed. Effect sizes for PTSD symptoms were determined using Cohen's d. Active rTMS showed a larger effect size of improvement for hyperarousal symptoms compared to  sham; 24-h urinary norepinephrine and serum T4 increased; serum prolactin decreased. Active rTMS with exposure may have symptomatic and physiological effects. Larger studies are needed to confirm these preliminary findings and verify whether rTMS plus exposure therapy has a role in the treatment of PTSD.

PMID: 18455908 [PubMed - in process]

 

J Anxiety Disord. 2009 Jan;23(1):27-37. Epub 2008 Mar 20.

Evaluating symptom expression as a function of a posttraumatic stress disorder severity.

Palm KM, Strong DR, Macpherson L.

Brown Medical School, Butler Hospital, United States.

Little is known about the relative severity or typical sequence of Diagnostic and Statistical Manual (DSM-IV) symptoms of posttraumatic stress disorder (PTSD). Using data from the National Comorbidity Study-Replication (NCS-R) [Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., & Hiripi, E., et al. (2004). The US National Comorbidity Survey-Replication (NCS-R): design and field  procedures. International Journal of Methods in Psychiatric Research, 13(2), 69-92], the current study used a logistic item response model to assess the degree to which DSM-IV symptoms combine to define a primary construct underlying  PTSD, to identify which symptoms are associated with greater severity of PTSD, and to determine whether the symptoms and symptom patterns are influenced by gender. Results suggested that PTSD symptoms can be combined to assess a single dimension of PTSD severity, providing support for a continuum of symptom severity. However, several DSM-IV symptoms provided overlapping information, potentially reducing the effectiveness of these symptoms in describing a broad range of PTSD. More precise assessment of PTSD severity may help improve the descriptive value of PTSD measures relationship to continuous measures of treatment outcomes, and ultimately inform more effective treatments.

PMID: 18434083 [PubMed - in process]

 

J Psychiatr Res. 2009 Jan;43(3):309-18. Epub 2008 May 19.

Hippocampal function during associative learning in patients with posttraumatic stress disorder.

Werner NS, Meindl T, Engel RR, Rosner R, Riedel M, Reiser M, Fast K.

Clinic of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich,  Germany; Department of Psychology, Ludwig-Maximilians-University of Munich, Germany.

In the last decade several studies have shown memory deficits in patients with posttraumatic stress disorder (PTSD) which have been associated with a reduced hippocampus volume. However, until now we do not know how or whether these structural abnormalities turn into functional abnormalities. Thus, the primary purpose of the present study was the investigation of the hippocampal function using functional magnet resonance imaging (fMRI). We compared PTSD patients and healthy control participants using an associative learning paradigm consisting of two encoding and one retrieval condition. During fMRI scanning participants had to learn face-profession pairs. Afterwards only faces were presented as cue stimuli for associating the category of the prior learned target profession and the participants had to decide whether this face belonged to a scientific or an artistic profession. Additionally, cognitive functioning, i.e. memory and attention, was examined using neuropsychological standard tests. During encoding  PTSD patients showed stronger hippocampal and weaker prefrontal activation compared to healthy control participants. During retrieval the two groups did not differ neither in hippocampus activation nor in accuracy of retrieval. PTSD patients however showed a reduced activation in the left parahippocampal gyrus and other memory-related brain regions. We did not find any significant memory differences between PTSD patients and healthy control participants. The results suggest that PTSD has an effect on memory-related brain function despite intact memory functioning. In particular the hippocampal/parahippocampal regions and the prefrontal cortex show functional alterations during associative learning and memory.

PMID: 18490028 [PubMed - in process]

 

Mol Psychiatry. 2009 Jan;14(1):86-94. Epub 2007 Oct 30.

WFS1 gene as a putative biomarker for development of post-traumatic syndrome in an animal model.

Kesner Y, Zohar J, Merenlender A, Gispan I, Shalit F, Yadid G.

Neuropharmacology Laboratory, Mina and Everard Goodman Faculty of Life Sciences and the Leslie and Susan Gonda (Goldshmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after the experiencing or witnessing of a life-threatening event. PTSD is defined by the coexistence of three clusters of symptoms: re-experiencing, avoidance and  hyperarousal, which persist for at least 1 month in survivors of the event (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Using an established model of PTSD, we addressed the well-accepted clinical finding that only a minority (about 20%) of the individuals exposed to a traumatic event develop PTSD. Moreover, we followed individual rat behavior for up to a month, and then treated the PTSD-like animals with citalopram. Our data demonstrate high face (20% of rats exposed to a reminder of the stressor develop symptoms characteristic of PTSD) and predictive (response to citalopram) validities. Based on these validities we identified alterations in the Wolframin gene in the CA1 and amygdala regions, specifically in exposed PTSD-like rats, which were normalized after treatment with citalopram. We suggest the Wolframin gene as a putative biomarker for PTSD. Since Wolframin gene undergoes alternative splicing  and has polymorphism in the population, it may serve a future marker for identification of the vulnerable population exposed to a traumatic event.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 17968352 [PubMed - in process]

 

Neuropsychol Rehabil. 2009 Jan;19(1):86-97. Epub 2008 May 1.

Cognitive behaviour therapy for post-traumatic stress symptoms in the context of  hydrocephalus: A single case.

Kneebone II, Hull SL.

Surrey NHS Primary Care Trust, UK.

There is limited information about anxiety disorders occurring in the context of  the challenging condition of hydrocephalus. This paper describes the treatment, via trauma-focused cognitive behaviour therapy (TFCBT), of post-traumatic stress  symptoms arising on account of hydrocephalus in a 23-year-old man. Specific components of the intervention included exposure, cognitive disputation, and relaxation training. The 20-session intervention appeared effective with decreases in anxiety (on the Hospital Anxiety and Depression Scale) and event impact (on the Impact of Events Scale) from clinical to sub-clinical levels. The  main contributor to change appeared to be the exposure element of the treatment.  The benefits of the intervention were maintained at one-, three-, and six-month follow-up.

PMID: 18609019 [PubMed - in process]

 

Occup Med (Lond). 2009 Jan;59(1):25-31. Epub 2008 Dec 12.

Alcohol misuse in the Royal Navy.

Henderson A, Langston V, Greenberg N.

King's Centre for Military Health Research, Academic Centre for Defence Mental Health, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. sososanta@aol.com

BACKGROUND: Evidence suggests that military personnel consume considerable amounts of alcohol which may have both medical and occupational implications. AIM: To compare alcohol consumption and misuse within the Royal Navy (RN) to that in the civilian population. METHODS: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire is a short measure of alcohol use disorders. It was administered to 1333 male RN personnel from operational naval units. 'Heavy' drinking was defined as consuming >21 units/week, 'very heavy' as  >42 units/week, binge drinking as >8 units in one session and 'problem' drinkers  as those advised to cut down in the last year. The study also measured psychological health using the General Health Questionnaire (GHQ)-12 and post-traumatic stress disorder checklist for civilians (PCL-C). RESULTS: The response rate was 70%. The majority (92%) scored as hazardous drinkers on the AUDIT-C, 40% met the criteria for heavy drinking, 27% for very heavy drinking, 48% reported binge drinking at least once a week and 15% were classed as problem  drinkers. Heavy drinking was associated with younger age, lower rank and higher scores for both PCL and GHQ. All results were substantially higher than in age-matched civilian samples. CONCLUSIONS: Excessive alcohol consumption, especially binge drinking, is significantly more prevalent in the RN than in the  general population. Such high levels of drinking are likely to impact upon occupational efficiency and have both short-term and long-term health effects. We suggest that more needs to be done to deter excessive levels of consumption in order to avoid long-term health consequences.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19074746 [PubMed - in process]

 

Psychooncology. 2009 Jan;18(1):30-41.

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing.

Salsman JM, Segerstrom SC, Brechting EH, Carlson CR, Andrykowski MA.

Evanston Northwestern Healthcare, Evanston, Illinois, USA. jsalsman@enh.org

INTRODUCTION: The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. METHODS: Fifty-five post-treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months  post-diagnosis, were recruited from a state cancer registry and completed baseline and 3-month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal),  and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). RESULTS: PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety,  and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3-month PTSD symptomatology and there was a trend  for baseline cognitive rehearsal predicting 3-month PTG. CONCLUSIONS: Additional  research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer. (c) 2008 John Wiley & Sons, Ltd.

PMID: 18481837 [PubMed - in process]

 

Law Hum Behav. 2008 Dec 30. [Epub ahead of print]

Sexual Harassment and Posttraumatic Stress Disorder: Damages Beyond Prior Abuse.

Stockdale MS, Logan TK, Weston R.

Department of Psychology, Southern Illinois University, Carbondale, IL, 62901-6502, USA, pstock@siu.edu.

This study examined the extent to which harassment experiences correlate with posttraumatic stress disorder (PTSD) symptoms, and whether diagnosable PTSD on the basis of sexual harassment occurs after accounting for prior PTSD, prior sexual abuse, and prior psychological dysfunction. The sample consisted of a two-wave panel of 445 women who had received a domestic violence protective order from a Kentucky court. Hierarchical linear and logistic analyses confirmed that sexual harassment experiences were significantly correlated with PTSD symptoms after controlling for an extensive set of trauma variables measured in both the baseline and follow up interviews. Our findings lend further evidence that claims of PTSD from sexual harassment may be credible even if claimants have been victims of other forms of trauma.

PMID: 19115099 [PubMed - as supplied by publisher]

 

J Interpers Violence. 2008 Dec 23. [Epub ahead of print]

Posttraumatic Stress Disorder Among Sri Lankan University Students as a Consequence of Their Exposure to Family Violence.

Haj-Yahia MM, Tishby O, Zoysa PD.

Hebrew University of Jerusalem.

The article presents the results of a study on the association between exposure to family violence (i.e., witnessing interparental violence and experiencing parental violence) during childhood and adolescence and adult posttraumatic stress disorder (PTSD). The study was conducted among a self-selected convenience sample of 476 students from Sri Lanka, using a self-administered questionnaire. The findings indicate that the more participants witnessed interparental violence and the more they experienced parental violence, the more they exhibited PTSD symptoms. Moreover, the findings reveal that participants' exposure to family violence explains a significant amount of the variance in their PTSD over and above the variance that can be attributed to their sociodemographic characteristics (age, gender, number of siblings, and family's socioeconomic status) and to their perceptions of the environment and functioning of their families. The limitations of the study and recommendations for future research are discussed.

PMID: 19106201 [PubMed - as supplied by publisher]

 

J Womens Health (Larchmt). 2008 Dec 23. [Epub ahead of print]

Lifetime Interpersonal Violence and Self-Reported Chlamydia trachomatis Diagnosis among California Women.

Alvarez J, Pavao J, Mack KP, Chow JM, Baumrind N, Kimerling R.

VA Palo Alto Health Care System, Palo Alto, California.

Abstract Objective: To examine the relationship between cumulative exposure to various types of interpersonal violence throughout the life span and self-reported history of Chlamydia trachomatis (CT) diagnosis in a population-based sample of California women. Methods: This was a cross-sectional  analysis of a population-based survey of California women aged 18-44 years (n = 3521). Participants reported their experience of multiple types of interpersonal  violence: physical or sexual abuse in childhood or adulthood and intimate partner violence (IPV) in the past 12 months. Current posttraumatic stress disorder (PTSD) and depressive symptoms were also reported. Separate logistic regression models assessed the association between experiencing each type of interpersonal violence, as well as women's cumulative exposure to violence, and past CT diagnosis, adjusting for age, race/ethnicity, and poverty, as well as mental health problems. Results: Six percent of women reported a past diagnosis of CT, and 40.8% reported experiencing at least one type of interpersonal violence in their lifetime. All types of violence were significantly associated with higher odds of having a past CT diagnosis even after controlling for sociodemographics.  Women who reported experiencing four or more types of violence experiences had over five times the odds of reporting a lifetime CT diagnosis compared with women who never experienced interpersonal violence (adjusted odds ratio = 5.71, 95% CI  3.27-9.58). Current PTSD and depressive symptoms did not significantly affect the relationship between a woman's cumulative experience of violence and her risk of  past CT diagnosis. Conclusions: There is a robust association between experiencing multiple forms of violence and having been diagnosed with CT. Women  who seek treatment for sexually transmitted diseases (STDs), such as CT, should be assessed for their lifetime history of violence, especially violence in their  current intimate relationships. Sexual risk reduction counseling may also be important for women who have a history of risky sexual behaviors and who are likely to be reinfected.

PMID: 19105689 [PubMed - as supplied by publisher]

 

Memory. 2008 Dec 22:1-15. [Epub ahead of print]

The normative and the personal life: Individual differences in life scripts and life story events among USA and Danish undergraduates.

Rubin DC, Berntsen D, Hutson M.

Duke University, Durham, NC, USA.

Life scripts are culturally shared expectations about the order and timing of life events in a prototypical life course. American and Danish undergraduates produced life story events and life scripts by listing the seven most important events in their own lives and in the lives of hypothetical people living ordinary lives. They also rated their events on several scales and completed measures of depression, PTSD symptoms, and centrality of a negative event to their lives. The Danish life script replicated earlier work; the American life script showed minor differences from the Danish life script, apparently reflecting genuine differences in shared events as well as less homogeneity in the American sample.  Both consisted of mostly positive events that came disproportionately from ages 15 to 30. Valence of life story events correlated with life script valence, depression, PTSD symptoms, and identity. In the Danish undergraduates, measures of life story deviation from the life script correlated with measures of depression and PTSD symptoms.

PMID: 19105087 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Dec 16. [Epub ahead of print]

The Role of the Galaninergic System in Modulating Stress-Related Responses in an  Animal Model of Posttraumatic Stress Disorder.

Kozlovsky N, Matar MA, Kaplan Z, Zohar J, Cohen H.

State of Israel Ministry of Health, State of Israel Ministry of Health, Chaim Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat Gan, Israel.

BACKGROUND: Converging evidence implicates the regulatory neuropeptide galanin in anxiety- and depression-related behaviors, through modulation of neuroendocrine,  serotonergic, and noradrenergic systems. This study examined the relationship between stress-induced posttraumatic stress disorder (PTSD)-like behavioral response patterns in rats and galanin mRNA levels in key brain areas and the effects of acute phase pharmacologic manipulation using an agonist (galnon) on behavioral, physiologic, and response patterns of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine-1A (5HT-1A). METHOD: Galanin mRNA expression was assessed in the frontal cortex and hippocampus in the short- and long-term (30 min and 7 days) after exposure to predator scent stress. The effects of intraperitoneal galnon .5 mg/kg versus saline 1 hour postexposure on behavioral tests (elevated plus maze and acoustic startle response) were evaluated 7 days later. Trauma-cue response, circulating corticosterone, and localized brain expression of 5HT-1A receptors and BDNF were subsequently assessed. All data were analyzed in relation to individual behavior patterns. RESULTS: Whereas animals with minimal behavioral disruption displayed a lasting upregulation of galanin mRNA in the hippocampal CA1 area, those with extreme behavioral responses displayed downregulation in both CA1 and frontal cortex. Immediate postexposure treatment with galnon significantly reduced prevalence rates of extreme responders, reduced trauma-cue freezing responses, corrected the corticosterone response, and increased CA1 expression of 5HT-1A and BDNF mRNA compared with saline controls. CONCLUSIONS: Galanin is actively involved in the neurobiological response to predator scent stress with resilience/recovery after  stress exposure and thus warrants further study as a potential therapeutic avenue for the treatment of anxiety-related disorders.

PMID: 19095221 [PubMed - as supplied by publisher]

 

J Psychiatr Res. 2008 Dec 15. [Epub ahead of print]

The role of trauma-related distractors on neural systems for working memory and emotion processing in posttraumatic stress disorder.

Morey RA, Dolcos F, Petty CM, Cooper DA, Hayes JP, Labar KS, McCarthy G.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3918, Durham, NC 27710, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA; Mental Illness Research Education and Clinical Center for Post Deployment Mental Health, Durham VA Medical Center, Durham, NC, USA.

The relevance of emotional stimuli to threat and survival confers a privileged role in their processing. In PTSD, the ability of trauma-related information to divert attention is especially pronounced. Information unrelated to the trauma may also be highly distracting when it shares perceptual features with trauma material. Our goal was to study how trauma-related environmental cues modulate working memory networks in PTSD. We examined neural activity in participants performing a visual working memory task while distracted by task-irrelevant trauma and non-trauma material. Recent post-9/11 veterans were divided into a PTSD group (n=22) and a trauma-exposed control group (n=20) based on the Davidson trauma scale. Using fMRI, we measured hemodynamic change in response to emotional (trauma-related) and neutral distraction presented during the active maintenance  period of a delayed-response working memory task. The goal was to examine differences in functional networks associated with working memory (dorsolateral prefrontal cortex and lateral parietal cortex) and emotion processing (amygdala,  ventrolateral prefrontal cortex, and fusiform gyrus). The PTSD group showed markedly different neural activity compared to the trauma-exposed control group in response to task-irrelevant visual distractors. Enhanced activity in ventral emotion processing regions was associated with trauma distractors in the PTSD group, whereas activity in brain regions associated with working memory and attention regions was disrupted by distractor stimuli independent of trauma content. Neural evidence for the impact of distraction on working memory is consistent with PTSD symptoms of hypervigilance and general distractibility during goal-directed cognitive processing.

PMID: 19091328 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2008 Dec 15;161(3):330-5. Epub 2008 Oct 25.

Basal and suppressed salivary cortisol in female Vietnam nurse veterans with and  without PTSD.

Metzger LJ, Carson MA, Lasko NB, Paulus LA, Orr SP, Pitman RK, Yehuda R.

Research Service, VA Medical Center, Research Service (151), 718 Smyth Rd, Manchester, NH 03104, United States; Departments of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Charlestown, MA 02129,  United States.

It has been suggested that discrepant findings regarding low basal cortisol levels and enhanced suppression of cortisol in response to dexamethasone (DEX) administration in post-traumatic stress disorder (PTSD) may reflect individual differences in gender, trauma type, stage of development at trauma occurrence (e.g., childhood vs. adulthood), early pre-traumatic risk factors, or other individual differences. This study examined salivary cortisol levels at 08.00h and 16.00h as well as cortisol response to 0.50 mg DEX in 40 female Vietnam nurse veterans who had current, chronic PTSD (Current) vs. 43 who never had PTSD (Never). Repeated measures analyses of covariance did not reveal significant group differences in cortisol levels or cortisol suppression. Given that nurses who served in Vietnam had similar exposures, ages at exposure, and duration since exposure to previously studied male Vietnam combat veterans, the present lack of  evidence for low cortisol and cortisol hyper-suppression in nurses with PTSD suggests that previous findings of low cortisol and cortisol hyper-suppression in male Vietnam veterans, females sexually abused as children, and other populations may reflect risk factors beyond simply having PTSD.

PMID: 18951637 [PubMed - in process]

 

AIDS Behav. 2008 Dec 12. [Epub ahead of print]

Lifetime and HIV-Related PTSD Among Persons Recently Diagnosed with HIV.

Martin L, Kagee A.

Department of Psychology, Stellenbosch University, Matieland, Private Bag X1, Stellenbosch, 7602, South Africa.

This cross-sectional study sought to determine the percentage of individuals who  met criteria for lifetime PTSD and HIV-related PTSD among 85 recently diagnosed HIV-positive patients attending public health clinics in the Western Cape, South  Africa. The PTSD module of the Composite International Diagnostic Interview (CIDI) was used to determine the percentage of those who met criteria for lifetime PTSD and HIV-related PTSD. The rate of lifetime PTSD and incidence of HIV-related PTSD was 54.1% (95% CI: 43.6-64.3%) and 40% (95% CI: 30.2-50.6%), respectively. Findings suggest that receiving an HIV-positive diagnosis and/or being HIV-positive may be considered a stressor that frequently results in HIV-related PTSD. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health of HIV-positive individuals is appropriately addressed.

PMID: 19082880 [PubMed - as supplied by publisher]

 

Cogn Process. 2008 Dec 11. [Epub ahead of print]

A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration.

Gruzelier J.

Department of Psychology, Goldsmiths, University of London, Lewisham Way, New Cross, London, SE14 6NW, UK, j.gruzelier@gold.ac.uk.

Professionally significant enhancement of music and dance performance and mood has followed training with an EEG-neurofeedback protocol which increases the ratio of theta to alpha waves using auditory feedback with eyes closed. While originally the protocol was designed to induce hypnogogia, a state historically associated with creativity, the outcome was psychological integration, while subsequent applications focusing on raising the theta-alpha ratio, reduced depression and anxiety in alcoholism and resolved post traumatic stress syndrome  (PTSD). In optimal performance studies we confirmed associations with creativity  in musical performance, but effects also included technique and communication. We extended efficacy to dance and social anxiety. Diversity of outcome has a counterpart in wide ranging associations between theta oscillations and behaviour in cognitive and affective neuroscience: in animals with sensory-motor activity in exploration, effort, working memory, learning, retention and REM sleep; in man with meditative concentration, reduced anxiety and sympathetic autonomic activation, as well as task demands in virtual spatial navigation, focussed and sustained attention, working and recognition memory, and having implications for  synaptic plasticity and long term potentiation. Neuroanatomical circuitry involves the ascending mescencephalic-cortical arousal system, and limbic circuits subserving cognitive as well as affective/motivational functions. Working memory and meditative bliss, representing cognitive and affective domains, respectively, involve coupling between frontal and posterior cortices, exemplify a role for theta and alpha waves in mediating the interaction between distal and widely distributed connections. It is posited that this mediation in part underpins the integrational attributes of alpha-theta training in optimal performance and psychotherapy, creative associations in hypnogogia, and enhancement of technical, communication and artistic domains of performance in the arts.

PMID: 19082646 [PubMed - as supplied by publisher]

 

Am J Med Genet B Neuropsychiatr Genet. 2008 Dec 5;147B(8):1488-94.

Association of the cannabinoid receptor gene (CNR1) with ADHD and post-traumatic  stress disorder.

Lu AT, Ogdie MN, Järvelin MR, Moilanen IK, Loo SK, McCracken JT, McGough JJ, Yang MH, Peltonen L, Nelson SF, Cantor RM, Smalley SL.

Department of Human Genetics, University of California, Los Angeles, California,  USA.

Attention deficit hyperactivity disorder (ADHD) is a highly heritable disorder affecting some 5-10% of children and 4-5% of adults. The cannabinoid receptor gene (CNR1) is a positional candidate gene due to its location near an identified ADHD linkage peak on chromosome 6, its role in stress and dopamine regulation, its association with other psychiatric disorders that co-occur with ADHD, and its function in learning and memory. We tested SNP variants at the CNR1 gene in two independent samples-an unselected adolescent sample from Northern Finland, and a  family-based sample of trios (an ADHD child and their parents). In addition to using the trios for association study, the parents (with and without ADHD) were used as an additional case/control sample of adults for association tests. ADHD and its co-morbid psychiatric disorders were examined. A significant association  was detected for a SNP haplotype (C-G) with ADHD (P = 0.008). A sex by genotype interaction was observed as well with this haplotype posing a greater risk in males than females. An association of an alternative SNP haplotype in this gene was found for post-traumatic stress disorder (PTSD) (P = 0.04 for C-A, and P = 0.01 for C-G). These observations require replication, however, they suggest that the CNR1 gene may be a risk factor for ADHD and possibly PTSD, and that this gene warrants further investigation for a role in neuropsychiatric disorders. Copyright 2008 Wiley-Liss, Inc.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18213623 [PubMed - in process]

 

Biol Psychiatry. 2008 Dec 4. [Epub ahead of print]

Amygdala Deactivation as a Neural Correlate of Pain Processing in Patients with Borderline Personality Disorder and Co-Occurrent Posttraumatic Stress Disorder.

Kraus A, Esposito F, Seifritz E, Di Salle F, Ruf M, Valerius G, Ludaescher P, Bohus M, Schmahl C.

Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.

BACKGROUND: Previous studies have revealed altered affective pain processing in patients with borderline personality disorder (BPD) as well as in patients with posttraumatic stress disorder (PTSD). Reduced levels of activation in the amygdala might be related to antinociceptive mechanisms pertinent to both disorders. This study aimed at clarifying whether central antinoceptive mechanisms discriminate BPD patients with and without co-occurrent PTSD. METHODS: We investigated 29 medication-free female outpatients with BPD, 12 with and 17 without co-occurrent PTSD. Psychophysical characteristics were assessed, and functional magnetic resonance imaging was performed during heat stimulation with  stimuli adjusted for equal subjective painfulness. RESULTS: No difference in pain sensitivity was found between both groups of patients. Amygdala deactivation, however, was more pronounced in BPD patients with co-occurrent PTSD compared with those without PTSD. Amygdala deactivation was independent of BPD symptom severity and dissociation. CONCLUSIONS: Amygdala deactivation seems to differentiate patients who meet criteria for both BPD and PTSD from BPD patients without co-occurrent PTSD. On the basis of these preliminary findings it might be speculated that reduced pain sensitivity or at least the emotional component of it is associated with amygdala deactivation in patients with both disorders, whereas BPD patients without PTSD use different yet unknown antinociceptive mechanisms.

PMID: 19058793 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Dec 4. [Epub ahead of print]

A Study of the Protective Function of Acute Morphine Administration on Subsequent Posttraumatic Stress Disorder.

Bryant RA, Creamer M, O'Donnell M, Silove D, McFarlane AC.

School of Psychiatry University of New South Wales, New South Wales, Sydney.

BACKGROUND: To index the extent to which acute administration of morphine is protective against development of posttraumatic stress disorder (PTSD). METHODS:  Consecutive patients admitted to hospital after traumatic injury (n = 155) were assessed for current psychiatric disorder, pain, and morphine dose in the initial week after injury and were reassessed for PTSD and other psychiatric disorders 3  months later (n = 120). RESULTS: Seventeen patients (14%) met criteria for PTSD at 3 months. Patients who met criteria for PTSD received significantly less morphine than those who did not develop PTSD; there was no difference in morphine levels in those who did and did not develop major depressive episode or another anxiety disorder. Hierarchical regression analysis indicated that PTSD severity at 3 months was significantly predicted by acute pain, mild traumatic brain injury, and elevated morphine dose in the initial 48 hours after trauma, after controlling for injury severity, gender, age, and type of injury. CONCLUSIONS: Acute administration of morphine may limit fear conditioning in the aftermath of  traumatic injury and may serve as a secondary prevention strategy to reduce PTSD  development.

PMID: 19058787 [PubMed - as supplied by publisher]

 

Drug Alcohol Depend. 2008 Dec 3. [Epub ahead of print]

Posttraumatic stress disorder and other psychopathology in substance abusing patients.

Cacciola JS, Koppenhaver JM, Alterman AI, McKay JR.

The University of Pennsylvania School of Medicine/Philadelphia Veterans Affairs Medical Center, Center for Studies of Addiction, Philadelphia, PA 19104, United States; The Treatment Research Institute, Philadelphia, PA 19106, United States.

Studies demonstrating greater problem severity in substance abuse patients with posttraumatic stress disorder (PTSD) versus those without have rarely considered  other co-occurring psychiatric disorders. This study of 466 male veterans recently admitted to outpatient substance abuse treatment attempts to identify problems associated with PTSD versus those associated with other nonsubstance use Axis I disorders. Problem severity, particularly psychiatric, was examined across four groups of patients with substance use disorders (SUDs). Those with: 1, SUDs  only (SU-Only); 2, PTSD, but no other Axis I disorders (SU+PTSD); 3, PTSD and other Axis I disorders (SU+PTSD+Axis I); and 4, no PTSD, but other Axis I disorders (SU+other Axis I). Results suggested a hierarchy of psychiatric, and to a lesser extent, other life problem severities associated with these diagnostic groupings. The most severe group was SU+PTSD+Axis I, followed in decreasing severity by the SU+other Axis I, SU+PTSD, and SU-Only groups. Additional analyses comparing the SU+PTSD+Axis I patients with a subgroup of Axis I patients with more than one Axis I disorder (SU+multiple Axis I) revealed few group differences except for more lifetime suicide attempts and psychiatric hospitalizations in the SU+PTSD+Axis I group. The findings suggest that it is not PTSD per se, but the frequent co-occurrence of PTSD and other psychopathology that largely accounts for previously reported greater problem severity of SUD patients with PTSD.

PMID: 19062202 [PubMed - as supplied by publisher]

 

J Burn Care Res. 2008 Dec 3. [Epub ahead of print]

The Effect of Propranolol on Posttraumatic Stress Disorder in Burned Service Members.

McGhee LL, Maani CV, Garza TH, Desocio PA, Gaylord KM, Black IH.

From the *Battlefield Pain Control Project Area and daggerCenter for Outcomes Research, United States Army Institute of Surgical Research; and double daggerDepartment of Anesthesiology, Brooke Army Medical Center, Ft. Sam Houston,  Texas.

Posttraumatic stress disorder (PTSD) is reported to affect almost one third of the civilian burn patient population. Predisposing factors for PTSD include experiencing a traumatic event. Of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) soldiers returning home after deployment without injury, 17% reported cognitive symptoms of PTSD. The authors recent study of soldiers burned  in OIF/OEF showed a PTSD prevalence of approximately 30%, which is similar to civilian studies. Burns are characterized by hypermetabolism and increased catecholamine levels. beta-Adrenergic receptor blocking agents, like propranolol, decrease catecholamine levels. Propranolol may reduce consolidation of memory and a prophylaxis for PTSD. This retrospective study examines the relationship between PTSD prevalence and propranolol administration. After institutional review board approval, propranolol received, number of surgeries, anesthetic/analgesic regimen, TBSA burned, and injury severity score were collected from patients charts. The military burn center received 603 soldiers injured in OIF/OEF, of which 226 completed the PTSD Checklist-Military. Thirty-one soldiers received propranolol and 34 matched soldiers did not. In propranolol patients, the prevalence of PTSD was 32.3% vs 26.5% in those not receiving propranolol (P = .785). These data suggest propranolol does not decrease PTSD development in burned soldiers. The prevalence of PTSD in patients  receiving propranolol is the same as those not receiving propranolol. More research is needed to determine the relationship between PTSD and propranolol.

PMID: 19060728 [PubMed - as supplied by publisher]

 

Am J Psychiatry. 2008 Dec 1. [Epub ahead of print]

Toward Validation of the Diagnosis of Posttraumatic Stress Disorder.

North CS, Suris AM, Davis M, Smith RP.

Unlike most psychiatric diagnoses, posttraumatic stress disorder (PTSD) is defined in relation to a potentially etiologic event (the traumatic "stressor criterion") that is fundamental to its conceptualization. The diagnosis of PTSD thus inherently depends on two separate but confounded processes: exposure to trauma and development of a specific pattern of symptoms that appear following the trauma. Attempts to define the range of trauma exposure inherent in the diagnosis of PTSD have generated controversy, as reflected in successive revisions of the criterion from DSM-III onward. It is still not established whether or not there are specific types of traumatic events and levels of exposure to them that are associated with a syndrome that is cohesive in clinical characteristics, biological correlates, familial patterns, and longitudinal diagnostic stability. On the other hand, the symptomatic description of PTSD is becoming more clear. Of three categories of symptoms associated with PTSD-intrusive memories, avoidance and numbing, and hyperarousal-avoidance and numbing appear to be the most specific for identification of PTSD. Research is now poised to answer questions about the relevance of traumatic events based on their relationship to symptomatic outcome. The authors recommend that future research begin with existing diagnostic criteria, testing and further refining them in accordance with the classic Robins and Guze strategy for validation of psychiatric diagnoses. In this process, diligent adherence to the criteria under  examination is paramount to successful PTSD research, and changes in criteria are driven by empirical data rather than theory. Collaborations among trauma research biologists, epidemiologists, and nosologists to map the correspondence between the clinical and biological indicators of psychopathology are necessary to advance validation and further understanding of PTSD.

PMID: 19047323 [PubMed - as supplied by publisher]

 

Am J Psychiatry. 2008 Dec;165(12):1566-75. Epub 2008 Nov 17.

Comment in:     Am J Psychiatry. 2008 Dec;165(12):1505-6.

Trauma, resilience, and recovery in a high-risk African-American population.

Alim TN, Feder A, Graves RE, Wang Y, Weaver J, Westphal M, Alonso A, Aigbogun NU, Smith BW, Doucette JT, Mellman TA, Lawson WB, Charney DS.

Department of Psychiatry, Howard University, Washington, DC, USA.

OBJECTIVE: Despite increased risk for psychiatric disorders after trauma exposure, many people are able to adapt with minimal life disruption, and others  eventually recover after a symptomatic period. This study examined psychosocial factors associated with resilience and recovery from psychiatric disorders in a high-risk sample of African American adults exposed to a range of severe traumas, who participated in structured diagnostic interviews. METHOD: The sample included 259 patients exposed to at least one severe traumatic event, recruited from primary care offices at Howard University and administered the Structured Clinical Interview for DSM-IV Axis I disorders. Multinomial logistic regression was used to identify potential psychosocial factors associated with resilience and recovery, including purpose in life, mastery, and coping strategies. RESULTS: Forty-seven patients had no lifetime psychiatric disorders (resilient), 85 met criteria for at least one past DSM-IV disorder but no current disorders (recovered), and 127 met criteria for at least one current DSM-IV disorder (currently ill). The resilient group was characterized by a significantly lower lifetime trauma load. Female gender was predictive of currently ill status. In the final model, purpose in life emerged as a key factor associated with both resilience and recovery, and mastery was also significantly associated with recovery. CONCLUSIONS: The identification of psychosocial factors associated with resistance to severe trauma can inform future studies of preventive and treatment interventions for high-risk populations. Further study is needed to determine which psychosocial factors are consistently associated with resilience and to what extent they can be modified through clinical intervention.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 19015233 [PubMed - indexed for MEDLINE]

 

52: Am J Public Health. 2008 Dec;98(12):2191-8. Epub 2008 Oct 15.

Canadian military personnel's population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations.

Sareen J, Belik SL, Afifi TO, Asmundson GJ, Cox BJ, Stein MB.

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada. sareen@cc.umanitoba.ca

OBJECTIVES: We investigated mental disorders, suicidal ideation, self-perceived need for treatment, and mental health service utilization attributable to exposure to peacekeeping and combat operations among Canadian military personnel. METHODS: With data from the Canadian Community Health Survey Cycle 1.2 Canadian Forces Supplement, a cross-sectional population-based survey of active Canadian military personnel (N = 8441), we estimated population attributable fractions (PAFs) of adverse mental health outcomes. RESULTS: Exposure to either combat or peacekeeping operations was associated with posttraumatic stress disorder (men: PAF = 46.6%; 95% confidence interval [CI] = 27.3, 62.7; women: PAF = 23.6%; 95% CI = 9.2, 40.1), 1 or more mental disorder assessed in the survey (men: PAF = 9.3%; 95% CI = 0.4, 18.1; women: PAF = 6.1%; 95% CI = 0.0, 13.4), and a perceived need for information (men: PAF = 12.3%; 95% CI = 4.1, 20.6; women: PAF = 7.9%; 95% CI = 1.3, 15.5). CONCLUSIONS: A substantial proportion, but not the majority, of mental health-related outcomes were attributable to combat or peacekeeping deployment. Future studies should assess traumatic events and their association with physical injury during deployment, premilitary factors, and postdeployment psychosocial factors that may influence soldiers' mental health.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18923111 [PubMed - indexed for MEDLINE]

 

53: Arch Gen Psychiatry. 2008 Dec;65(12):1410-8.

Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age: the Vietnam experience study.

Gale CR, Deary IJ, Boyle SH, Barefoot J, Mortensen LH, Batty GD.

Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, England. crg@mrc.soton.ac.uk

CONTEXT: Lower cognitive ability is a risk factor for some forms of psychopathology, but much of the evidence for risk is based on individuals who required specialist care. It is unclear whether lower ability influences the risk of particular patterns of comorbidity. OBJECTIVE: To examine the relation between premorbid cognitive ability in early adulthood and the risk of major depression,  generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), alcohol and other drug abuse or dependence, and comorbid forms of these conditions in midlife. DESIGN: Prospective cohort study in which cognitive ability was measured on enlistment into military service at a mean age of 20.4 years and psychiatric disorder was assessed by structured diagnostic interview at a mean age of 38.3 years. SETTING: The United States. PARTICIPANTS: A total of 3258 male veterans, participants in the Vietnam Experience Study. MAIN OUTCOME MEASURES: Major depression, GAD, PTSD, and alcohol or other drug abuse or dependence since enlistment and currently, diagnosed according to the DSM-III. RESULTS: Lower cognitive ability was associated with an increased risk of depression, GAD, alcohol abuse or dependence, and PTSD and with some patterns of comorbidity. For  a 1-SD decrease in cognitive ability, unadjusted odds ratios (95% confidence interval) for having these disorders currently were 1.32 (1.12-1.56) for depression, 1.43 (1.27-1.64) for GAD, 1.20 (1.08-1.35) for alcohol abuse or dependence, 1.39 (1.18-1.67) for PTSD, 2.50 (1.41-4.55) for PTSD plus GAD, 2.17 (1.47-3.22) for PTSD plus GAD plus depression, and 2.77 (1.12-6.66) for all 4 disorders. Most associations remained statistically significant after adjustment  for confounders. CONCLUSIONS: Lower cognitive ability is a risk factor for several specific psychiatric disorders, including some forms of comorbidity. Understanding the mechanisms whereby ability is linked to individual patterns of  psychopathology may inform intervention.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 19047528 [PubMed - indexed for MEDLINE]

 

Assessment. 2008 Dec;15(4):404-25. Epub 2008 Jun 20.

Exploratory and confirmatory factor analyses of the structured interview for disorders of extreme stress.

Scoboria A, Ford J, Lin HJ, Frisman L.

Department of Psychology, University of Windsor, Windsor, ON, Canada. scoboria@uwindsor.ca

Two studies were conducted to provide the first empirical examination of the factor structure of a revised version of the clinically derived Structured Interview for Disorders of Extreme Stress, a structured interview designed to assess associated features of posttraumatic stress disorder (PTSD) thought to be  related to early onset, interpersonal, and prolonged traumatic exposure. Five factors representing demoralization, somatic dysregulation, anger dysregulation,  risk/self-harm, and altered sexuality were derived from an exploratory factor analysis conducted with adult trauma survivors in substance abuse treatment. They provided a good fit in a confirmatory factor analysis conducted in a second study with a nonclinical sample of ethnoculturally diverse, socioeconomically disadvantaged, incarcerated adults. Evidence of the derived factors' internal consistency and convergent and discriminant validity is reported. Evidence supported the association of these factors with interpersonal trauma (physical and/or sexual), its repetition, and its earlier onset. Implications for clinical  assessment of complex posttraumatic stress disorder are discussed.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, P.H.S.

PMID: 18567699 [PubMed - in process]

 

Assessment. 2008 Dec;15(4):391-403. Epub 2008 Apr 24.

Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans.

Vogt DS, Proctor SP, King DW, King LA, Vasterling JJ.

Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare  System, Boston, MA 02130, USA. dawne.vogt@va.gov

The Deployment Risk and Resilience Inventory (DRRI) is a suite of scales that can be used to assess deployment-related factors implicated in the health and well-being of military veterans. Although initial evidence for the reliability and validity of DRRI scales based on Gulf War veteran samples is encouraging, evidence with respect to a more contemporary cohort of Operation Iraqi Freedom (OIF) veterans is not available. Therefore, the primary goal of the present study was to validate scales from the DRRI in a large sample of OIF army personnel diversified in occupational and demographic characteristics. In general, results  supported the use of these DRRI scales in this population. Internal consistency reliability estimates were quite strong. Additionally, support was obtained for criterion-related validity, as demonstrated by associations with mental and physical health measures, and discriminative validity, as demonstrated by differences between key military subgroups.

Publication Types:      Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18436857 [PubMed - in process]

 

Aust N Z J Psychiatry. 2008 Dec;42(12):1051-9.

Naturalistic comparison of models of programmatic interventions for combat-related post-traumatic stress disorder.

Forbes D, Lewis V, Parslow R, Hawthorne G, Creamer M.

Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia. dforbes@unimelb.edu.au

OBJECTIVES: Post-traumatic stress disorder (PTSD) is a difficult-to-treat sequel  of combat. Data on effectiveness of alternate treatment structures are important  for planning veterans' psychiatric services. The present study compared clinical  presentations and treatment outcomes for Australian veterans with PTSD who participated in a range of models of group-based treatment. METHOD: Participants  consisted of 4339 veterans with combat-related PTSD who participated in one of five types of group-based cognitive behavioural programmes of different intensities and settings. Data were gathered at baseline (intake), as well as at  3 and 9 month follow up, on measures of PTSD, anxiety, depression and alcohol misuse. Analyses of variance and effect size analyses were used to investigate differences at intake and over time by programme type. RESULTS: Small baseline differences by programme intensity were identified. Although significant improvements in symptoms were evident over time for each programme type, no significant differences in outcome were evident between programmes. When PTSD severity was considered, veterans with severe PTSD performed less well in the low-intensity programmes than in the moderate- or high-intensity programmes. Veterans with mild PTSD improved less in high-intensity programmes than in moderate- or low-intensity programmes. CONCLUSION: Comparable outcomes are evident across programme types. Outcomes may be maximized when veterans participate in programme intensity types that match their level of PTSD severity. When such matching is not feasible, moderate-intensity programmes appear to offer the most consistent outcomes. For regionally based veterans, delivering treatment in their local environment does not detract from, and may even enhance, outcomes. These findings have implications for the planning and purchasing of mental health services for sufferers of PTSD, particularly for veterans of more recent combat or peacekeeping deployments.

PMID: 19016093 [PubMed - in process]

 

Behav Res Ther. 2008 Dec;46(12):1305-10. Epub 2008 Sep 25.

Anxiety and post-traumatic stress symptoms following wisdom tooth removal.

de Jongh A, Olff M, van Hoolwerff H, Aartman IH, Broekman B, Lindauer R, Boer F.

Academic Centre for Dentistry Amsterdam, Department of Social Dentistry and Behavioural Sciences, University of Amsterdam, Louwesweg 1, 1066 EA Amsterdam, The Netherlands. a.de.jongh@acta.nl

The purpose of the present study was to determine the psychological impact of wisdom teeth removal and to identify the psychological risk factors for the development of dental anxiety and post-traumatic stress symptoms. Participants were 34 consecutive elective patients referred for surgical removal of a wisdom tooth under local anesthesia. Frequency of previous distressing dental events and general traumatic life events were assessed at baseline (t1), and emotional distress (pain, state anxiety and disturbance) immediately after treatment (t2).  Post-traumatic stress responses were determined three days after treatment (t3),  and at four weeks follow-up (t4), while severity of dental trait anxiety was assessed at t1 and at t4. Two patients (8%) met screening criteria for Post-Traumatic Stress Disorder (PTSD) at t4. Multivariate analysis revealed that  previous exposure to distressing dental events and pre-operative anxiety level predicted anxiety level at t4, accounting for 71% of the variance. Severity of pain during treatment was a significant predictor variable of PTSD symptom severity at t4 (25% explained variance). The findings underline the importance of pain-free treatments and awareness of patients' individual predisposition to anxiety or trauma-related symptoms to reduce the risk of iatrogenic psychological harm.

PMID: 18954863 [PubMed - in process]

 

Behav Ther. 2008 Dec;39(4):386-97. Epub 2008 Jun 6.

Risk factors for isolated sleep paralysis in an African American sample: a preliminary study.

Ramsawh HJ, Raffa SD, White KS, Barlow DH.

Boston University, Boston, MA, USA. hramsawh@ucsd.edu

Isolated sleep paralysis (ISP) is a temporary period of involuntary immobility that can occur at sleep onset or offset. It has previously been reported in association with both panic disorder (PD) and posttraumatic stress disorder (PTSD). The current study examined the association between ISP and several possible risk factors--anxiety sensitivity, trauma exposure, life stress, and paranormal beliefs--in a sample of African American participants with and without a history of ISP. Significant between-group differences were found for PD and PTSD diagnoses, anxiety sensitivity, life stress, and certain aspects of paranormal belief, with the ISP group being higher on all of these indices. No differences were found with regard to trauma exposure. Hierarchical regression analyses indicated that PD, anxiety sensitivity, and life stress each contributed unique variance to ISP cognitive symptoms, whereas PTSD and paranormal beliefs did not. These results provide preliminary support for an association between ISP and anxiety sensitivity and corroborate previous reports of ISP's association with PD and life stress. The current trauma/PTSD findings are mixed, however, and warrant future research.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19027435 [PubMed - in process]

 

Burns. 2008 Dec;34(8):1082-9. Epub 2008 Jun 3.

PTSD in persons with burns: an explorative study examining relationships with attributed responsibility, negative and positive emotional states.

Van Loey NE, van Son MJ, van der Heijden PG, Ellis IM.

Association of Dutch Burn Centres, Beverwijk, The Netherlands. nvanloey@burns.nl

A sample of 90 persons who had been hospitalized for severe burns were interviewed 1-4 years after the incident. Current DSM-IV post-traumatic stress disorder (PTSD) was assessed with the Composite International Diagnostic Interview. Perceived attributed responsibility and related positive and negative  emotional states were examined using a semi-structured interview. Findings showed that PTSD was established in 8% of the participants and partial PTSD in 13%. In a homogeneity analysis (HOMALS), PTSD was associated with the attribution of responsibility for the incident to impersonal relationships and with a negative emotional state. The absence of (partial) PTSD was associated with the attribution of responsibility to close relationships, internal and circumstance-related attribution of responsibility and neutral or forgiving feelings. In logit analyses, both emotional state as well as attributed responsibility are significantly related to (partial) PTSD. However, the model including emotional state showed to have the best fit. Although further research  is needed, these results may indicate that professionals working in burn care should consider the emotional state in relation to perceived attribution of responsibility when considering PTSD. Promoting forgiveness may be a beneficial strategy in dealing with post-traumatic stress reactions.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18511200 [PubMed - in process]

 

Cyberpsychol Behav. 2008 Dec;11(6):775-7.

BusWorld: an analog pilot test of a virtual environment designed to treat posttraumatic stress disorder originating from a terrorist suicide bomb attack.

Josman N, Reisberg A, Weiss PL, Garcia-Palacios A, Hoffman HG.

Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, Israel. naomij@research.haifa.ac.il

Exposure therapy treatment can lead to large reductions in posttraumatic stress disorder (PTSD) symptoms. Virtual reality exposure (VRE) therapy is designed to facilitate cognitive behavioral therapy for PTSD. During VRE therapy, patients go into an immersive computer-generated environment (go back to the scene of the traumatic event) to help them gain access to their memories of the traumatic event, change unhealthy thought patterns, gradually habituate to their anxiety, and reduce the intensity of associated emotions. The therapist's ability to manipulate the amount of anxiety experienced by the client during therapy is an important element of successful exposure therapy. Using a within-subjects design, 30 asymptomatic volunteers each experienced four levels of a virtual world depicting a terrorist bus bombing, designed to be increasingly distressful. There was a statistically significant difference between the mean subjective units of discomfort scores (SUDS) of the four levels, and several planned paired comparisons showed significantly higher SUDS ratings with higher simulation levels. Results suggest that sound may play an important role in successful elicitation of emotional responses during VRE. The results of this analog study provide initial validation of the potential of BusWorld to provide graded exposure for individuals suffering from PTSD originating from suicide bus bombings. Future research exploring whether VR exposure therapy with BusWorld can reduce PTSD in clinical patients is warranted.

PMID: 18991534 [PubMed - in process]

 

Encephale. 2008 Dec;34(6):577-83. Epub 2008 Apr 2.

[Prevalence of trauma-related disorders in the French WHO study: Santémentale en  population générale (SMPG).]

[Article in French]

Vaiva G, Jehel L, Cottencin O, Ducrocq F, Duchet C, Omnes C, Genest P, Rouillon F, Roelandt JL.

Secteur des urgences psychiatriques, pôle des urgences, CHRU de Lille, rue André-Verhaeghe, 59037 Lille, France; GIS épidémiologie en santé mentale, CHU de  Sainte-Anne, Paris, France.

INTRODUCTION: Trauma-related disorders are disabling affections of which epidemiological data change according to the country, population and measuring instruments. The prevalence of posttraumatic stress disorder (PTSD) appears to have increased over the past 15 years, but one cannot tell whether it has indeed  increased or whether the standardized procedure has improved. Moreover, very few  epidemiologic studies among the general population have been conducted in Europe, notably in France. DESIGN OF THE STUDY: The "Santé mentale en population générale" (SMPG) survey, that took place in France between 1999 and 2003 among more than 36 000 individuals, gives an estimation of the prevalence of psychotraumatic disorders in the general population. Multi-varied analyses were performed on PTSD-related variables and comorbid disorders. The instantaneous prevalence (past month) of PTSD was of 0.7% among the whole SMPG sample, with almost the same proportion of men (45%) and women (55%). There was a high rate of comorbidity among PTSD individuals, notably with mood disorders, anxiety disorders and addictive behaviour. There was an obvious relationship with suicidal behaviour, with 15-fold more suicide attempts during the past month among the PTSD population. RESULTS: This survey analysed the consequences of a psychic traumatism over and above complete PTSD according to DSM-IV criteria, observing for instance the consequences for people exposed both to a trauma and suffering from at least one psychopathological symptom since the trauma. Those who suffered from a psychotraumatic syndrome, according to our enlarged definition, represented 5.3% of the population, half suffered from daily discomfort and a third of them used medication. Then, we compared those psychotraumatic syndromes to complete PTSD from a sociodemographic, functional and type of care point of view. There was little difference in prevalence of PTSD between men and women in the SMPG survey (45% vs 55%), which is clearly distinct  from the other epidemiologic surveys named above. Regarding age, as in the ESEMeD survey, anxiety disorders appeared to be more frequent among younger people. The  originality of the SMPG survey is obviously in the fact that it studied the functional impact of the psychic disorder, the type of care and the satisfaction  level after care. Only 50% of the PTSD population feels sick which is, however, twice as high as for the psychotraumatized population. This doesn't fit either with the fact that 100% of the PTSD population say they feel uncomfortable with other people. The type of care is in the same vein: 50% of psychotherapies and 75% of medication, but also 25% of mild medicines and 25% of traditional medicines. Moreover, among the drugs, antidepressants (that are still the first choice treatment in all international recommendations) represent only 30%, whereas anxiolytics, hypnotics and phytotherapy represent the remaining 70%. DISCUSSION: Regarding the type of care, the differences between the psychotraumatized population and the PTSD population are obvious. They are obvious in that which concerns the type of care, since the medication is similar. From a very global point of view, patients suffering from a subsyndromal PTSD rarely choose medical care (religion, mild or traditional medicine), while full PTSD patients definitely choose classical medical care (drugs, psychotherapy, and 30% of hospitalization). The prevalence of those who ask for care is very close to that observed in the ESEMeD survey, which was four individuals out of 10 suffering from PTSD. CONCLUSION: The SMPG data show that its necessary to maintain the distinction between subsyndromal PTSD and full PTSD since the populations differ, but both need care.

Publication Types:      English Abstract

PMID: 19081454 [PubMed - in process]

 

Eur J Neurosci. 2008 Dec;28(11):2299-309. Epub 2008 Nov 3.

Impaired extinction of learned fear in rats selectively bred for high anxiety--evidence of altered neuronal processing in prefrontal-amygdala pathways.

Muigg P, Hetzenauer A, Hauer G, Hauschild M, Gaburro S, Frank E, Landgraf R, Singewald N.

Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Peter-Mayer-Strasse 1,  A-6020 Innsbruck, Austria.

The impaired extinction of acquired fear is a core symptom of anxiety disorders,  such as post-traumatic stress disorder, phobias or panic disorder, and is known to be particularly resistant to existing pharmacotherapy. We provide here evidence that a similar relationship between trait anxiety and resistance to extinction of fear memory can be mimicked in a psychopathologic animal model. Wistar rat lines selectively bred for high (HAB) or low (LAB) anxiety-related behaviour were tested in a classical cued fear conditioning task utilizing freezing responses as a measure of fear. Fear acquisition was similar in both lines. In the extinction trial, however, HAB rats showed a marked deficit in the  attenuation of freezing responses to repeated auditory conditioned stimulus presentations as compared with LAB rats, which exhibited rapid extinction. To gain information concerning the putatively altered neuronal processing associated with the differential behavioural response between HAB and LAB rats, c-Fos expression was investigated in the main prefrontal-amygdala pathways important for cued fear extinction. HAB compared to LAB rats showed an attenuated c-Fos response to repeated conditioned stimulus presentations in infralimbic and cingulate cortices, as well as in the lateral amygdala, but facilitated the c-Fos response in the medial part of the central amygdala. In conclusion, the present results support the notion that impaired extinction in high anxiety rats is accompanied by an aberrant activation profile in extinction-relevant prefrontal-amygdala circuits. Thus, HAB rats may represent a clinically relevant  model to study the mechanisms and potential targets to accelerate delayed extinction processes in subjects with enhanced trait anxiety.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19019199 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1523-8. Epub 2008 Mar 13.

The symptom structure of posttraumatic stress disorder in the National Comorbidity Replication Survey.

Cox BJ, Mota N, Clara I, Asmundson GJ.

Department of Psychiatry, University of Manitoba, Canada. coxbj@cc.umanitoba.ca

Previous research has provided mixed findings for the validity of various three-  and four-factor models of posttraumatic stress disorder (PTSD) symptomatology. However, much of this research has been restricted to clinical samples rather than nationally representative community-based samples. The current study employed confirmatory factor analysis to evaluate the validity of three competing models of PTSD symptom structure using the DSM-IV-based National Comorbidity Replication Survey (part II of the NCS-R: N=5692). Individuals with a lifetime diagnosis of PTSD (N=588) were selected and symptom assessment was based on the World Health Organization Composite International Diagnostic Interview. Strong support was found for both the DSM-IV three-factor model and a four-factor model  of PTSD symptoms by King et al. [King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment,10, 90-96], a variation of the DSM-IV model in which avoidance and numbing are viewed as separate factors. There was some evidence, however, that the King et al. [King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment,10, 90-96] model demonstrated a significantly superior fit over the DSM-IV three-factor model. Because this study provided support for both the DSM-IV three-factor model and the King et al., four-factor model of PTSD symptoms, further research is still necessary to provide more definitive conclusions in this area.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18440773 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1393-402. Epub 2008 Feb 29.

Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure.

Adkins JW, Weathers FW, McDevitt-Murphy M, Daniels JB.

Department of Psychology, Auburn University, Auburn, AL 36849, United States.

In this study psychometric properties of seven self-report measures of posttraumatic stress disorder (PTSD) were compared. The seven scales evaluated were the Davidson Trauma Scale (DTS), the PTSD Checklist (PCL), the Posttraumatic Stress Diagnostic Scale (PDS), the Civilian Mississippi Scale (CMS), the Impact of Event Scale-Revised (IES-R), the Penn Inventory for Posttraumatic Stress Disorder (Penn), and the PK scale of the MMPI-2 (PK). Participants were 239 (79 male and 160 female) trauma-exposed undergraduates. All seven measures exhibited  good test-retest reliability and internal consistency. The PDS, PCL and DTS demonstrated the best convergent validity; the IES-R, PDS, and PCL demonstrated the best discriminant validity; and the PDS, PCL, and IES-R demonstrated the best diagnostic utility. Overall, results most strongly support the use of the PDS and the PCL for the assessment of PTSD in this population.

PMID: 18436427 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1496-509. Epub 2008 Mar 13.

Psychometric properties of the Trauma Relevant Assumptions Scale.

Buck N, Kindt M, Arntz A, van den Hout M, Schouten E.

Maastricht University, Department of Medical, Clinical and Experimental Psychology, P.O. Box 616, 6200 MD Maastricht, The Netherlands. N.Buck@erasmusmc.NL

This article describes the psychometric properties of a novel questionnaire, i.e. the Trauma Relevant Assumptions Scale (TRAS). The added value of the TRAS over previous trauma relevant belief questionnaires is that the TRAS enables measuring valence and rigidity of beliefs simultaneously. Both aspects are thought to be predictive of the development of chronic PTSD symptoms. For the exploratory factor analysis, the TRAS was administered to 309 adult volunteers. Principal components analysis yielded two factors: Assumptions about Self and Assumptions about the World. The two-factor structure was confirmed in a sample of 185 traumatized individuals. The TRAS seems to be a valid and reliable instrument, which is strongly related to post-trauma symptoms and has good discriminative validity. Apart from research settings, the TRAS may also be suitable in therapeutic settings to identify the severity of dysfunctional assumptions, and to assess the progress in change from negative assumptions to more positive assumptions.

PMID: 18424063 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1542-50. Epub 2008 Mar 13.

Critiquing symptom validity tests for posttraumatic stress disorder: a modification of Hartman's criteria.

Morel KR, Marshman KC.

Neuropsychology Laboratory/Psychology Service, Department of Veterans Affairs Tennessee Valley Health Care System, Psychology Service 116B, 1310 24th Avenue South, Nashville, TN 37212-2637, United States. k_morel@yahoo.com

The differential diagnosis of malingering in psychological evaluations for Posttraumatic Stress Disorder (PTSD) is complex and relies upon the integration of clinical knowledge and appropriate psychometric instruments. Over the years, there has been an increase in the use of validity measures, including Symptom Validity Tests (SVTs). In 2005, the National Academy of Neuropsychology published Symptom validity assessment: Practice issues and medical necessity, an official policy statement recognizing the importance of effort on test performance and recommending the utilization of specific SVTs to assess for response bias in neurocognitive and personality evaluations. As new SVTs become available, clinicians need a clear understanding of how to critique these tests and determine the strengths and limitations. This article demonstrates the fundamental principles of critiquing an SVT by applying a modified set of Hartman's [Hartman, D. E. (2002). The unexamined lie is a lie worth fibbing: Neuropsychological malingering and the Word Memory Test. Archives of Clinical Neuropsychology, 17, 709-714] criteria, originally developed for neuropsychological SVTs, to the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT).

PMID: 18423958 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1447-53. Epub 2008 Mar 2.

Predicting children's post-traumatic stress symptoms following hospitalization for accidental injury: combining the Child Trauma Screening Questionnaire and heart rate.

Olsson KA, Kenardy JA, De Young AC, Spence SH.

Centre of National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Australia.

This study investigated the utility of combining the Child Trauma Screening Questionnaire (CTSQ) [Kenardy, J. A., Spence, S. H., & Macleod, A. C. (2006). Screening for post-traumatic stress disorder in children after accidental injury. Pediatrics, 118, 1002-1009] and children's heart rate (HR; emergency department and 24-h post-admission) to identify children likely to develop post-traumatic stress disorder (PTSD) symptoms at 1 and 6 months post-injury. Children completed the CTSQ within 2 weeks of injury. PTSD symptoms were assessed with the Anxiety Disorders Interview Schedule for DSM-IV [Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV, Child Version, Parent Interview Schedule. Orlando, Florida: The Psychological Corporation], for 79 children aged 7-16 years. A combination of the CTSQ plus HR (CTSQ-HR) was better  than the CTSQ alone or HR alone at identifying children likely to develop PTSD symptoms. These findings suggest that the CTSQ-HR screen may increase identification of children who are likely to develop PTSD symptoms, enabling development of targeted prevention programs.

PMID: 18394860 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1377-83. Epub 2008 Feb 7.

The factor structure of Posttraumatic Stress Disorder symptoms among bereaved individuals: a confirmatory factor analysis study.

Boelen PA, van den Hout MA, van den Bout J.

Department of Clinical and Health Psychology, Utrecht University, The Netherlands. P.A.Boelen@uu.nl

Posttraumatic Stress Disorder (PTSD) is defined in DSM-IV as an anxiety disorder  that encompasses symptom-clusters of reexperiencing, avoidance, and hyperarousal. Several studies have examined the factor structure of PTSD symptoms. To our knowledge, no studies have yet examined the factor structure of loss-related PTSD symptoms in samples exclusively comprised of bereaved individuals. Such an examination is important because it can advance our understanding of the stability of the structure of PTSD symptoms across groups confronted with different aversive life-events and of processes underlying the occurrence of PTSD symptoms after loss. In this study, five alternative models of the factor structure of PTSD symptoms were examined in a sample of 347 mourners. Results showed that, in this group, PTSD symptoms are best conceptualized as forming four factors: reexperiencing, avoidance, dysphoria, and hyperarousal. Patterns of correlations with depression and complicated grief supported the validity of the  model.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18342486 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1355-68. Epub 2008 Feb 7.

The PTSD symptom scale's latent structure: an examination of trauma-exposed medical patients.

Naifeh JA, Elhai JD, Kashdan TB, Grubaugh AL.

Disaster Mental Health Institute, The University of South Dakota, Vermillion, SD  57069-2390, United States.

Several studies have employed confirmatory factor analysis (CFA) to evaluate the  latent structure of posttraumatic stress disorder (PTSD) assessment measures among various trauma-exposed populations. Findings have generally failed to support the current three-factor DSM-IV PTSD conceptualization, demonstrating the need to consider alternative models. The present study used CFA to evaluate seven models, including intercorrelated and hierarchical versions of two models with the most empirical support. Data were utilized from a heterogeneous trauma-exposed sample of general medical patients (n=252). Based on several indices, the three-factor DSM-IV PTSD model was shown to be inferior to alternative models. The strongest support was found for an intercorrelated four-factor model, separating avoidance and numbing symptoms into distinct factors. Validity for this model was partially supported by divergent relations between factors and external variables. Implications of the results are discussed, and a framework is proposed for resolving discrepant findings in the PTSD CFA literature.

PMID: 18337058 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1326-36. Epub 2008 Feb 5.

Chronic thought suppression and posttraumatic symptoms: data from the Madrid March 11, 2004 terrorist attack.

Vázquez C, Hervás G, Pérez-Sales P.

Complutense University, Madrid, School of Psychology, Campus de Somosaguas, 28223 Madrid, Spain. cvazquez@psi.ucm.es

Although a considerable number of people either witnessed directly or in the mass media the traumatic scenes of the terrorist attack that took place on March 11th, 2004 in Madrid, only a fraction of Madrid citizens developed posttraumatic symptoms. In this study, posttraumatic stress-related symptoms, degree of exposure, coping strategies related to the attack, and chronic attempts to avoid  intrusive thoughts (i.e., thought suppression) were assessed in a general population Madrid sample (N=503) 2-3 weeks after the attacks. Our results showed  that participants with higher scores in chronic thought suppression exhibited higher levels of PTSD symptoms. Higher scores in chronic thought suppression also correlated positively with the use of avoidant coping strategies after the attacks. We discuss the possible common roots of avoidance of intrusive thoughts  and avoidant coping strategies and the implications of this relationship for the  emergence of stress-related symptoms as well as for public health policies.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18329844 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1337-46. Epub 2008 Feb 2.

The effects of direct versus witnessed threat on emergency department healthcare  workers: implications for PTSD criterion A.

Alden LE, Regambal MJ, Laposa JM.

Department of Psychology, University of British Columbia, Vancouver, B.C. V6T 1Z4, Canada. lalden@psych.ubc.ca

We compared post-traumatic stress disorder (PTSD) symptom severity and symptom cluster profiles in hospital emergency department (ED) medical staff (N=100) who  experienced an emotionally distressing work event that presented either a direct  threat to themselves or a witnessed threat to patients. The two groups displayed  similar levels of PTSD symptoms, however, they differed on symptom profiles and work consequences. The direct threat group experienced significantly greater fear during the event, more ongoing arousal symptoms, and more job dissatisfaction than the witnessed threat group. The witnessed threat group was more likely to appraise their PTSD symptoms as reflecting personal weakness. Overall, the results point to the need for further research to identify distinctive features of responses to different types of traumatic stressors.

PMID: 18325730 [PubMed - in process]

 

J Anxiety Disord. 2008 Dec;22(8):1297-302. Epub 2008 Jan 19.

Developing a symptom validity test for posttraumatic stress disorder: application of the binomial distribution.

Morel KR, Shepherd BE.

Neuropsychology Laboratory, Psychology Service 116B, Department of Veterans Affairs Tennessee Valley Health Care System, 1310 24th Avenue South, Nashville, TN 37212-2637, United States. k_morel@yahoo.com

The past decade has witnessed a significant increase in research on the detection of malingered Posttraumatic Stress Disorder (PTSD) in civil litigation, other disability pension contexts, and in forensic cases. This article reviews the basic principles and statistical procedures that can be used to design and develop a Symptom Validity Test (SVT) for PTSD. We demonstrate how the practical  application of the binomial distribution can detect response bias in specific psychiatric disorders such as PTSD and can provide empirically grounded probabilistic evidence of malingering. We cite the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT) as an example.

PMID: 18295444 [PubMed - in process]

 

J Behav Ther Exp Psychiatry. 2008 Dec;39(4):546-57. Epub 2008 Jan 25.

The influence of data-driven versus conceptually-driven processing on the development of PTSD-like symptoms.

Kindt M, van den Hout M, Arntz A, Drost J.

Faculty of Social and Behavioural Sciences, Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands. m.kindt@uva.nl

Ehlers and Clark [(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345] propose that a predominance of data-driven processing during the trauma predicts subsequent PTSD. We wondered whether, apart from data-driven encoding, sustained data-driven processing after  the trauma is also crucial for the development of PTSD. Both hypotheses were tested in two analogue experiments. Experiment 1 demonstrated that relative to conceptually-driven processing (n=20), data-driven processing after the film (n=14), resulted in more intrusions. Experiment 2 demonstrated that relative to the neutral condition (n=24) and the data-driven encoding condition (n=24), conceptual encoding (n=25) reduced suppression of intrusions and a trend emerged  for memory fragmentation. The difference between the two encoding styles was due  to the beneficial effect of induced conceptual encoding and not to the detrimental effect of data-driven encoding. The data support the viability of the distinction between data-driven/conceptually-driven processing for the understanding of the development of PTSD.

PMID: 18328462 [PubMed - in process]

 

J Behav Ther Exp Psychiatry. 2008 Dec;39(4):424-35. Epub 2008 Jan 18.

The effect of pre-existing vulnerability factors on a laboratory analogue trauma  experience.

Laposa JM, Alden LE.

University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada. Judith_Laposa@camh.net

This study examined how pre-existing emotional and personality vulnerability factors affect responses to an analogue trauma experience. Sixty-eight undergraduate participants viewed a distressing film and completed measures of trait anxiety, intelligence, depression, trait dissociation, as well as changes in state anxiety, then recorded intrusions over the following week. Results revealed that trait anxiety, depression, trait dissociation, change in anxiety, and post-state anxiety were associated with intrusion frequency. Post-state anxiety mediated the relationship between trait anxiety, depression and trait dissociation, and intrusions. Implications for PTSD theories and laboratory trauma analogue research examining specific elements of cognitive models of PTSD  are discussed.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18294615 [PubMed - in process]

 

J Consult Clin Psychol. 2008 Dec;76(6):923-32.

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

O'Donnell ML, Creamer MC, Parslow R, Elliott P, Holmes AC, Ellen S, Judson R, McFarlane AC, Silove D, Bryant RA.

Australian Centre for Posttraumatic Mental Health, Heidelberg West, Victoria, Australia. mod@unimelb.edu.au

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during  hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for  PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves  were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19045961 [PubMed - in process]

 

J Fam Psychol. 2008 Dec;22(6):809-18.

Intimate partner abuse and PTSD symptomatology: Examining mediators and moderators of the abuse-trauma link.

Babcock JC, Roseman A, Green CE, Ross JM.

Department of Psychology, University of Houston.

Posttraumatic stress disorder (PTSD) has been linked to intimate partner abuse, physiological reactivity, and social support. The authors used structural equation modeling to test social support as a moderator and psychophysiological reactivity and anger as mediators of the relation between abuse and traumatic symptoms among a sample of women reporting psychological abuse, including women reporting both physical violence and no physical violence. Both physical and psychological abuse were related to PTSD symptoms. Whereas physical and psychological abuse were highly correlated, psychological abuse did not predict PTSD symptomatology over and above the effect due to physical assault. Psychophysiological reactivity and anger and fear displayed during an argument with the partner did not mediate the abuse?trauma link. Social support moderated  the relation between psychological abuse and PTSD symptomatology. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 19102602 [PubMed - in process]

 

J Nerv Ment Dis. 2008 Dec;196(12):912-8.

Trait dissociation predicts posttraumatic stress disorder symptoms in a prospective study of urban police officers.

McCaslin SE, Inslicht SS, Metzler TJ, Henn-Haase C, Maguen S, Neylan TC, Choucroun G, Marmar CR.

Mental Health Service, San Francisco VA Medical Center, San Francisco, California 94121, USA. Shannon.McCaslin@ucsf.edu

The current study prospectively examines the predictive relationship of trait dissociation, assessed during academy training, to PTSD symptoms assessed at 12 months of active police duty in relatively young and healthy police academy recruits (N = 180). The roles of pre-academy trauma exposure, exposure to life-threatening critical incidents during police duty, and peritraumatic dissociation at the time of the officer's worst critical incident were also examined. Utilizing path analytic techniques, greater trait dissociation, assessed during academy training, was predictive of both peritraumatic dissociation, and PTSD symptoms assessed at 12 months of police service. Moreover, after accounting for trait dissociation and peritraumatic dissociation, the relationship of previous trauma to later PTSD symptoms was no longer significant, demonstrating that the effect of previous trauma on later vulnerability to PTSD symptoms in this sample may be mediated by both trait and peritraumatic dissociation.

PMID: 19077859 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Dec;196(12):906-11.

Positive and negative psychological impact after secondary exposure to politically motivated violence among body handlers and rehabilitation workers.

Shiri S, Wexler ID, Alkalay Y, Meiner Z, Kreitler S.

Department of Psychology, Tel Aviv University, Tel Aviv, Israel. shimons3@post.tau.ac.il

The positive and negative psychological impact of secondary exposure to politically motivated violence was examined among body handlers and hospital rehabilitation workers, 2 groups that differed in their proximity and immediacy to violent events. Survivors of politically motivated violence served as a comparison group. Body handlers experienced high levels of positive psychological impact and traumatic stress symptoms. Levels of positive psychological impact among on-scene body handlers were higher than those experienced by rehabilitation workers. Traumatic stress symptoms predicted positive psychological impact among  body handlers. These findings indicate that proximity to stressors is associated  with higher levels of positive and negative psychological impact. Physical proximity is a major contributory factor to both positive and negative psychological effects of secondary exposure to trauma.

Publication Types:      Comparative Study

PMID: 19077858 [PubMed - indexed for MEDLINE]

 

J Neurosurg. 2008 Dec;109(6):1027-33.

Posttraumatic stress disorder in the family and friends of patients who have suffered spontaneous subarachnoid hemorrhage.

Noble AJ, Schenk T.

Department of Psychology, Durham University, Stockton-on-Tees, United Kingdom. a_j_noble@hotmail.com

OBJECT: Significant others (SOs), such as spouses and life partners, of patients  who have survived subarachnoid hemorrhage (SAH) can experience psychiatric symptoms and psychosocial disability. The cause of such symptoms has not been established. Authors of the present study analyzed whether posttraumatic stress disorder (PTSD) subsequent to a loved one's SAH is a plausible explanation for these symptoms. METHODS: The authors examined a large representative sample of 86 patient/SO pairs 3.5 months postictus. All SOs were evaluated using a diagnostic  PTSD measure, and coping skills were assessed. The cognitive, physical, and emotional status of patients was comprehensively examined. RESULTS: Twenty-six percent of SOs met the diagnostic criteria for PTSD, which represents a 3-fold increase in the rate expected within the general population. To establish the cause of PTSD, a logistic regression was performed, and results of this test showed that the use of maladaptive coping strategies was the best predictor of the disorder. A patient's level of disability held no significant association with the development of PTSD in his or her SO. CONCLUSIONS: The elevated incidence of PTSD in SOs helps to explain why these persons report concerning levels of psychiatric symptomatology and psychosocial disability. Greater attention must be given to an SO's adjustment to the experience of having a loved one suffer an SAH. This need is all the more pertinent given that SOs often act as informal caregivers and that PTSD could interfere with their ability to effectively minister. Because bad coping skills seem to be the main cause of PTSD, teaching SOs better strategies might prevent the disorder and any resulting psychosocial disability.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19035715 [PubMed - in process]

 

J Psychosom Obstet Gynaecol. 2008 Dec;29(4):240-50.

Post-traumatic stress disorder following childbirth: current issues and recommendations for future research.

Ayers S, Joseph S, McKenzie-McHarg K, Slade P, Wijma K.

Department of Psychology, University of Sussex, Brighton, UK.

Background. An increasing body of research shows that a proportion of women experience significant symptoms of Post-Traumatic Stress Disorder (PTSD) following childbirth. Aims and method. An international group of researchers, clinicians, and user-group representatives met in 2006 to discuss the research to date into PTSD following childbirth, issues and debates within the field, and recommendations for future research. This paper reports the content of four discussions on (1) prevalence and comorbidity, (2) screening and treatment, (3) diagnostic and conceptual issues, and (4) theoretical issues. Conclusions. Current knowledge from the perspectives of the researchers is summarized, dilemmas are articulated and recommendations for future research into PTSD following childbirth are made. In addition, methodological and conceptual issues  are considered.

PMID: 18608815 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):521-9.

PTSD symptoms, forgiveness, and revenge among Israeli Palestinian and Jewish adolescents.

Hamama-Raz Y, Solomon Z, Cohen A, Laufer A.

School of Social Work, Ariel University Center of Samaria, Israel.

Exposure to political terror and its psychological toll were assessed in 276 Israeli Palestinian and 1,469 Jewish adolescents using self-report questionnaires. Israeli Palestinians displayed more posttraumatic symptoms, higher levels of objective exposure to terror, more negative life events, lower ability to forgive, and a higher need for vengeance than their Jewish counterparts. Although the two groups did not differ in fear levels, Israeli Palestinians expressed more favorable attitudes toward peace. Ethnicity played a  major role in explaining the variance of posttraumatic symptomatology. Israeli Palestinians displayed increased vulnerability to mental distress when compared to their Jewish counterparts. The unique roles of subjective fear, attitudes towards peace, forgiveness, and revenge among Israeli Palestinians are discussed.

PMID: 19107729 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):556-8.

Self-compassion and PTSD symptom severity.

Thompson BL, Waltz J.

Department of Psychology, University of Montana, Missoula, MT 59812, USA. brian.l.thompson@gmail.com

Neff's (2003a, 2003b) notion of self-compassion emphasizes kindness towards one's self, a feeling of connectedness with others, and mindful awareness of distressing experiences. Because exposure to trauma and subsequent posttraumatic  stress symptoms (PSS) may be associated with self-criticism and avoidance of internal experiences, the authors examined the relationship between self-compassion and PSS. Out of a sample of 210 university students, 100 endorsed experiencing a Criterion A trauma. Avoidance symptoms significantly correlated with self-compassion, but reexperiencing and hyperarousal did not. Individuals high in self-compassion may engage in less avoidance strategies following trauma  exposure, allowing for a natural exposure process.

PMID: 19107727 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):503-6.

Early intervention for trauma: where are we and where do we need to go? A commentary.

Litz BT.

VA Boston Healthcare System, National Center for PTSD, Massachusetts Veterans Epidemiological Research and Information Center, Boston, MA 02130, USA. brett.litz@va.gov

In this commentary, the author underscores the importance of early intervention for trauma and describes the challenges that lie ahead for researchers, decision  makers, and care providers. The author also provides a review of where things stand, briefly reviews psychological first aid strategies, and underscores where  we need to go from here. Although the field has advanced considerably in the last decade or so, and there are compelling trials underway, there is much work that needs to be done, especially in terms of effectiveness and the task of integrating early intervention into various work cultures, such as the military.

PMID: 19107726 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):530-9.

Low cortisol, high DHEA, and high levels of stimulated TNF-alpha, and IL-6 in women with PTSD.

Gill J, Vythilingam M, Page GG.

National Institute of Nursing Research, National Institutes of Health, Bethesda,  MD 20892-1506, USA. jgill@mail.nih.gov

Posttraumatic stress disorder (PTSD) has been associated with hypothalamic-pituitary-adrenal (HPA) axis and immune function alterations; however, few studies have simultaneously investigated these systems in participants with PTSD. In this study, HPA axis and immune function in 26 women with PTSD with and without major depressive disorder was compared to 24 traumatized controls and to 21 nontraumatized controls. Posttraumatic stress disorder was associated with low cortisol and higher levels of DHEA and greater production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) compared to traumatized and healthy controls. Women with PTSD and depression exhibited greater production of IL-6 and higher levels of dehydroepiandrosterone  (DHEA) than those with PTSD, but without depression. These findings suggest dysregulated HPA axis and immune function in women with PTSD, and that comorbid depression may contribute to these abnormalities.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 19107725 [PubMed - in process]

 

J Trauma Stress. 2008 Dec;21(6):548-55.

Effects of early nightmares on the development of sleep disturbances in motor vehicle accident victims.

Kobayashi I, Sledjeski EM, Spoonster E, Fallon WF Jr, Delahanty DL.

Department of Psychology, Kent State University, Kent, OH 44242, USA.

The present study prospectively examined the extent to which trauma-related nightmares affected the subsequent development of insomnia symptoms in 314 motor  vehicle accident (MVA) victims. Participants were assessed in-hospital and at 2 weeks, 6 weeks, 3 months, and 1 year post-MVA. Hierarchical linear regression analyses showed that 6-week PTSD symptoms (PTSS) and 3-month nightmares, but not  2-week nightmares were positively associated with sleep onset and maintenance problems reported at 3-month post-MVA. Nightmares reported at 3-months post-MVA were positively associated with 1-year sleep maintenance problems. These findings highlight the dynamic relationship between PTSS and sleep problems as well as the potential importance of early intervention for trauma-related nightmares as a means to prevent sleep problems after a traumatic experience.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 19107721 [PubMed - in process]

 

Minerva Pediatr. 2008 Dec;60(6):1393-9.

The concept of post-traumatic mood disorder and its implications for adolescent suicidal behavior.

Sher L.

Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA LS2003@columbia.edu.

Post-traumatic stress disorder (PTSD) is a common psychiatric disorder which is frequently comorbid with major depressive disorder (MDD). It has been suggested that some or all individuals diagnosed with comorbid PTSD and MDD have a separate psychobiological condition that can be termed ''post-traumatic mood disorder'' (PTMD). The idea was based on the fact that a significant number of studies suggested that patients suffering from comorbid PTSD and MDD differed clinically  and biologically from individuals with PTSD alone or MDD alone. Individuals with  comorbid PTSD and MDD are characterized by greater severity of symptoms and the higher level of impairment in social and occupational functioning compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings from neuroendocrine challenge, cerebrospinal fluid, neuroimaging, sleep and other studies. It has been demonstrated that child abuse increases the risk for PTSD, MDD, and suicidal behavior in adolescents and adults. Many victims of childhood abuse develop comorbid PTSD and depression, i.e., they develop PTMD. PTMD is associated with suicidal behavior. The link between childhood abuse, suicidal behavior in adolescents and PTMD indicates that it is important to develop interventions to prevent PTMD in victims of child abuse; to develop measures to prevent suicidal behavior in adolescents with PTMD; and to study psychobiology of PTMD in order to develop treatments for PTMD. Priorities for intervening to reduce adolescent suicidal behavior lie with interventions focused upon the improved recognition, treatment and management of adolescents with psychiatric disorders including PTMD.

PMID: 18971900 [PubMed - in process]

 

Neurosurgery. 2008 Dec;63(6):1095-104; discussion 1004-5.

Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term.

Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T.

Department of Psychology, Durham University, Stockton-on-Tees, England.

OBJECTIVE: A subarachnoid hemorrhage reduces patients' quality of life (QoL) in both the short and long term. Neurological problems alone cannot explain this reduction. We examined whether posttraumatic stress disorder (PTSD) and fatigue provide an explanation. METHODS: We prospectively studied a representative sample of 105 subarachnoid hemorrhage patients. Patients were examined at approximately  3 and 13 months postictus. Examinations included assessments of PTSD, fatigue, sleep, cognitive and physical outcomes, and QoL. Patients' coping skills were also assessed. Regression analyses identified predictors for QoL and PTSD. RESULTS: Thirty-seven percent met the diagnostic criteria for PTSD at both assessment points. This is a fourfold increase compared with the rate of PTSD in  the general population. Fatigue in patients was also consistently elevated, higher, in fact, than the notoriously high fatigue level reported for cancer patients undergoing chemotherapy. PTSD was the best predictor for mental QoL, the domain most persistently impaired. It also helped predict physical QoL. Moreover, PTSD was linked to increased sleep problems and may, therefore, have led to fatigue in both the acute and later stages of recovery. To establish the cause of PTSD, a logistic regression was performed. This showed that maladaptive coping was the best predictor of PTSD. CONCLUSION: PTSD explains why some subarachnoid hemorrhage patients, despite relatively good clinical outcomes, continue to experience a reduced QoL. Given that maladaptive coping skills seem the main cause of PTSD, teaching patients better coping skills early on might prevent PTSD and QoL reduction.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19057321 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):546-50.

[Psychosocial consequences of sexual abuse]

[Article in German]

Vyssoki D, Schürmann-Emanuely A.

Arztl. Leiter Ambulanz ESRA Tempelgasse 5, 1020 Wien, Austria. d.vyssoki@esra.at

Violence is what the victims experience as violence. Only they are able to measure what oppression, injury, pain or sexual violence can cause. Violence starts where human beings are constrained, humiliated, abjected and injured in their self-determination by other human beings. The experienced violence causes a trauma in most cases and in many cases also a PTSD. As a lot of epidemiological studies have affirmed, the highest lifetime-prevalence of PTSD appears after one  respectively after a repeated act of sexual violence.It is important to define the circumstances of the action, by defining three fields of violence: domestic sexual violence, sexual violence in civil everyday life respectively violence, that occurs not inside families and sexual violence in wartime.Victims of all fields of violence can be found in Western Europe, the last mentioned form of violence predominant among refugees, but also among survivors of the last world war.

Publication Types:      English Abstract

PMID: 19011596 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):532-45.

[Therapeutic possibilities after traumatic experiences]

[Article in German]

Kapfhammer HP.

Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, Graz, Austria. Hans-peter.kapfhammer@klinikum-graz.at

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following trauma. A major subgroup of patients face a chronic course of illness associated with an increased psychiatric comorbidity and significant impairments in psychosocial adaptation. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. The complex etiopathogenesis of acute and posttraumatic  stress disorder favours multimodal approaches in the treatment. Differential psychotherapeutic and pharmacological strategies are available. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. Positive effects of cognitive-behavioral interventions can be established for ASD. Psychodynamic psychotherapy, cognitive-behavioral therapy and EMDR show promising results in the treatment of  PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care. In an empirical analysis the SSRIs are the most and  best studied medications for ASD and PTSD. In comparison to tricyclic antidepressants SSRIs demonstrate a broader spectrum of therapeutic effects and are better tolerated. The substance classes of SSNRI, DAS, SARI and NaSSA are to  be considered as drugs of second choice. They promise a therapeutic efficacy equivalent to the SSRIs, being investigated so far only in open studies. MAO-inhibitors may dispose of a positive therapeutic potential, their profile of  side effects must be respected, however. Mood stabilizers and atypical neuroleptics may be used first and foremost in add-on strategies. Benzodiazepines should be used only with increased caution for a short time in states of acute crisis. In early interventions, substances blocking the norepinephric hyperactivity seem to be promising alternatives. Stress doses of hydrocortisone may be considered as an experimental pharmacological strategy so far.

Publication Types:      English Abstract

PMID: 19011595 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):474-84.

Mental health care of psychotraumatized persons in post-war Bosnia and Herzegovina--experiences from Tuzla Canton.

Avdibegović E, Hasanović M, Selimbasić Z, Pajević I, Sinanović O.

University Clinical Centre Tuzla, Trnovac b.b, 75000 Tuzla, Bosna and Herzegovina.

BACKGROUND: Majority of Bosnia-Herzegovina (BH) residents were exposed to cumulative traumatic events during and after the (1992-1995) war, which demanded  emergency organizing of psychosocial support as well as psychiatric-psychological treatment of psychotraumatized individuals. OBJECTIVES: To describe organizing of psychosocial help during and after the BH war, institutional treatment of psychotraumatized in the frame of mental health service reform program with an overview on the model of psychosocial support and psychiatry-psychological treatment of psychotraumatized persons of Tuzla Canton region. SUBJECTS AND METHODS: The retrospective analysis of functioning in the Department for traumatic stress disorders on the Psychiatry Clinic in Tuzla for the 1999-2003 period has been described in regard of number, gender, age and trauma related mental disorders of referred patients. RESULTS: In the observed period, 8.329 of  patients in the outpatient care program were included, 617 of inpatients were treated in the Clinic, while 301 of patients in the Partial hospitalization program were included. Mean +/- standard deviation of patients' age was 45+/-8.06 years. More psychotraumatized women (60.8%) were encompassed in the partial hospitalization program than in inpatients (23.9%) or outpatients (18.3%) care programs. In regard of trauma related mental disorders, majority outpatients had  Posttraumatic stress disorder (PTSD) in co morbidity with other mental disorders  (72.5%), PTSD was presented amongst the majority of inpatients (64.5%) and in partial hospitalization program there were (47.5%) patients with PTSD. CONCLUSIONS: In the treatment of psychotraumatized persons, in the organizing of  health care system schema in postwar Bosnia and Herzegovina, meaningful obstacles are presented still today on the both, social and political level, despite mental health service reform performed in Bosnia-Herzegovina. The stigmatization of mental health issues is an important problem in treatment of traumatized individuals especially among war veterans. The lack a single Center for psychotrauma in postwar BH shows absence of political will in BH to resolve the problem of war veterans with trauma related psychological disorders.

PMID: 19011588 [PubMed - in process]

 

Psychiatr Danub. 2008 Dec;20(4):466-73.

Social support and PTSD symptoms in war-traumatized women in Bosnia and Herzegovina.

Klarić M, Francisković T, Klarić B, Kresić M, Grković J, Lisica ID, Stevanović A.

Department of Psychiatry, Mostar University School of Medicine, Mostar, Bosnia and Herzegovina. klaricmiro@net.hr

OBJECTIVE: To determine the correlation between social support and PTSD symptoms  in women traumatized by the war and postwar social insecurity in Herzegovina. SUBJECTS AND METHODS: The experimental group consisted of 187 randomly selected women living in Mostar, who were exposed to a wide spectrum of traumatic events during the war. The control group included 180 women living in the area surrounding Mostar who were not directly exposed to war destruction. Demographic  data were obtained and a battery of psychological tests was used to measure the level of war traumatization and PTSD symptoms, along with the perception of social support. RESULTS: Women in the experimental group had significantly lower  levels of perceived social support from friends (t=2.91; p<0.05) and coworkers (t=2.30; p<0.05). However, its protective significance for all levels of posttraumatic symptoms was strong, even stronger than social support from the family. Of all the sources of emotional social support, low level of perceived support from friends is the only significant predictor of PTSD. CONCLUSION: The sources of social support which the traumatized women drew from family, friends and coworkers change their significance depending on their availability. These sources are a strong predictive factor of PTSD development.

PMID: 19011587 [PubMed - in process]

 

Psychiatr Genet. 2008 Dec;18(6):261-6.

Heritabilities of symptoms of posttraumatic stress disorder, anxiety, and depression in earthquake exposed Armenian families.

Goenjian AK, Noble EP, Walling DP, Goenjian HA, Karayan IS, Ritchie T, Bailey JN.

UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, USA. armengoenjian@cnstrial.com

OBJECTIVE: To examine the heritabilities of symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, and the shared genetic component of these symptoms among family members exposed to the 1988 Spitak earthquake in Armenia. METHODS: Two hundred members of 12 multigenerational families exposed to the Spitak earthquake were studied using a battery that assessed earthquake exposure  and symptoms of PTSD, anxiety, and depression. Heritabilities of these phenotypes were determined using variance component analyses and shared genetic vulnerabilities between these phenotypes were determined using bivariate analyses. RESULTS: Heritabilities were as follows: PTSD symptoms 41% (P<0.001), anxiety symptoms 61% (P<0.001), and depressive symptoms 66% (P<0.001). The genetic correlation (rhog>0) of PTSD symptoms with anxiety symptoms was 0.75 (P<0.001) and with depressive symptoms it was 0.71 (P<0.001). The genetic correlation of anxiety with depressive symptoms was 0.54 (P<0.001). CONCLUSION: The heritabilities found in this multigenerational family study indicate that the genetic make-up of some individuals renders them substantially more vulnerable than others to develop symptoms of PTSD, anxiety, and depression. A large proportion of the genetic liability for PTSD, anxiety, and depression are shared. The findings offer promise for identifying susceptibility genes for these phenotypes.

PMID: 19018230 [PubMed - in process]

 

Psychiatry Clin Neurosci. 2008 Dec;62(6):713-20.

Relationship between post-traumatic stress disorder-like behavior and reduction of hippocampal 5-bromo-2'-deoxyuridine-positive cells after inescapable shock in  rats.

Kikuchi A, Shimizu K, Nibuya M, Hiramoto T, Kanda Y, Tanaka T, Watanabe Y, Takahashi Y, Nomura S.

Division of Behavioral Sciences, National Defense Medical College Research Institute, Tokyo, Japan.

AIM: Inescapable shocks (IS) have been reported to reduce the number of 5-bromo-2'-deoxyuridine (BrdU)-positive cells in hippocampus. Antidepressants prevent this reduction, and the role of neurogenesis in depression is now suggested. It has been reported, however, that the number of BrdU-positive cells  was not different between the rats that developed learned helplessness and those  that did not. This suggests that reduction of neurogenesis does not constitute a  primary etiology of depression. It has been previously shown that IS can cause various post-traumatic stress disorder (PTSD)-like behavioral changes in rats. The aim of the present was therefore to examined whether the reduction of BrdU-positive cells relates to any PTSD-like behavioral changes in this paradigm. METHODS: Rats were given either inescapable foot-shocks (IS) or not shocked (non-S) treatment in a shuttle box on day 1 and received BrdU injections once daily during the first week after IS/non-S treatment. On day 14, rats treated with IS and non-S were given an avoidance/escape test in the shuttle box and dorsal hippocampal SGZ were analyzed by BrdU immunohistochemistry. RESULTS: In accordance with previously reported results, IS loading resulted in fewer BrdU-positive cells in the hippocampal subgranular zone (SGZ). Furthermore, in the IS-treated group, the number of BrdU-positive cells in the hippocampal SGZ was negatively correlated at a significant level with several hyperactive behavioral parameters but not with hypoactive behavioral parameters. Earlier findings had indicated that chronic selective serotonin re-uptake inhibitor administration, which is known to increase hippocampal neurogenesis, restored the increase in hypervigilant/hyperarousal behavior but did not attenuate the increase in numbing/avoidance behavior. CONCLUSION: The regulatory mechanism responsible for the decreased proliferation and survival of cells in the hippocampus may be related to the pathogenic processes of hypervigilance/hyperarousal behaviors.

PMID: 19068009 [PubMed - in process]

 

Psychiatry Clin Neurosci. 2008 Dec;62(6):646-52.

Clinical evaluation of paroxetine in post-traumatic stress disorder (PTSD): 52-week, non-comparative open-label study for clinical use experience.

Kim Y, Asukai N, Konishi T, Kato H, Hirotsune H, Maeda M, Inoue H, Narita H, Iwasaki M.

National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

AIM: The present study was a 52-week, non-comparative, open-label study of flexible dose paroxetine (20-40 mg) in 52 Japanese post-traumatic stress disorder (PTSD) patients in order to obtain clinical experience regarding efficacy and safety in regular clinical practice. METHODS: Efficacy was measured using the Clinician-Administered PTSD Scale One Week Symptom Status Version (CAPS-SX). RESULTS: The mean change from baseline in CAPS-SX total score was -19.1, -22.8 and -32.3 at weeks 4, 12 and 52, respectively, and that in the Clinical Global Impression (CGI) Severity of Illness score was -1.1 at week 12 and -1.7 at week 52. A total of 46.9% were CGI responders at week 12, while 67.3% were improved on the CGI at week 52. Of 52 subjects who entered into the drug treatment, 25 completed the study. Only one patient withdrew from the study due to lack of efficacy. In patients who were rated as 'moderately ill' or less at baseline, the proportion of CGI responders at end-point was higher at a dose of 20 mg/day than  at higher doses, whereas in patients rated as 'markedly ill' or more, it was higher at 30 and 40 mg/day, suggesting that severely ill patients could benefit from higher doses. CONCLUSION: Paroxetine appeared generally tolerated in short-  and long-term use, and the safety profile in this study was consistent with international trials and other Japanese populations (i.e. patients suffering from depression, panic disorder or obsessive-compulsive disorder). Although the study  was not conducted in double-blind fashion, the current findings suggest that paroxetine may contribute to clinically meaningful improvement that is maintained during long-term use and is generally well tolerated.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19068000 [PubMed - in process]

 

Psychol Assess. 2008 Dec;20(4):327-40.

The MMPI-2 Restructured Clinical Scales in the assessment of posttraumatic stress disorder and comorbid disorders.

Wolf EJ, Miller MW, Orazem RJ, Weierich MR, Castillo DT, Milford J, Kaloupek DG,  Keane TM.

National Center for PTSD, VA Boston Healthcare System.

This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared with that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties and patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of  the RCSs compared with the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 19086756 [PubMed - in process]

 

Psychol Assess. 2008 Dec;20(4):317-26.

The utility and comparative incremental validity of the MMPI-2 and Trauma symptom Inventory validity scales in the detection of feigned PTSD.

Efendov AA, Sellbom M, Bagby RM.

Centre for Addiction and Mental Health.

The authors examined the comparative predictive capacity of the Trauma Symptom Inventory (TSI) Atypical Response Scale (ATR) and the standard set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) fake-bad validity scales (i.e., F, F-sub(B), F-sub(p), FBS) to detect feigned posttraumatic stress disorder (PTSD).  Remitted trauma victims (n = 60) completed the TSI and MMPI-2 under standard (honest) instructions and then were randomly assigned to 1 of 2 experimental conditions (noncoached/validity scale coached) in which they were administered these instruments again with instruction to fake PTSD. These test protocols were  compared with TSI and MMPI-2 results from workplace injury claimants with PTSD (n = 84). The ATR and FBS were able to distinguish only the noncoached participants  instructed to fake from the PTSD claimants; in contrast, the F, F-sub(B), and F-sub(p) scales were able to distinguish both the noncoached and the validity-scale-coached participants from the PTSD claimants. F, F-sub(B), and F-sub(p) always outperformed the ATR and FBS; neither the ATR nor the FBS was able to add incremental predictive variance to that of F, F-sub(B), or F-sub(p).  (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 19086755 [PubMed - in process]

 

Psychol Med. 2008 Dec;38(12):1771-80. Epub 2008 Feb 25.

Dissociative responses to conscious and non-conscious fear impact underlying brain function in post-traumatic stress disorder.

Felmingham K, Kemp AH, Williams L, Falconer E, Olivieri G, Peduto A, Bryant R.

Brain Dynamics Centre, Westmead Millennium Institute, Westmead Hospital, Australia. kim_felmingham@wmi.usyd.edu.au

BACKGROUND: Dissociative reactions in post-traumatic stress disorder (PTSD) have  been regarded as strategic responses that limit arousal. Neuroimaging studies suggest distinct prefrontal responses in individuals displaying dissociative and  hyperarousal responses to threat in PTSD. Increased prefrontal activity may reflect enhanced regulation of limbic arousal networks in dissociation. If dissociation is a higher-order regulatory response to threat, there may be differential responses to conscious and automatic processing of threat stimuli. This study addresses this question by examining the impact of dissociation on fear processing at different levels of awareness. METHOD: Functional magnetic resonance imaging (fMRI) with a 1.5-T scanner was used to examine activation to fearful (versus neutral) facial expressions during consciously attended and non-conscious (using backward masking) conditions in 23 individuals with PTSD. Activation in 11 individuals displaying non-dissociative reactions was compared to activation in 12 displaying dissociative reactions to consciously and non-consciously perceived fear stimuli. RESULTS: Dissociative PTSD was associated with enhanced activation in the ventral prefrontal cortex for conscious fear, and in the bilateral amygdala, insula and left thalamus for non-conscious fear compared to non-dissociative PTSD. Comparatively reduced activation in the dissociative group was apparent in dorsomedial prefrontal regions for conscious fear faces. CONCLUSIONS: These findings confirm our hypotheses of enhanced prefrontal activity to conscious fear and enhanced activity in limbic networks to non-conscious fear in dissociative PTSD. This supports the theory that dissociation is a regulatory strategy invoked to cope with extreme arousal in PTSD, but this strategy appears to function only during conscious processing of threat.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18294420 [PubMed - in process]

 

Psychoneuroendocrinology. 2008 Dec 1. [Epub ahead of print]

No PTSD-related differences in diurnal cortisol profiles of genocide survivors.

Eckart C, Engler H, Riether C, Kolassa S, Elbert T, Kolassa IT.

Clinical Psychology & Neuropsychology, Department of Psychology, University of Konstanz, Germany.

Posttraumatic stress disorder (PTSD) has been associated with reduced cortisol levels. Opposing results have been interpreted as resulting from methodological differences between studies. We investigated the diurnal profile of salivary cortisol in a population of highly traumatized adult males from Rwanda with and without PTSD, who spent the whole day of examination together under a maximally standardized schedule. Besides the detection of PTSD-related alterations in cortisol release we aimed at determining physiologically relevant effects of cumulative trauma exposure on HPA functioning in interaction with or independent  of diagnosis. There were no differences in the diurnal pattern of cortisol release between subjects with and without PTSD. We observed an increasing prevalence of PTSD with increasing number of different traumatic event types experienced, replicating earlier results on a "building-block effect" of multiple traumatization. However, size of cumulative exposure was not related to any of the cortisol measures. The results suggest that besides methodological constraints also confounding factors not previously controlled for, e.g., sex differences or current life stress, might contribute to the diverging results of  lowered, unchanged or enhanced cortisol secretion in PTSD. Future research should therefore closely monitor these possible confounds to optimize models for cortisol in research on stress-dependent illnesses.

PMID: 19054622 [PubMed - as supplied by publisher]

 

Psychooncology. 2008 Dec;17(12):1172-9.

Discrimination between worry and anxiety among cancer patients: development of a  Brief Cancer-Related Worry Inventory.

Hirai K, Shiozaki M, Motooka H, Arai H, Koyama A, Inui H, Uchitomi Y.

Center for the Study of Communication Design, Department of Psychology and Behavioral Sciences, Graduate School of Human Sciences, Osaka University, Osaka,  Japan. khirai@grappo.jp

OBJECTIVES: A psychometric scale for assessing cancer-related worry among cancer  patients, called the Brief Cancer-Related Worry Inventory (BCWI), was developed.  METHODS: A cross-sectional questionnaire survey for item development was conducted of 112 Japanese patients diagnosed with breast cancer, and test-retest  validation analysis was conducted using the data from another prospective study of 20 lung cancer patients. The questionnaire contained 15 newly developed items  for cancer-related worry, the Hospital Anxiety and Depression Scale, The Impact of Event Scale Revised, and the Medical Outcomes Study Short Form-8. RESULTS: Exploratory factor analysis of the 15 items yielded a 3-factor structure including (1) future prospects, (2) physical and symptomatic problems and (3) social and interpersonal problems. A second-order confirmatory factor analysis identified a second-order factor called cancer-related worry and confirmed the factor structure with an acceptable fit (chi-square (df=87)=160.16, P=0.001; GFI=0.83; CFI=0.92; RMSEA=0.09). The internal consistency and test-retest reliability were confirmed with the lung cancer sample. Multidimensional scaling  found that cancer-related worry is separate from anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms. CONCLUSION: Our study succeeded in developing and confirming the validity and reliability of a BCWI. The study also  confirmed the discriminable aspects of cancer-related worry from anxiety, depression, and PTSD symptoms. (c) 2008 John Wiley & Sons, Ltd.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18457339 [PubMed - in process]

 

Res Nurs Health. 2008 Dec;31(6):576-85.

Perceived stress in survivors of suicide: psychometric properties of the Perceived Stress Scale.

Mitchell AM, Crane PA, Kim Y.

Department of Health and Community Systems, University of Pittsburgh School of Nursing and School of Medicine, 3500 Victoria Street, 415 Victoria Building, Pittsburgh, PA 15261, USA.

The purpose of this study was to evaluate the psychometric properties of three versions of the Perceived Stress Scale (PSS; American Sociological Association) in adults who had survived the death of a family member or significant other by suicide. Reliability and validity were examined. Exploratory factor analysis was  conducted to assess dimensionality of the underlying constructs. All three versions of the PSS demonstrated acceptable reliability. Two shorter versions retained good psychometric properties and demonstrated convergent and concurrent  validity with measures of posttraumatic stress symptoms and mental health quality of life. Factor analysis provided further evidence of their usefulness as brief and valid measures of perceived stress in acutely bereaved adult survivors of suicide. In a sub-sample of closely related survivors, the psychometric properties of the 4-item version of the PSS were retained. (c) 2008 Wiley Periodicals, Inc.

Publication Types:      Research Support, Non-U.S. Gov't     Validation Studies

PMID: 18449942 [PubMed - indexed for MEDLINE]

 

Schmerz. 2008 Dec;22(6):644-51.

[PTSD and chronic pain: development, maintenance and comorbidity - a review.]

[Article in German]

Liedl A, Knaevelsrud C.

Behandlungszentrum für Folteropfer Berlin, Turmstr. 21, 10559, Berlin, Deutschland, a.liedl@bzfo.de.

In addition to posttraumatic stress disorder (PTSD) many traumatized individuals  also suffer from chronic pain. Understanding the development and maintenance of these two disorders and how they interact is of crucial importance for treatment. This article provides an overview of the current literature on mechanisms of development, maintenance and comorbidity of PTSD and chronic pain. Moreover the perpetual avoidance model and its implications for practical application are presented.

Publication Types:      English Abstract

PMID: 18726123 [PubMed - in process]

 

Soc Sci Med. 2008 Dec;67(11):1737-46. Epub 2008 Oct 22.

Scientific resistance to research, training and utilization of eye movement desensitization and reprocessing (EMDR) therapy in treating post-war disorders.

Russell MC.

Psychology, U.S. Naval Hospital Yokosuka, Japan. mark.russell2@med.navy.mil

In this study, Barber's [(1961). Resistance by scientists to scientific discovery. Science, 134, 596-602] analysis of scientists' resistance to discoveries is examined in relation to an 18-year controversy between the dominant cognitive-behavioral paradigm or zeitgeist and its chief rival - eye movement desensitization and reprocessing (EMDR) in treating trauma-related disorders. Reasons for persistent opposition to training, utilization and research into an identified 'evidence-based treatment for post-traumatic stress disorder' (EBT-PTSD) within US military and veterans' agencies closely parallels  Barber's description of resistance based upon socio-cultural factors and scientific bias versus genuine scientific skepticism. The implications of sustained resistance to EMDR for combat veterans and other trauma sufferers are discussed. A unified or super-ordinate goal is offered to reverse negative trends impacting current and future mental healthcare of military personnel, veterans and other trauma survivors, and to bridge the scientific impasse.

PMID: 18950925 [PubMed - in process]

 

Transcult Psychiatry. 2008 Dec;45(4):611-38.

Daily stressors, war experiences, and mental health in afghanistan.

Miller KE, Omidian P, Rasmussen A, Yaqubi A, Daudzai H.

Boston Center for Refugee Health and Human Rights at Boston University. millerk@bu.edu.

Working in Afghanistan's capital city of Kabul, the authors assessed the relative contribution of daily stressors and war-related experiences of violence and loss  to levels of depression, PTSD, impaired functioning, and a culturally specific measure of general psychological distress. For women, daily stressors were a better predictor than war experiences of all mental health outcomes except for PTSD; for men, daily stressors were a better predictor of depression and functional impairment, while war experiences and daily stressors were similarly predictive of general distress. For men, daily stressors moderated the relationship between war experiences and PTSD, which was significant only under conditions of low daily stress. The study's implications for research and intervention in conflict and post-conflict settings are considered.

PMID: 19091728 [PubMed - in process]

 

J Psychiatr Res. 2008 Nov 27. [Epub ahead of print]

Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the  effects of abortion in the national comorbidity survey.

Coleman PK, Coyle CT, Shuping M, Rue VM.

Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, United States.

The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without  hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables.  Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future  research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

PMID: 19046750 [PubMed - as supplied by publisher]

 

Child Abuse Negl. 2008 Nov 26. [Epub ahead of print]

Children's expressed emotions when disclosing maltreatment.

Sayfan L, Mitchell EB, Goodman GS, Eisen ML, Qin J.

Department of Psychology, University of California, One Shields Avenue, Davis, CA 95616, USA.

OBJECTIVE: Our goal was to examine children's expressed emotions when they disclose maltreatment. Little scientific research exists on this topic, and yet children's emotional expressions at disclosure may inform psychological theory and play a crucial role in legal determinations. METHOD: One hundred and twenty-four videotaped forensic interviews were coded for children's emotional displays. In addition, children's trauma-related symptoms (depression, dissociation, and PTSD) and global adaptive functioning were assessed, and abuse  type and frequency were documented. RESULTS: Most children in the sample evinced  neutral emotion during disclosure. However, stronger negative reactions were linked to indices of psychopathology. Number of abuse experiences was inversely related to negative emotional displays. CONCLUSION: Fact finders may profit from  knowing that maltreated children do not necessarily cry or display strong emotion when disclosing maltreatment experiences. Nevertheless, predictors of greater negative affect at disclosure can be identified: fewer abuse experiences; higher  global adaptive functioning; and for sexually abused children, greater dissociative tendencies. PRACTICE IMPLICATIONS: Although further research is needed, practitioners should consider that children who disclose abuse may display relatively neutral affect despite having experienced maltreatment.

PMID: 19041134 [PubMed - as supplied by publisher]

 

J Abnorm Child Psychol. 2008 Nov 26. [Epub ahead of print]

Impact of Traumatic Life Events in a Community Sample of Toddlers.

Mongillo EA, Briggs-Gowan M, Ford JD, Carter AS.

Department of Psychology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125-3393, USA.

Toddlers may be at particularly high risk for a number of psychiatric, developmental and neurobiological consequences in the aftermath of trauma. The social and emotional impact of potentially traumatic life events experienced between 6 and 36-months of age was assessed in an epidemiological birth cohort of 18- to 36-month-olds from the Greater New Haven Area. Event-exposed toddlers evidenced greater symptom severity on the ITSEA Internalizing, Externalizing, Dysregulation, Atypical and Maladaptive scales, as well on the CBCL Internalizing and Externalizing scales than those not exposed. Approximately one-fifth of event-exposed toddlers were reported by their parents to have experienced a dramatic change in functioning following the event, and were described as experiencing higher levels of symptoms consistent with Post-Traumatic Stress Disorder (PTSD), namely re-experiencing and arousal, than exposed toddlers whose  parents did not report a change in their functioning. Implications for clinicians and child care providers working with toddlers and their parents are discussed.

PMID: 19034643 [PubMed - as supplied by publisher]

 

Psychol Psychother. 2008 Nov 26. [Epub ahead of print]

Traditional versus modern values, self-perceived interpersonal factors, and posttraumatic stress in Chinese and German crime victims.

Maercker A, Mohiyeddini C, Müller M, Xie W, Yang ZH, Wang J, Müller J.

Objectives The influence of cultural factors on mental health is not disputed in  general - but elaborated research approaches are still lacking. We investigate cultural influences not only by nationality but also by value orientation (modern vs. traditional). A cross-cultural comparison with Chinese and German crime victims included an assessment of value orientation according to Schwartz's theory (Schwartz, 1994) of personal values. Design Chinese and German adult crime victims were assessed. By means of structural equation multi-sample analysis, data of the two groups were compared. Method Traditional (conformity, benevolence, customs orientation) and modern values (achievement, hedonism, stimulation), traumatic exposure, posttraumatic stress (PTS), and two self-perceived interpersonal mediator processes (disclosure intentions, social acknowledgement as a victim) were assessed by self-report measures in 130 Chinese and 151 German crime victims. Results The two patterns of prediction for PTS differed between the countries: In the German sample both value types but in the  Chinese sample only traditional values were directly or indirectly predictive of  PTS. Traditional values inhibited social acknowledgement as a victim in China and Germany. In Germany, traditional values were related to increased PTS severity. Modern values predicted social acknowledgement as well as lower symptoms in Germany, but not in China. Conclusions The study shows cultural and interpersonal factors that may contribute to the development of PTSD that are under-researched  in contemporary psychology and psychotherapy.

PMID: 19040793 [PubMed - as supplied by publisher]

 

Cases J. 2008 Nov 25;1(1):352.

A case of PTSD presenting with psychotic symptomatology: a case report.

Floros GD, Charatsidou I, Lavrentiadis G.

2nd Department of Psychiatry, Psychiatric Hospital of Thessaloniki, 196 Langada str,, 564 29 Thessaloniki, Greece. georgefloros@gmail.com.

ABSTRACT: A male patient aged 43 presented with psychotic symptomatology after a  traumatic event involving accidental mutilation of the fingers. Initial presentation was uncommon although the patient responded well to pharmacotherapy. The theoretical framework, management plan and details of the treatment are presented.

PMID: 19032788 [PubMed - in process]

 

Addict Behav. 2008 Nov 21. [Epub ahead of print]

Trauma-related risk factors for substance abuse among male versus female young adults.

Danielson CK, Amstadter AB, Dangelmaier RE, Resnick HS, Saunders BE, Kilpatrick DG.

National Crime Victims Research & Treatment Center, Medical University of South Carolina, United States.

Clinical efforts to reduce risk for Substance Use Disorders (SUDs) among young adults rely on the empirical identification of risk factors for addictive behaviors in this population. Exposure to traumatic events and Posttraumatic Stress Disorder (PTSD) have been linked with SUDs in various populations. Emerging data, particularly from adolescent samples, suggest that traumatic event exposure increases risk for SUDs for young women, but not young men. The purpose  of the current study was to examine trauma-related risk factors for alcohol and drug abuse among a national sample of young adults and compare such risk factors  between men and women. Participants were 1753 young adults who participated in the 7-8 year follow-up telephone-based survey to the original National Survey of  Adolescents. In the full sample, 29.1% met criteria for substance abuse. Trauma-related risk factors for alcohol and drug abuse differed for men and women. Clinical implications of these results are discussed.

PMID: 19110381 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2008 Nov 21. [Epub ahead of print]

Psychometric properties of the Trauma Assessment for Adults.

Gray MJ, Elhai JD, Owen JR, Monroe R.

Department of Psychology, University of Wyoming, Laramie, Wyoming.

Background: The Trauma Assessment for Adults (TAA) was developed to facilitate the assessment of exposure to traumatic events that could result in posttraumatic stress disorder (PTSD). The TAA inquires about numerous potentially traumatic events that an individual may have experienced. Although the TAA has been used extensively for clinical and research purposes, its psychometric properties have  never been formally evaluated. The objective of the present investigation was to  evaluate the psychometric properties of this frequently used measure. Methods: The studies reported here describe the performance of the TAA in two samples-college undergraduates (N=142) and community mental health center clients (N=67). Among undergraduates, 1-week temporal stability was evaluated and, in both samples, item- and scale-level convergence of the TAA with an established trauma exposure measure was assessed. Convergence of the TAA with clinically related constructs was also evaluated. Results: The TAA exhibited adequate temporal stability (r=.80) and satisfactory item-level convergence with existing  measures of trauma history among college students. In the clinical sample, the TAA again converged well with an established measure of trauma exposure (r=.65).  It was not as strongly predictive, in either sample, of trauma-related distress relative to an alternate trauma exposure measure. Conclusion: Although it performs satisfactorily, the TAA does not appear to be superior to other existing measures of trauma exposure. Depression and Anxiety 0:1-6, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 19031486 [PubMed - as supplied by publisher]

 

Sleep Breath. 2008 Nov 21. [Epub ahead of print]

Psychometric properties of the Persian version of the Pittsburgh Sleep Quality Index addendum for PTSD (PSQI-A).

Farrahi J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A.

Kerman Neuroscience Research Center, Kerman University of Medical Sciences, 76195-1447, Kerman, Iran.

BACKGROUND: Considering the frequent occurrence of natural disasters in Iran, the need for an inventory assessing the quality of sleep in the posttraumatic stress  disorder (PTSD) patients is clearly evident. The Pittsburgh Sleep Quality Index addendum for PTSD (PSQI-A) has been recently developed to assess the disruptive nocturnal behaviors in the PTSD patients. This study was aimed to explore the reliability and validity of the Persian version of the PSQI-A. MATERIALS AND METHODS: Eighty-five PTSD patients related to the two recent major earthquakes of Kerman Province were enrolled in the study, and 133 healthy subjects were conveniently selected as the control group. The inventory was translated and then back-translated according to standard methods. The reliability was checked by computing the Cronbach;s alpha coefficient and corrected item-total correlation.  The sensitivity and specificity were assessed by comparing the PSQI-A score with  the DSM-IV-TR diagnosis. Convergent validity was checked against the General Health Questionnaire 12 (GHQ-12). RESULTS: The mean (+/-SD) of the two groups were 42.1(+/-13.8) and 34.2 (+/-9.8), respectively. The sex distribution was comparable in the two groups (females consisted 55% and 58% of the PTSD and control groups, respectively). There were significant differences between the items comparing the two groups except for the "acting out dreams". Overall the Cronbach;s alpha coefficient was 0.89, and the item-total correlation of all the  seven items were over 0.4 except for the acting out dreams. At cut-off of 7/8, the sensitivity and specificity were 100% and 93%, respectively. The sum score showed a correlation of 0.66 with the GHQ-12. CONCLUSION: Although the psychometric properties of one of the seven items of the inventory were to some extent unsatisfactory, the overall reliability and validity of the questionnaire  were acceptable.

PMID: 19023608 [PubMed - as supplied by publisher]

 

Neuropsychopharmacology. 2008 Nov 19. [Epub ahead of print]

CRF(1) and CRF(2) Receptors are Required for Potentiated Startle to Contextual but not Discrete Cues.

Risbrough VB, Geyer MA, Hauger RL, Coste S, Stenzel-Poore M, Wurst W, Holsboer F.

[1] 1Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA [2] 2Psychiatry Service, VA Healthcare System, San Diego, CA, USA.

Corticotropin-releasing factor (CRF) peptides and their receptors have crucial roles in behavioral and endocrine responses to stress. Dysregulation of CRF signaling has been linked to post-traumatic stress disorder, which is associated  with increased startle reactivity in response to threat. Thus, understanding the  mechanisms underlying CRF regulation of startle may identify pathways involved in this disorder. Here, we tested the hypothesis that both CRF(1) and CRF(2) receptors contribute to fear-induced increases in startle. Startle responses of wild type (WT) and mice with null mutations (knockout, KO) for CRF(1) or CRF(2) receptor genes were measured immediately after footshock (shock sensitization) or in the presence of cues previously associated with footshock (ie fear-potentiated startle, FPS). WT mice exhibited robust increases in startle immediately after footshock, which was dependent upon contextual cues. This effect was completely absent in CRF(1) KO mice, and significantly attenuated in CRF(2) KO mice. In contrast, CRF(1) and CRF(2) KO mice exhibited normal potentiation of startle by discrete conditioned cues. Blockade of both receptors via CRF(1) receptor antagonist treatment in CRF(2) KO mice also had no effect on FPS. These results support an additive model of CRF(1) and CRF(2) receptor activation effects on potentiated startle. These data also indicate that both CRF receptor subtypes contribute to contextual fear but are not required for discrete cued fear effects on startle reactivity. Thus, we suggest that either CRF(1) or CRF(2) could contribute to the increased startle observed in anxiety disorders with CRF system abnormalities.Neuropsychopharmacology advance online publication, 19 November 2008; doi:10.1038/npp.2008.205.

PMID: 19020499 [PubMed - as supplied by publisher]

 

Ann Gen Psychiatry. 2008 Nov 18;7:24.

Risk factors predict post-traumatic stress disorder differently in men and women.

Christiansen DM, Elklit A.

Department of Psychology, University of Aarhus, Aarhus, Denmark. aske@psy.au.dk.

ABSTRACT: BACKGROUND: About twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic  events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable. METHODS: The present work examines the effect of age,  previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident. RESULTS: Some gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than  in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD  for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender. CONCLUSION: Gender differences in the predictive value of social support on PTSD appear to be very complex, and no  clear conclusions can be made based on the two studies included in this article.

PMID: 19017412 [PubMed - in process]

 

J Anxiety Disord. 2008 Nov 18. [Epub ahead of print]

Memory modification as an outcome variable in anxiety disorder treatment.

Tryon WW, McKay D.

Department of Psychology, Fordham University, Bronx, NY 10458-9993, United States.

Learning and memory are interdependent processes. Memories are learned, and cumulative learning requires memory. It is generally accepted that learning contributes to psychopathology and consequently to pertinent memory formation. Neuroscience and psychological research have established that memory is an active reconstructive process that is influenced by thoughts, feelings, and behaviors including post-event information. Recent research on the treatment of anxiety disorders using medications (i.e., d-cyclcloserine) to alter neurological systems associated with memory used in conjunction with behavior therapy suggests that memory is part of a central mechanism in the etiology and maintenance of these conditions. The main thesis of this article is that learning-based interventions  create new memories that may modify existing ones. This raises the possibility of using such memory modifications to measure intervention outcome. A connectionist  context for understanding this phenomenon and informing intervention is provided, with specific reference to post-traumatic stress disorder, obsessive-compulsive disorder, and generalized anxiety disorder. Recommendations for future research examining the role of memory change in treatment outcome are suggested.

PMID: 19117720 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Nov 18. [Epub ahead of print]

Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers.

Giosan C, Malta L, Jayasinghe N, Spielman L, Difede J.

Department of Psychiatry, Weill Medical College of Cornell University, New York,  United States.

The present study examined the relationships between memories for a single incident traumatic event - the 9/11 attack on the World Trade Center (WTC) - and  posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed  at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that,  of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.

PMID: 19117719 [PubMed - as supplied by publisher]

 

J Clin Psychiatry. 2008 Nov 18. pii: ej07m04024. [Epub ahead of print]

A Multisite Study of Initial Respiration Rate and Heart Rate as Predictors of Posttraumatic Stress Disorder.

Bryant RA, Creamer M, O'Donnell M, Silove D, McFarlane AC.

From the School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. r.bryant@unsw.edu.au.

OBJECTIVE: Fear-conditioning models posit that increased arousal at the time of trauma predicts subsequent posttraumatic stress disorder (PTSD). This multisite study evaluated the extent to which acute heart rate and respiration rate predict subsequent chronic PTSD. METHOD: Traumatically injured patients admitted to 4 hospitals across Australia between April 2004 and February 2006 were initially assessed during hospital admission (N = 1105) and were reassessed 3 months later  for PTSD by using the Clinician-Administered PTSD Scale-IV and for major depressive disorder (MDD) by using the Mini-International Neuropsychiatric Interview (English version 5.0.0) (N = 955). Heart rate, respiration rate, and blood pressure were assessed on the initial day of traumatic injury. RESULTS: Ninety patients (10%) met criteria for PTSD and 159 patients (17%) met criteria for MDD at the 3-month assessment. Patients with PTSD compared to those without PTSD had higher heart rate (90.16 +/- 18.66 vs. 84.84 +/-17.41, t = 2.74, p < .01) and respiration rate (20.24 +/- 5.16 vs. 18.58 +/- 4.29, t = 3.43, p < .001) immediately after injury. There were no heart rate or respiration rate differences between patients who did and did not develop MDD. Patients were more  likely to develop PTSD at 3 months if they had a heart rate of at least 96 beats  per minute (15% vs. 8%, OR = 2.12, 95% CI = 1.34 to 3.33) or respiration rate of  at least 22 breaths per minute (18% vs. 8%, OR = 2.42, 95% CI = 1.48 to 3.94). CONCLUSIONS: Elevated heart rate and respiration rate are predictors of subsequent PTSD. These data underscore the need for future research into secondary prevention strategies that reduce acute arousal immediately after trauma and may limit PTSD development in some individuals.

PMID: 19014750 [PubMed - as supplied by publisher]

 

Prog Neuropsychopharmacol Biol Psychiatry. 2008 Nov 14. [Epub ahead of print]

Homocysteine and serum lipids concentration in male war veterans with posttraumatic stress disorder.

Jendričko T, Vidović A, Grubišić-Ilić M, Romić Z, Kovačić Z, Kozarić-Kovačić D.

University Hospital Dubrava, Department of Psychiatry, Refferal Centre of the Ministry of Health and Social Welfare for Stress-related Disorders, Avenija Gojka Suska 6, HR-10000 Zagreb, Croatia.

The evidence of increased cardiovascular disease (CVD) risk in posttraumatic stress disorder (PTSD) is accumulating. The present study aimed to determine whether chronic, combat-related PTSD is associated with serum lipid and homocysteine concentrations that could indicate higher CVD risk. The authors tested 66 war veterans with PTSD, 33 war veterans without PTSD, and 42 healthy volunteers for serum concentrations of homocysteine, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides. All the subjects were men and the analyses were adjusted for age, body mass index and smoking. Potential influences of depression, anxiety, and psychotic symptoms on the outcome measures were checked  by introducing the scores from the Hamilton Depression Rating Scale (HAM-D-17), the Hamilton Anxiety Scale (HAMA), and the Positive and Negative Syndrome Scale (PANSS) into the overall statistical model. No differences in total cholesterol,  LDL-C, HDL-C and triglycerides were found between the groups. Non-smoking PTSD war veterans had higher homocysteine concentrations (mean=10.4 mumol/L, SD=1.7) when compared to non-smoking war veterans without PTSD (mean=8.2 mumol/L, SD=4.0, P=0.014) and both smoking (mean=8.7 mumol/L, SD=2.3, P=0.008) and non-smoking healthy volunteers (mean=8.8 mumol/L, SD=2.2, P=0.021). The results of our cross-sectional study are possibly confounded by many factors, especially behavioral and life-style related which are difficult to control comprehensively  and might have influenced serum lipids and homocysteine concentration in a complex manner. An increase in the homocysteine concentration observed in the non-smoking PTSD patients needs further investigation with a carefully designed prospective study to confirm associated, possibly enhanced CVD risk.

PMID: 19038303 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Nov 8. [Epub ahead of print]

The effect of retrieval on recall of information in individuals with posttraumatic stress disorder.

Amir N, Badour CL, Freese B.

SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University, CA 92120-4913, United States.

Cognitive theories of posttraumatic stress disorder (PTSD) suggest that associative memory processes may play a crucial role in the development and maintenance of the disorder. In the current study we examined the effect of associative pair rehearsal on recall ability for threatening and non-threatening  information using the retrieval-practice paradigm in individuals with PTSD, traumatized controls (TC), and non-traumatized controls (NAC). Across word type,  NACs demonstrated a typical retrieval-induced forgetting effect. However, individuals with PTSD benefited less from rehearsal, and failed to inhibit recall of unpracticed words in practiced categories. Participants in the TC group displayed a retrieval-induced forgetting effect similar to those individuals in the PTSD group. These findings are consistent with research indicating that individuals with PTSD may derive less benefit from rehearsal and display general  inhibitory difficulties when compared to non-traumatized controls.

PMID: 19070459 [PubMed - as supplied by publisher]

 

Int J Psychophysiol. 2008 Nov 5. [Epub ahead of print]

Altered resting psychophysiology and startle response in Croatian combat veterans with PTSD.

Jovanovic T, Norrholm SD, Sakoman AJ, Esterajher S, Kozarić-Kovačić D.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.

Posttraumatic stress disorder (PTSD) is a prolonged reaction to an extremely traumatic experience. One of the core symptoms of PTSD is hyper-arousal which can be the result of an elevated activation of the autonomic nervous system. Including psychophysiological assessment methods in PTSD research can point to the neurobiological bases of the disorder. The studies of psychophysiology of PTSD to date have mostly measured reactivity. The aim of the current study was to compare resting state psychophysiology and startle reflexes in PTSD patients and  controls in a sample of Croatian combat veterans. We measured heart-rate, respiratory sinus arrhythmia, skin conductance, and eyeblink muscle contraction during an acclimation period and during the presentation of startle stimuli in 45 male PTSD patients and 33 male healthy controls. We found that PTSD patient had elevated baseline heart-rate and decreased respiratory sinus arrhythmia compared  to the controls. Furthermore, PTSD patients had impaired habituation to the startle probe, but there was no group difference in initial startle magnitude. There was also no group difference in skin conductance level or skin conductance  response. Startle habituation and baseline heart-rate appear to offer the most reliable psychophysiological indices of PTSD. This finding replicates trends in the literature in a new population of PTSD patients.

PMID: 19013485 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Nov 5. [Epub ahead of print]

Anxiety disorders moderate the association between externalizing problems and substance use disorders: Data from the National Comorbidity Survey-Revised.

Hofmann SG, Richey JA, Kashdan TB, McKnight PE.

Boston University, Boston, United States.

Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6-8.1), alcohol dependence (OR: 7.6, CI: 5.9-9.6), substance abuse (OR: 9.9, CI: 8.1-12.2), and substance dependence (OR: 13.1, CI: 9.6-17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4-15.5). Individuals who met  diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the  fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.

PMID: 19059752 [PubMed - as supplied by publisher]

 

Psychiatr Prax. 2008 Nov 4. [Epub ahead of print]

[Are Migrants More Susceptible to Mental Disorders?]

[Article in German]

Glaesmer H, Wittig U, Brähler E, Martin A, Mewes R, Rief W.

Universität Leipzig, Abteilung für Medizinische Psychologie und Soziologie.

OBJECTIVES There are few, methodically heterogeneous and unsatisfactory studies about the mental health of immigrants. Commonly, these studies refer to a single  group of immigrants and in consequence general statements about the mental health of immigrants are impossible. METHODS In a representative population survey in Germany (N = 2 510) depressive and somatoform symptoms were screened with the Patients Health Questionnaire, Post Traumatic Stress Disorder was screened with the PTDS. If at least one parent was born abroad, people are classified as immigrants. RESULTS 11.1 % of the sample are immigrants, which are mostly better  integrated ones. There are no significant differences in the prevalence of the investigated mental disorders of immigrants compared to the native population. CONCLUSION The sample includes a large variety of immigrants living in Germany and does not refer to a single group. Asylum seekers and undocumented migrants are not included, those immigrants with low language skills might be underrepresented because of the methodology. Against our expectations, no differences in the mental health between imigrants and native Germans could be proven. This finding stands in a marked contrast to the well established deficit-oriented point of view on the health of immigrants.

PMID: 18988144 [PubMed - as supplied by publisher]

 

Br J Health Psychol. 2008 Nov 3. [Epub ahead of print]

What predicts posttraumatic stress following spinal cord injury?

Hatcher MB, Whitaker C, Karl A.

Objectives Spinal cord injury (SCI) is a severe, traumatic event and recently research into the role of post-traumatic stress disorder (PTSD) subsequent to the injury has become of increasing interest. This study has been conducted in order  to investigate potential risk factors for the development of post-traumatic stress disorder symptoms in those with SCI. Design This cross-sectional study used multiple regression analysis to look for associations between posttraumatic  stress symptom severity, SCI-related factors and previously identified risk factors for PTSD such as dysfunctional cognitions, demographic factors and personality predispositions (neuroticism, alexithymia). Method A total of 102 participants with SCI completed measures of posttraumatic stress severity, acceptance of injury, posttraumatic cognitions, social support, neuroticism and alexithymia. In addition, information about type, level and cause of the SCI was  assessed. Results High levels of posttraumatic stress symptoms were found. Potential risk factors for the development of PTSD were negative cognitions of self and neuroticism. Variables that added to the variance explained by the models included time since injury and difficulty identifying feelings. Acceptance of injury was mediated by negative cognitions of the self and neuroticism. Conclusions The study highlights the need for services to be aware of the psychological difficulties experienced by this client group. An important finding is that the acceptance of the injury is mediated by negative cognitions of the self which need to be identified as potential risk factors in order to prevent the development of posttraumatic symptoms in this population.

PMID: 18983727 [PubMed - as supplied by publisher]

 

Ugeskr Laeger. 2008 Nov 3;170(45):3643-5.

[Stress disorder in parents of premature neonates--secondary publication]

[Article in Danish]

Elklit A, Hartvig T, Christiansen M.

Psykologisk Institut, Aarhus Universitet, DK-8000 Arhus C. aske@psy.au.dk

The current study evaluated the psychological sequelae in 66 parents of premature neonates (mean weight 842 grams). A total of 35% of the parents reported that their child had a handicap, while 20% of the women met the criteria of post-traumatic stress disorder (PTSD) at the time of the study, and an additional 10% met the criteria for subclinical PTSD. Female gender, the child's handicap, general distress during hospitalization, distressing contact with hospital staff, experienced distress at homecoming, and emotional coping explained 72% of the degree of traumatization.

Publication Types:      English Abstract

PMID: 18988368 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2008 Nov;33(11):1448-53. Epub 2008 May 22.

Smoking in help-seeking veterans with PTSD returning from Afghanistan and Iraq.

Kirby AC, Hertzberg BP, Collie CF, Yeatts B, Dennis MF, McDonald SD, Calhoun PS,  Beckham JC.

Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.

Past research has shown that veterans and individuals with posttraumatic stress disorder (PTSD) have increased rates of smoking. However, the rates of smoking in younger help-seeking veterans returning from Afghanistan and Iraq, and possible correlates of smoking among this population are unknown. In this study, we evaluated the rate of lifetime and current smoking among a sample of 90 returning male veterans diagnosed with PTSD. Fifty-nine percent reported a lifetime history of smoking including 32% that were current smokers. Current smokers were significantly younger than non-smokers. Current smokers (mean age=31) reported a  mean age of smoking onset as 15.86 with a pack year history of 8.89. These smokers reported on average five previous quit attempts. According to a stages of change model, one-half of the smokers were in the contemplation phase of stopping smoking (50%), 29% were in the pre-contemplation phase and 21% were in the preparation phase. The results are placed in the context of non-psychiatric and psychiatric smokers.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18571871 [PubMed - in process]

 

Addict Behav. 2008 Nov;33(11):1441-7. Epub 2008 Apr 8.

Relationship between PTSD symptomatology and nicotine dependence severity in crime victims.

Baschnagel JS, Coffey SF, Schumacher JA, Drobes DJ, Saladin ME.

The University at Mississippi Medical Center, Department of Psychiatry and Human  Behavior, 2500 North State St. Jackson, MS 39216, USA. jbaschnagel@psychiatry.umsmed.edu

Smoking rates are higher and cessation rates are lower among individuals with posttraumatic stress disorder (PTSD) compared to the general population, thus understanding the relationship between PTSD and nicotine dependence is important. In a sample of 213 participants with a crime-related trauma (109 with PTSD), the  relationship between PTSD status, smoking status (smoker vs. non-smoker), substance abuse diagnosis (SUD), PTSD symptoms, and sex was assessed. SUD diagnosis was significantly related to smoking status, but PTSD symptomatology and sex were not. Among smokers (n=117), increased nicotine dependence severity was associated with being male and with increased level of PTSD avoidance symptoms. Correlations indicated that PTSD avoidance and hyperarousal symptom clusters and total PTSD symptom scores were significantly related to nicotine dependence severity in males, while PTSD symptomatology in general did not correlate with dependence severity for females. The results suggest that level of PTSD symptomatology, particularly avoidance symptoms, may be important targets for smoking cessation treatment among male smokers who have experienced a traumatic event.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18442884 [PubMed - in process]

 

Aging Ment Health. 2008 Nov;12(6):807-19.

Can the past keep life pleasant even for old-old trauma survivors?

Shrira A, Shmotkin D.

Department of Psychology, Tel Aviv University, Tel Aviv, Israel. amitshar@post.tau.ac.il

OBJECTIVES: This study examined the relative effect of positive and negative autobiographical aspects in later life as a function of the traumatic experience  of the Holocaust and age. METHOD: Old (age <or=80) and old-old (age >80) participants who were identified as Holocaust survivors (n = 225), and comparison of pre-war (n = 103) and post-war (n = 254) European-descent immigrants referred  to their past in a biographical interview. The participants depicted personally perceived outstanding life periods defined as anchor periods (Shmotkin, D. (2005). Happiness in face of adversity: Reformulating the dynamic and modular bases of subjective well-being. Review of General Psychology, 9, 291-325). They rated their happiness and suffering during major anchor periods ('the happiest period' and 'the most miserable period') as well as their life satisfaction. RESULTS: The findings suggest that even after massive trauma and under accelerating decline associated with old-old age, the past can keep life pleasant, as indicated by the stronger association of past happiness, compared to that of past suffering, with life satisfaction. Nevertheless, past suffering was  associated with life satisfaction among the Holocaust survivors and manifested a  stronger effect among most of the old-old participants. CONCLUSION: Holocaust survivors demonstrated a greater difficulty to compensate for age-related losses  while the comparison groups showed a greater optimization of satisfaction through narrative means in old-old age.

Publication Types:      Comparative Study

PMID: 19023733 [PubMed - indexed for MEDLINE]

 

AIDS Care. 2008 Nov;20(10):1279-83.

The relationship between behavioural inhibition, anxiety disorders, depression and CD4 counts in HIV-positive adults: a cross-sectional controlled study.

Fincham D, Smit J, Carey P, Stein DJ, Seedat S.

MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, South Africa. dylan@sun.ac.za

This study examined the relationships between behavioural inhibition (BI), anxiety disorders, depression and CD4 counts in 456 HIV-infected adults attending primary healthcare HIV clinics in South Africa. Our first hypothesis was that BI  would be positively correlated with anxiety disorders and with depression. Our second hypothesis was that BI, anxiety disorders and depression would be negatively correlated with CD4 counts. Participants completed the Retrospective Self-Report of Childhood Inhibition scale (RSRCI), the Center for Epidemiologic Studies Depression scale (CES-D) and the Mini-International Neuropsychiatric Interview (MINI). We found that BI was positively correlated with depression, agoraphobia, social phobia (social anxiety disorder) and posttraumatic stress disorder (PTSD). In addition, we found that BI, anxiety disorders and depression  were not associated with CD4 counts. Finally, we found no gender effects for BI,  depression, CD4 counts or any anxiety disorder diagnosis. While BI was linked to  certain anxiety disorders, we found no evidence to suggest that BI, a diagnosis of an anxiety disorder, and/or depressive symptoms were associated with CD4 counts among HIV-positive adults.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19012085 [PubMed - in process]

 

Alcohol Alcohol. 2008 Nov-Dec;43(6):706-12. Epub 2008 Sep 12.

Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak.

Wu P, Liu X, Fang Y, Fan B, Fuller CJ, Guan Z, Yao Z, Kong J, Lu J, Litvak IJ.

Mailman School of Public Health, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 43, NY 10032, USA. pw11@columbia.edu

AIMS: The aim of this study was to examine alcohol abuse/dependence symptoms among hospital employees exposed to a severe acute respiratory syndrome (SARS) outbreak, and the relationship between types of exposure to the SARS outbreak and subsequent alcohol abuse/dependence symptoms. METHODS: A survey was conducted among 549 randomly selected hospital employees in Beijing, China, concerning the  psychological impact of the 2003 SARS outbreak. Subjects were assessed on sociodemographic factors and types of exposure to the outbreak, and on symptoms of post-traumatic stress (PTS), alcohol abuse/dependence and depression. RESULTS: Current alcohol abuse/dependence symptom counts 3 years after the outbreak were positively associated with having been quarantined, or worked in high-risk locations such as SARS wards, during the outbreak. However, having had family members or friends contract, SARS was not related to alcohol abuse/dependence symptom count. Symptoms of PTS and of depression, and having used drinking as a coping method, were also significantly associated with increased alcohol abuse/dependence symptoms. The relationship between outbreak exposure and alcohol abuse/dependence symptom count remained significant even when sociodemographic and other factors were controlled for. When the intrusion, avoidance and hyperarousal PTS symptom clusters were entered into the model, hyperarousal was found to be significantly associated with alcohol abuse/dependence symptoms. CONCLUSIONS: Exposure to an outbreak of a severe infectious disease can, like other disaster exposures, lead not only to PTSD but also to other psychiatric conditions, such as alcohol abuse/dependence. The findings will help policy makers and health professionals to better prepare for potential outbreaks of diseases such as SARS or avian flu.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural

PMID: 18790829 [PubMed - in process]

 

Am J Addict. 2008 Nov-Dec;17(6):478-87.

The relationship between posttraumatic growth and substance use in homeless women with histories of traumatic experience.

Stump MJ, Smith JE.

Department of Psychology, St. Louis University, St. Louis, Missouri, USA.

Posttraumatic growth (PTG)--namely, the experience of positive change in oneself  or one's life following trauma--is particularly relevant for homeless women because they have greater trauma exposure than the general population, as well as higher rates of substance use. The present study examined PTG and substance use in this population. Fifty homeless women with trauma histories participated. In line with predictions, more current substance use was related to less PTG, more reliance on avoidant coping once approach coping was accounted for, and greater PTSD symptomatology. Levels of growth were comparable to those found in samples with less trauma exposure.

PMID: 19034739 [PubMed - in process]

 

Am J Crit Care. 2008 Nov;17(6):534-43; quiz 544.

Symptoms of acute posttraumatic stress disorder after intensive care.

Wallen K, Chaboyer W, Thalib L, Creedy DK.

Research Centre for Clinical Practice Innovation, Griffith University Gold Coast, Queensland, Australia. K.Wallen@griffith.edu.au

BACKGROUND: Admission to intensive care is often a sudden and unexpected event precipitated by a life-threatening condition, 2 determinants thought to influence the development of posttraumatic stress disorder. OBJECTIVES: To identify the frequency of acute symptoms of posttraumatic stress disorder and to describe factors predictive of these symptoms in patients 1 month after discharge from intensive care. METHODS: In this prospective cohort study, all patients meeting the inclusion criteria during the study period were invited to participate. Participants completed the Impact of Event Scale-Revised, and demographic and clinical data were accessed from an intensive care unit database. RESULTS: During a 9-month period, 114 of 137 patients who met the inclusion criteria consented to participate in the study, and 100 (88%) completed it. The mean total score on the Impact of Event Scale-Revised was 17.8 (SD, 13.4; possible range, 0-88). A total  of 13 participants (13%) scored higher than the cutoff score for clinical posttraumatic stress disorder. Neither sex nor length of stay was predictive of acute symptoms of post-traumatic stress disorder. In multivariate analysis, the only independent predictor of symptoms was age. Patients younger than 65 years were 5.6 times (95% confidence interval, 1.17-26.89) more likely than those 65 years and older to report symptoms. CONCLUSION: The rate of symptoms of posttraumatic stress disorder 1 month after discharge from intensive care was relatively low. Consistent with findings of previous research, being younger than 65 years was the only independent predictor of symptoms.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18978238 [PubMed - indexed for MEDLINE]

 

Am J Nurs. 2008 Nov;108(11):60-8; quiz 68-9.

The Impact of Event Scale--Revised: a quick measure of a patient's response to trauma.

Hyer K, Brown LM.

School of Aging Studies, University of South Florida, Tampa, USA. khyer@cas.usf.edu

A person may suffer debilitating anxiety and other physical and psychological symptoms without recognizing that they're a response to a traumatic event. And older adults in particular may be reluctant to admit to experiencing such symptoms. The Impact of Event Scale--Revised (IES-R) is an easy-to-administer questionnaire used to evaluate the degree of distress a patient feels in response to trauma. It provides a structured way for a patient to communicate distress when she or he may not have the words to do so. For a free online video showing nurses using the IES-R with an older patient, go to http://links.lww.com/A316.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18946269 [PubMed - indexed for MEDLINE]

 

Anesthesiology. 2008 Nov;109(5):927-9.

Operating room desensitization as a novel treatment for post-traumatic stress disorder after intraoperative awareness.

Mashour GA, Wang LY, Esaki RK, Naughton NN.

Department of Anesthesiology, University of Michigan, 1H247 University Hospital,  Ann Arbor, MI 48109-0048, USA. gmashour@umich.edu

Publication Types:      Case Reports

PMID: 18946306 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2008 Nov;65(11):1324-30.

Posttraumatic stress symptoms and predicted mortality in patients with implantable cardioverter-defibrillators: results from the prospective living with an implanted cardioverter-defibrillator study.

Ladwig KH, Baumert J, Marten-Mittag B, Kolb C, Zrenner B, Schmitt C.

Institute of Epidemiology, Helmholtz Zentrum National Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. ladwig@helmholtz-muenchen.de

CONTEXT: Cardiac disease and treatment with an implantable cardioverter-defibrillator (ICD) may be psychologically traumatic. Posttraumatic  stress disorder (PTSD) is generally overlooked in cardiac patients, and no study  to date (to our knowledge) has evaluated the effect of PTSD symptoms on the prognosis in patients with ICDs. OBJECTIVE: To test whether PTSD symptoms at baseline predict long-term mortality risk in patients with ICDs. DESIGN: Prospective cohort study with a mean follow-up period of 5.1 years, accounting for 743 person-years observed. SETTING: Data were derived from the Living With an Implanted Cardioverter-Defibrillator-Study, which initially included 211 patients with ICDs routinely attending the German Heart Center Munich outpatient clinic. PARTICIPANTS: The Impact of Event Scale-Revised was used in 147 patients (125 men and 22 women) who qualified for the "A" criterion of PTSD (survival of a life-threatening event). Thirty-eight patients scoring in the upper quartile of the scale constituted the PTSD index group. MAIN OUTCOME MEASURES: Mortality risk per 1000 person-years as assessed by Cox proportional hazards regression analysis based on an appropriate model fit (area under the curve, >0.80). RESULTS: Index patients experienced more anxiety and depression, had more cardiac symptoms, but  showed no differences in left ventricular ejection fraction status or extent of ICD discharges compared with non-index patients. Forty-five patients (30.6%) died during the follow-up period. The relative mortality risk (multivariate adjusted for age, sex, diabetes mellitus, left ventricular ejection fraction, beta-blocker prescription, prior resuscitation, ICD shocks received, depression, and anxiety)  hazard ratio was 3.45 (95% confidence interval, 1.57-7.60; P = .002) for the PTSD group. Compared with 55 fatal events per 1000 person-years in patients without PTSD, the long-term absolute mortality risk accounted for 80 fatal events per 1000 person-years in patients with PTSD. CONCLUSION: The adverse effect of PTSD symptoms on the long-term mortality risk in ICD-treated cardiac event survivors,  independent of disease severity, supports the need for routinely applied interdisciplinary psychosocial aftercare.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18981344 [PubMed - indexed for MEDLINE]

 

Behav Modif. 2008 Nov;32(6):876-96. Epub 2008 Jul 9.

Posttraumatic stress disorder and social support in female victims of sexual assault: the impact of spousal involvement on the efficacy of cognitive-behavioral therapy.

Billette V, Guay S, Marchand A.

Trauma Study Center, Centre de Recherche Fernand-Seguin of Louis-H. Lafontaine Hospital, Université du Québec à Montréal. valeriebillette@hotmail.com

The goal of this study is to enhance the efficacy of CBT with victims of sexual assault suffering from PTSD by getting the spouse involved. Thus, in addition to  attempting to reduce PTSD symptoms, the therapy focuses on improving the support  offered by the spouse and favors management of the impact of the traumatic event  within the couple. A single-case, multiple-baseline across-subjects design is used. Three victims of sexual assault with a diagnosis of PTSD participated in the study. Results at posttreatment and at 3-month follow-up are promising. None  of the participants presents a diagnosis of PTSD, and all report a significant improvement in their satisfaction with the support received from their spouses.

PMID: 18614698 [PubMed - in process]

 

Br J Psychiatry. 2008 Nov;193(5):378-82.

Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample.

Kelleher I, Harley M, Lynch F, Arseneault L, Fitzpatrick C, Cannon M.

Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.

BACKGROUND: Children and adolescents who report psychotic symptoms appear to be at increased risk for psychotic disorders in adulthood - a putative ;symptomatic' high-risk group. However, little research has investigated whether those in this  high-risk population have increased rates of exposure to traumatic events in childhood, as seen in patients who have a psychotic illness. AIMS: To examine whether adolescents with psychotic symptoms have an increased rate of traumatic experiences. METHOD: Psychiatric interviews were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about a number of early traumatic events including  physical and sexual abuse, exposure to domestic violence and bullying. RESULTS: Fourteen adolescents (6.6% of those interviewed) reported experiencing at least one psychotic symptom. Adolescents who reported psychotic symptoms were significantly more likely to have been physically abused in childhood, to have been exposed to domestic violence and to be identified as a bully/victim (that is, both a perpetrator and victim of bullying) than those who did not report such symptoms. These findings were not confounded by comorbid psychiatric illness or family history of psychiatric history. CONCLUSIONS: Our findings suggest that childhood trauma may increase the risk of psychotic experiences. The characteristics of bully/victims deserve further study.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18978317 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Nov;32(11):1026-36.

Children's expressed emotions when disclosing maltreatment.

Sayfan L, Mitchell EB, Goodman GS, Eisen ML, Qin J.

Department of Psychology, University of California, One Shields Avenue, Davis, CA 95616, USA.

OBJECTIVE: Our goal was to examine children's expressed emotions when they disclose maltreatment. Little scientific research exists on this topic, and yet children's emotional expressions at disclosure may inform psychological theory and play a crucial role in legal determinations. METHOD: One hundred and twenty-four videotaped forensic interviews were coded for children's emotional displays. In addition, children's trauma-related symptoms (depression, dissociation, and PTSD) and global adaptive functioning were assessed, and abuse  type and frequency were documented. RESULTS: Most children in the sample evinced  neutral emotion during disclosure. However, stronger negative reactions were linked to indices of psychopathology. Number of abuse experiences was inversely related to negative emotional displays. CONCLUSION: Fact finders may profit from  knowing that maltreated children do not necessarily cry or display strong emotion when disclosing maltreatment experiences. Nevertheless, predictors of greater negative affect at disclosure can be identified: fewer abuse experiences; higher  global adaptive functioning; and for sexually abused children, greater dissociative tendencies. PRACTICE IMPLICATIONS: Although further research is needed, practitioners should consider that children who disclose abuse may display relatively neutral affect despite having experienced maltreatment.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 19090025 [PubMed - in process]

 

Evid Based Ment Health. 2008 Nov;11(4):126.

Comment on:     BMJ. 2008 Feb 16;336(7640):366-71.

Deployment with combat exposure increases the risk of new-onset PTSD.

Lapierre CB.

Tarleton State University - Central Texas, Killeen, Texas, USA.

Publication Types:      Comment

PMID: 18952975 [PubMed]

 

Expert Opin Drug Saf. 2008 Nov;7(6):783-94.

Paroxetine: safety and tolerability issues.

Marks DM, Park MH, Ham BJ, Han C, Patkar AA, Masand PS, Pae CU.

Duke University Medical Center, Department of Psychiatry and Behavioural Sciences, 2218 Elder Street, Durham 27705, USA.

Paroxetine is a selective serotonin re-uptake inhibitor (SSRI) available in immediate release and controlled release (CR) formulations. Paroxetine is the most potent inhibitor of serotonin re-uptake among the now available SSRIs. Paroxetine has been approved for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder (PD), generalised anxiety disorder, post traumatic stress disorder (PTSD), and social anxiety disorder (SAD) in adults, whereas paroxetine CR is approved for the treatment of MDD, SAD, PD and premenstrual dysphoric disorder in adults. The overall efficacy of paroxetine seems to be comparable to other SSRIs in the treatment of approved indications, although paroxetine treatment induces more sedation, constipation, sexual dysfunction, discontinuation syndrome and weight gain than other SSRIs. Recent data suggest that paroxetine treatment leads to increased rates of congenital malformations, although this evidence is not conclusive. Paroxetine and paroxetine CR are not indicated for use in the paediatric population and are  categorised as Pregnancy Class D. In conclusion, whether the tolerability profile of paroxetine differs substantially from other new antidepressants (including other SSRIs) needs to be determined in adequately powered well-designed randomised controlled comparative clinical trials.

PMID: 18983224 [PubMed - in process]

 

Gen Hosp Psychiatry. 2008 Nov-Dec;30(6):536-45. Epub 2008 Sep 5.

Physician-reported practice of managing childhood posttraumatic stress in pediatric primary care.

Banh MK, Saxe G, Mangione T, Horton NJ.

Department of Psychology, Boston University, Boston, MA 02215, USA. my.banh@gmail.com

OBJECTIVE: This study investigated pediatrician-reported practices in identifying, assessing, and treating traumatic exposure and posttraumatic stress  disorder (PTSD) in children. METHOD: Focus groups guided the development of a survey that was mailed to primary care pediatricians in Massachusetts in 2005. Descriptive statistics and multivariate analyses were used to describe clinical practices and perceived barriers to care. RESULTS: A 60% (N=597) survey response-rate was obtained. On average, pediatricians reported that less than 8%  of patients had psychological problems that may be related to traumatic exposure. Only 18% of pediatricians agreed that they had adequate knowledge of childhood PTSD. About 15% of pediatricians reported frequently learning about traumatic event(s) from direct inquiry in the past year. Only 10% of pediatricians reported frequent assessment and treatment of posttraumatic stress symptoms. Most pediatricians (72%) agreed that greater collaborations with mental health providers would improve pediatric assessment of PTSD. Finally, having received PTSD-specific training and believing that pediatricians should identify and manage PTSD were each significantly associated with learning about a traumatic event from direct inquiry. CONCLUSION(S): Providing PTSD-specific training and changing pediatricians' attitudes about childhood PTSD may be useful first steps  in improving care for children.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19061680 [PubMed - in process]

 

J Affect Disord. 2008 Nov;111(1):74-82. Epub 2008 Apr 2.

Consistent impaired verbal memory in PTSD: a meta-analysis.

Johnsen GE, Asbjørnsen AE.

Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway. grethe.johnsen@psybp.uib.no

BACKGROUND: Qualitative review papers have indicated that verbal memory impairment is found to be the most consistent cognitive impairment related to PTSD. These review papers have used qualitative methods to describe the effects,  and consequently they have not been able to estimate the strength of the memory-PTSD association. METHODS: This meta-analysis of 28 studies examined the empirical evidence for this relationship, and factors affecting the results. RESULTS: Overall, the results showed medium effect sizes in patients with PTSD compared to controls on verbal memory across studies. Marked impairment was found in the patient groups compared to healthy controls, while modest impairment was found compared to exposed non-PTSD controls. Meta-analyses found strongest effects in war veterans compared to sexual and physical assault related PTSD. Rather unexpectedly no effect was found for the sexually abused PTSD groups compared to exposed controls. The analyses further showed that the effect was dependent on the test procedures used. The studies using WMS and AVLT had stronger effects than studies using CVLT. LIMITATIONS: Insufficient data were available to analyze a more complete attention-memory profile. CONCLUSIONS: This  meta-analysis confirms that verbal memory impairment is present in adults with PTSD, and they are consistent across studies. This impairment should be the focus of work in clinical settings.

Publication Types:      Comparative Study     Meta-Analysis     Research Support, Non-U.S. Gov't

PMID: 18377999 [PubMed - indexed for MEDLINE]

 

J Epidemiol Community Health. 2008 Nov;62(11):980-6.

Food insecurity, stressful life events and symptoms of anxiety and depression in  east Africa: evidence from the Gilgel Gibe growth and development study.

Hadley C, Tegegn A, Tessema F, Cowan JA, Asefa M, Galea S.

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA. chadley@emory.edu

OBJECTIVES: Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in  sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among  adults. METHODS: The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms. RESULTS: Among  902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress. CONCLUSIONS: Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18854502 [PubMed - in process]

 

J Exp Psychol Gen. 2008 Nov;137(4):591-614.

Memory in posttraumatic stress disorder: properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms.

Rubin DC, Boals A, Berntsen D.

Department of Psychology and Neuroscience, Duke University, Durham, NC 27708-0086, USA. david.rubin@duke.edu

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed  tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD.  (c) 2008 APA, all rights reserved

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18999355 [PubMed - indexed for MEDLINE]

 

J Forensic Leg Med. 2008 Nov;15(8):527-8. Epub 2008 Aug 8.

The need for measures to prevent "solitary deaths" after large earthquakes - based on current conditions following the Great Hanshin-Awaji Earthquake.

Fujita Y, Inoue K, Seki N, Inoue T, Sakuta A, Miyazawa T, Eguchi K.

Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kanagawa, Japan.

Publication Types:      Comparative Study

PMID: 18926507 [PubMed - indexed for MEDLINE]

 

J Health Psychol. 2008 Nov;13(8):1008-11.

Application of the DSM-IV Criteria to the Experience of Living with AIDS: Some Concerns.

Kagee A.

Stellenbosch University, South Africa. skagee@sun.ac.za.

A diagnosis with HIV is often considered traumatic. According to the DSM-IV-TR's  criteria for PTSD, a traumatic event precipitates a set of reactions in an individual that includes avoidant behaviour, intrusive thoughts, and physiologic  hyperarousal. However, persons diagnosed with HIV are typically concerned with events that will occur in the future such as physical decline and death, access to treatment, the welfare of dependants, and stigma and discrimination. Their concerns are thus future-oriented rather than anchored to a past traumatic event, which is the requirement of PTSD. This article argues that an HIV diagnosis may be inappropriately regarded as traumatic.

PMID: 18987073 [PubMed - in process]

 

J Interpers Violence. 2008 Nov;23(11):1555-78. Epub 2008 Mar 18.

The role of young adolescents' perception in understanding the severity of exposure to community violence and PTSD.

Aisenberg E, Ayón C, Orozco-Figueroa A.

University of Washington, Seattle, WA 98105-6299, USA. ginoa@u.washington.edu

This study seeks to (a) identify and measure the lifetime exposure to community violence of 137 African American and Latino middle school students from a low income neighborhood and apply numerical weights to each violent event; (b) examine the relationship between the objective severity of child self reported violence exposure and the child's subjective perception of the most bothersome event; and (c) examine the relationship between child's exposure and posttraumatic stress disorder (PTSD). Results highlight that students' designation of their most bothersome exposure to community violence did not correspond to the most severe violent event they experienced. Regression analyses reveal the weight of the most severe event explains a larger percentage of the variance in PTSD compared with the relationship to victim, level of exposure, weight of the most bothersome exposure, and cumulative weight of all exposure. This study underscores the importance of assessing a child's perception of violent events.

PMID: 18349341 [PubMed - indexed for MEDLINE]

 

J Med Ethics. 2008 Nov;34(11):e23.

Propranolol, post-traumatic stress disorder and narrative identity.

Bell J.

Dalhousie University, Halifax, Nova Scotia, Canada. jah.bell@utoronto.ca

FUNDING: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object  to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President's Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat to the self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don't respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case.

PMID: 18974403 [PubMed - in process]

 

J Midwifery Womens Health. 2008 Nov-Dec;53(6):538-46.

Physical health and posttraumatic stress disorder symptoms in women experiencing  intimate partner violence.

Woods SJ, Hall RJ, Campbell JC, Angott DM.

University of Akron College of Nursing, Akron, OH 44325-3701, USA. sw5@uakron.edu

This correlational-predictive study addresses the associations between intimate partner violence (IPV) and physical health and posttraumatic stress disorder (PTSD) symptoms, including: 1) detailed physical health symptoms reported and health care sought by women in intimate abusive relationships, 2) relationships between physical health symptoms, IPV, and PTSD, and 3) unique predictors of physical health symptoms. An ethnically diverse sample of 157 abused women was recruited from crisis shelters and the community. The women averaged almost 34 years of age and had been in the abusive relationship for slightly more than 5 years. The women experienced physical health symptoms falling into 4 groups: neuromuscular, stress, sleep, and gynecologic symptoms. Women experiencing more severe IPV reported more physical health and PTSD symptomatology. PTSD avoidance  and threats of violence or risk of homicide uniquely predicted physical health. More than 75% of the women had sought treatment from a health care professional in the previous 9 months. Implications for practice are discussed.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18984510 [PubMed - in process]

 

J Nerv Ment Dis. 2008 Nov;196(11):852-5.

Negative affect predicts posttraumatic stress symptoms in Brazilian volunteer United Nations peacekeepers in Haiti.

Souza WF, Figueira I, Mendlowicz MV, Volchan E, Mendonça-de-Souza AC, Duarte AF,  Monteiro da Silva AM, Marques-Portella C, Mari JJ, Coutinho ES.

Department of Epidemiology, National School of Public Health (ENSP-FIOCRUZ), Federal University of Rio de Janeiro, Brazil. wanderson.souza@gmail.com

Our study evaluated the relationship between positive affect (PA) and negative affect (NA) traits on the development of posttraumatic stress symptoms (PTSS) among peacekeepers. A longitudinal study with 138 army personnel deployed to a peacekeeping mission in Haiti was conducted. An instrument for measuring PA and NA traits was used before deployment. PTSS, indexed by posttraumatic stress disorder Checklist--Military Version (PCL-M) and frequency of stressful situations were measured after return. Regression analysis showed that both NA and number of stressful situations contributed toward increasing PCL-M scores (Adjusted R = 0.25; p < 0.001). We also found that NA traits interact with intensively stressful situations enhancing the occurrence of PTSS (Adjusted R = 0.32; p < 0.001). These findings suggest that NA traits are an important predictor for PTSS among peacekeepers and also worsen the consequences of being exposed to stressful situations.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19008738 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Nov;196(11):844-6.

Anger and posttraumatic stress disorder in disaster relief workers exposed to the September 11, 2001 World Trade Center disaster: one-year follow-up study.

Jayasinghe N, Giosan C, Evans S, Spielman L, Difede J.

Department of Psychiatry, Weill Medical College of Cornell University, New York,  New York 10065, USA. nij2001@med.cornell.edu

Although anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 () indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a 1-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.

PMID: 19008736 [PubMed - indexed for MEDLINE]

 

J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1275-81. Epub 2008 May 9.

The effect of telephone counselling on reducing post-traumatic symptoms after mild traumatic brain injury: a randomised trial.

Bell KR, Hoffman JM, Temkin NR, Powell JM, Fraser RT, Esselman PC, Barber JK, Dikmen S.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA. krbell@u.washington.edu

BACKGROUND: Mild traumatic brain injury (MTBI) is a significant public health problem affecting approximately 1 million people annually in the USA. A total of  10-15% of individuals are estimated to have persistent post-traumatic symptoms. This study aimed to determine whether focused, scheduled telephone counselling during the first 3 months after MTBI decreases symptoms and improves functioning  at 6 months. METHODS: This was a two-group, parallel, randomised clinical trial with the outcome assessed by blinded examiner at 6 months after injury. 366 of 389 eligible subjects aged 16 years or older with MTBI were enrolled in the emergency department, with an 85% follow-up completion rate. Five telephone calls were completed, individualised for patient concerns and scripted to address education, reassurance and reactivation. Two composites were analysed, one relating to post-traumatic symptoms that developed or worsened after injury and their impact on functioning, the other related to general health status. RESULTS: The telephone counselling group had a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score, 95% confidence interval (CI) 1.2  to 12.0), but no difference in general health outcome (1.5 difference in adjusted mean functional score, 95% CI 2.2 to 5.2). A smaller proportion of the treatment  group had each individual symptom (except anxiety) at assessment. Similarly, fewer of the treatment group had daily functioning negatively impacted by symptoms with the largest differences in work, leisure activities, memory and concentration and financial independence. CONCLUSIONS: Telephone counselling, focusing on symptom management, was successful in reducing chronic symptoms after MTBI. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, #NCT00483444.

Publication Types:      Randomized Controlled Trial     Research Support, U.S. Gov't, P.H.S.

PMID: 18469027 [PubMed - indexed for MEDLINE]

 

J Pain. 2008 Nov;9(11):1049-57. Epub 2008 Aug 13.

Chronic pain in women survivors of intimate partner violence.

Wuest J, Merritt-Gray M, Ford-Gilboe M, Lent B, Varcoe C, Campbell JC.

University of New Brunswick, Faculty of Nursing, Fredericton, New Brunswick, Canada. wuest@unb.ca

In this descriptive study of chronic pain in a community sample of 292 women who  had separated from their abusive partners on average 20 months previously, more than one-third experienced high disability pain as measured by Von Korff's Chronic Pain Grade. Beyond the usual pain locations associated with abuse, 43.2%  reported swollen/painful joints. More interference in daily life was attributed to joint pain than to back, head, stomach, pelvic or bowel pain. Women with high  disability pain were more likely to have experienced child abuse, adult sexual assault, more severe spousal abuse, lifetime abuse-related injuries, symptoms of  depression and post-traumatic stress disorder, lifetime suicide attempts, difficulty sleeping, and unemployment. High disability pain also was associated with visits to a family doctor and psychiatrist and use of medication in more than prescribed dosages. Less than 25% of women with high disability pain were taking opioids, or prescription nonsteroidal anti-inflammatory medications. Interestingly, high disability pain was not related to smoking, use of street drugs, potential for alcohol dependence, age, income, or education. The findings  add to knowledge of severity and patterns of chronic pain in abused women and support the need for further multivariate analysis of the relationships among abuse experiences, mental health, and chronic pain severity to better inform decisions regarding diagnosis and treatment. PERSPECTIVE: Understanding patterns  of chronic pain in abuse survivors and their associations with abuse history, mental health symptoms, health service use, and medication is important for clinical assessment and intervention. Chronic pain persisted long after leaving abusive partners and extended beyond usual locations (back, headache, pelvic, gastrointestinal) to include swollen/painful joints.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18701353 [PubMed - indexed for MEDLINE]

 

J Psychosoc Nurs Ment Health Serv. 2008 Nov;46(11):39-44.

Late-onset posttraumatic stress disorder.

Snyder M.

University of Illinois at Chicago, Department of Health Systems Science, Chicago, Illinois 60612-7350, USA. snyderm@uic.edu

Posttraumatic stress disorder (PTSD) is a complex psychological response to a perceived life-threatening trauma that includes re-experiencing the trauma, avoidance, intrusive thoughts, hyperarousal, and dissociation. Exposure to trauma in early adulthood increases the potential for further psychological threats throughout life. In older adult populations, PTSD is an underrecognized and undertreated disorder that can result in psychosocial disability, substance use,  and other negative health outcomes. This article examines the range of symptoms related to PTSD in older adults and expands on health care provider sensitivity to the interrelationship of mental and physical health when addressing the needs  of older adults with this disorder.

PMID: 19051577 [PubMed - in process]

 

J Trauma. 2008 Nov;65(5):1054-65.

Ethnic differences in posttraumatic stress disorder after musculoskeletal trauma.

Williams AE, Smith WR, Starr AJ, Webster DC, Martinez RJ, Vojir CP, Sakalys JA, Morgan SJ.

Eastern Colorado Health Care System, Denver, Colorado, USA. allison.williams3@va.gov

BACKGROUND: Psychological distress is known to contribute to poor outcomes in orthopedic patients. Limited information exists concerning ethnic differences in  psychological sequelae after musculoskeletal injury. This study examined ethnic variations in prevalence of posttraumatic stress disorder (PTSD) after musculoskeletal trauma. METHODS: A secondary analysis was conducted using data collected for a study examining PTSD after musculoskeletal trauma. Two hundred eleven consecutive patients with musculoskeletal injuries were enrolled. Psychological status was assessed using the Revised Civilian Mississippi Scale for PTSD. A chart review was completed to gather demographic and injury information. Independent samples t tests, Fisher's exact, Chi-square, and logistic regression analyses were performed to assess differences. RESULTS: Ninety-six (45.5%) Hispanic and 115 (54.5%) non-Hispanic White adults participated. Few significant demographic or health differences were found. No significant differences were found regarding injury characteristics. Fisher's exact tests indicated a higher prevalence of PTSD symptomatology among Hispanics  than non-Hispanic Whites (p < 0.01). Additionally, U.S. born Hispanics were more  likely than non-U.S. born Hispanics to have PTSD symptomatology (p = 0.004). Odds ratios indicated that women (OR = 2.2), persons with a psychiatric comorbidity (OR = 5.1), Hispanics (OR = 6.6), and persons born in the United States (OR = 3.7) had an increased likelihood of PTSD symptomatology. CONCLUSIONS: Results indicate an ethnic difference in prevalence of PTSD symptomatology after musculoskeletal injury. Hispanic participants were nearly seven times more likely to be positive for PTSD symptomatology. Furthermore, U.S. born Hispanic participants had a higher prevalence of PTSD symptomatology. Future research should explore factors contributing to these differences.

Publication Types:      Multicenter Study     Research Support, Non-U.S. Gov't

PMID: 19001973 [PubMed - indexed for MEDLINE]

 

J Urban Health. 2008 Nov;85(6):880-909. Epub 2008 Sep 11.

An Overview of 9/11 Experiences and Respiratory and Mental Health Conditions among World Trade Center Health Registry Enrollees.

Farfel M, Digrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson D, Frieden TR, Thorpe L.

New York City Department of Health and Mental Hygiene, New York, NY, USA, mfarfel@health.nyc.gov.

To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2-3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR  to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were  self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable  posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income <$25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600-70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.

PMID: 18785012 [PubMed - in process]

 

Mil Med. 2008 Nov;173(11):1136-41.

Trichotillomania and post-traumatic stress disorder: a case study.

Corso KA, McGeary DD.

Eglin Hospital, Suite 114, 307 Boatner Road, Eglin Air Force Base, FL 32542, USA. kentcorso@gmail.com

This is a clinical case study of a 45-year-old, Caucasian male, active duty military officer. It demonstrates the short-term efficacy of habit-reversal training on the treatment of trichotillomania (TTM) in three 50-minute sessions,  with concomitant, but unanticipated decreases in post-traumatic stress disorder (PTSD) symptoms and emotional distress as measured by the PTSD Checklist, Form PCL-M and OQ-45, respectively. This study discusses the benefits and limitations  of such a short treatment for comorbid TTM and PTSD, while positing the relationship between the two disorders. Finally, it lends support for the classification of TTM as an anxiety disorder rather than an impulse-control disorder.

PMID: 19055191 [PubMed - in process]

 

Psychophysiology. 2008 Nov;45(6):886-95. Epub 2008 Sep 24.

Neural activity and diurnal variation of cortisol: evidence from brain electrical tomography analysis and relevance to anhedonia.

Putnam KM, Pizzagalli DA, Gooding DC, Kalin NH, Davidson RJ.

National Center for PTSD, VA Boston Healthcare Center, Department of Psychiatry,  Boston University School of Medicine, Boston, Massachusetts 02130, USA. katherine.putnam.va.gov

The medial prefrontal cortex (mPFC), hippocampus, and amygdala are implicated in  the regulation of affect and physiological processes, including hypothalamic-pituitary-adrenal (HPA) axis function. Anhedonia is likely associated with dysregulation of these processes. Dense-array resting electroencephalographic and cortisol were obtained from healthy and anhedonic groups. Low-resolution electromagnetic tomography was used to compute intracerebral current density. For the control group, voxelwise analyses found a  relationship between current density in beta and gamma bands and steeper cortisol slope (indicative of more adaptive HPA axis functioning) in regions of the hippocampus, parahippocampal gyrus, and mPFC. For the anhedonic group, the mPFC finding was absent. Anhedonia may be characterized by disruptions of mPFC-mediated neuroendocrine regulation, which could constitute a vulnerability to the development of stress-related disorders.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18823425 [PubMed - in process]

 

Psychosom Med. 2008 Nov;70(9):1028-34. Epub 2008 Nov 3.

Acute stress disorder after myocardial infarction: prevalence and associated factors.

Roberge MA, Dupuis G, Marchand A.

Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.

OBJECTIVE: To examine the prevalence of acute stress disorder (ASD) after a myocardial infarction (MI) and the factors associated with its development. METHODS: Of 1344 MI patients admitted to three Canadian hospitals, 474 patients did not meet the inclusion criteria and 393 declined participation in the study;  477 patients consented to participate in the study. A structured interview and questionnaires were administered to patients 48 hours to 14 days post MI (mean +/- standard deviation = 4 +/- 2.73 days). RESULTS: Four percent were classified  as having ASD using the Structured Clinical Interview for DSM-IV, ASD module. The presence of symptoms of depression (Beck Depression Inventory; odds ratio (OR) =  29.92) and the presence of perceived distress during the MI (measured using the question "How difficult/upsetting was the experience of your MI?"; OR = 3.42, R(2) = .35) were associated with the presence of symptoms of ASD on the Modified  PTSD Symptom Scale. The intensity of the symptoms of depression was associated with the intensity of ASD symptoms (R = .65). The models for the detection and estimation of ASD symptoms were validated by applying the regression equations to 72 participants not included in the initial regressions. The results obtained in  the validation sample did not differ from those obtained in the initial sample. CONCLUSIONS: The symptoms of depression and the subjective distress during the MI could be used to improve the detection of ASD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18981272 [PubMed - in process]

 

Soc Sci Med. 2008 Nov;67(10):1589-95. Epub 2008 Sep 5.

Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa.

Kaminer D, Grimsrud A, Myer L, Stein DJ, Williams DR.

Department of Psychology, University of Cape Town, South Africa. Debbie.Kaminer@uct.ac.za

The South African population is exposed to multiple forms of violence. Using nationally representative data from 4351 South African adults, this study examined the relative risk for post-traumatic stress disorder (PTSD) associated with political, domestic, criminal, sexual and other (miscellaneous) forms of assault in the South African population. Violence exposure was assessed using the 'worst event' list from the WHO's Composite International Diagnostic Interview (CIDI) and a separate questionnaire assessing experiences of human rights abuses, and lifetime PTSD was assessed according to the APA's Diagnostic and Statistical  Manual of Mental Disorders criteria using the CIDI. Findings indicated that over  a third of the South African population has been exposed to some form of violence. The most common forms of violence experienced by men were criminal and  miscellaneous assaults, while physical abuse by an intimate partner, childhood physical abuse and criminal assaults were most common for women. Among men, political detention and torture were the forms of violence most strongly associated with a lifetime diagnosis of PTSD, while rape had the strongest association with PTSD among women. At a population level, criminal assault and childhood abuse were associated with the greatest number of PTSD cases among men, while intimate partner violence was associated with the greatest number of PTSD cases among women. Recommendations for mental health service provision in South Africa and for future research on the relative risk for PTSD are offered.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18774211 [PubMed - in process]

 

J Anxiety Disord. 2008 Oct 31. [Epub ahead of print]

The epidemiology of anxiety disorders in the Arab world: A review.

Tanios CY, Abou-Saleh MT, Karam AN, Salamoun MM, Mneimneh ZN, Karam EG.

Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.

Epidemiological studies are quite rare in the Arab world. The Institute for Development Research Advocacy and Applied Care (IDRAAC) has conducted a systematic review of all epidemiologic research on anxiety disorders in the Arab  world up to 2006. Specific keywords were used in the search for affective disorders, namely anxiety, generalized anxiety disorder, GAD, panic, separation anxiety disorder, SAD, overanxious disorder, OAD, phobia, fear, post-traumatic stress disorder, PTSD, obsessive compulsive disorder (OCD), obsessive compulsive  symptom (OCS), obsession, compulsion, obsessive, compulsive. All results were screened and categorized. Epidemiological data on prevalence, gender differences, age of onset, comorbidity, risk factors and treatment of anxiety disorders in the Arab world were found in clinical and community samples. There is an evident need for national data on anxiety disorders in the Arab world in order to identify the magnitude of these diseases and their burden on the individual and community.

PMID: 19091509 [PubMed - as supplied by publisher]

 

BMJ. 2008 Oct 30;337:a2267. doi: 10.1136/bmj.a2267.

Childhood stress linked to emotional disorders.

Hitchen L.

Publication Types:      News

PMID: 18974254 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 Oct 30;161(1):67-75. Epub 2008 Sep 11.

Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression?

Ehring T, Ehlers A, Cleare AJ, Glucksman E.

Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. t.w.a.ehring@uva.nl

The study investigated the relationship between the acute psychological and psychobiological trauma response and the subsequent development of posttraumatic  stress disorder (PTSD) and depressive symptoms in 53 accident survivors attending an emergency department. Lower levels of salivary cortisol measured in the emergency room predicted greater symptom levels of PTSD and depression 6 months later, and lower diastolic blood pressure, past emotional problems, greater dissociation and data-driven processing predicted greater PTSD symptoms. Heart rate was not predictive. Low cortisol levels correlated with data-driven processing during the accident, and, in female participants only, with prior trauma and prior emotional problems. Higher evening cortisol 6 months after the accident correlated with PTSD and depressive symptoms at 6 months, but this relationship was no longer significant when levels of pain were controlled. The results support the role of the acute response to trauma in the development and maintenance of PTSD and provide promising preliminary evidence for a meaningful relationship between psychobiological and psychological factors in the acute trauma phase.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18789538 [PubMed - in process]

 

Fed Regist. 2008 Oct 29;73(210):64208-10.

Posttraumatic stress disorder. Interim final rule.

Department of Veterans Affairs.

The Department of Veterans Affairs (VA) is amending its adjudication regulations  regarding service connection for posttraumatic stress disorder (PTSD) by eliminating the requirement of evidence corroborating occurrence of the claimed in-service stressor in claims in which PTSD is diagnosed in service. This amendment is necessary to facilitate the proof of service connection in such claims. By this amendment, we intend to reduce claim-processing time for such claims.

PMID: 19115527 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct 28. [Epub ahead of print]

Anger potentiates the reporting of threatening interpretations: An experimental study.

Barazzone N, Davey GC.

The University of Sussex, UK.

This paper reports the results of an experiment investigating the effect of induced anger on interpretational bias using the homophone spelling task. Four groups of participants experienced anger, anxiety, happy or neutral mood inductions and then completed the homophone spelling task. Participants who experienced anger and anxiety inductions reported significantly more threat/neutral homophones as threats compared to control participants; moods had  an emotion-congruent effect on threat reporting, with negative moods increasing the tendency to report threat/neutral homophones as threats and positive moods increasing the tendency to report positive/neutral homophones as positive. The findings provide evidence that anger potentiates the reporting of threatening interpretations and does so independently of any effect of concurrent levels of state and trait anxiety. The mechanism mediating this effect is unclear, but the  results do lend support to those theories of psychopathology - and especially of  PTSD - that see a causal role for anger in the maintenance of symptoms.

PMID: 19070989 [PubMed - as supplied by publisher]

 

Int Arch Occup Environ Health. 2008 Oct 25. [Epub ahead of print]

Specificity of the links between workplace harassment and PTSD: primary results using court decisions, a pilot study in France.

Bonafons C, Jehel L, Coroller-Béquet A.

Laboratoire d'éthique médicale, Université Paris Descartes, 75006, Paris, France, bonafons.claire@free.fr.

OBJECTIVES: France is one of the first countries to have passed specific legislation concerning "mental harassment" (In French the term used in the legislation is "harcèlement moral" referring to harassment or bullying leading to mental or psychological distress.) in the workplace. However, the definition of mental harassment at work remains fairly vague. It is, indeed, a complex issue, since no objective and precise consensual definition has been given so far. The objective of this study is to clarify the criteria that French judges consider as characteristic of mental harassment, and to check whether the specific links between mental harassment at work and PTSD pointed to in recent international studies have been taken into account. This study proposes the main lines for debate in countries that have not yet adopted legal clauses on mental harassment  at work. METHODS: Our study is based on a sample of 22 people who were legally recognised as having been mentally harassed at work; this sample is taken as representative of all court decisions passed on harassment and published as such  on the French Ministry of Justice website. RESULTS: To establish whether they were considering a case of harassment, the judges based their decisions on the nature of the accusations. In all cases (22/22), the charges brought against the  defendant had to do with offences against the employee's dignity. Five cases out  of 22 dealt with an offence infringing their rights, 10 cases out of 22 related to the employee's future within the company being compromised, while half of the  cases (11/22) concerned a deterioration in the person's health. In more than half of the cases, the judges also looked for other factors, such as repetition and duration of the period of harassment. Whenever the judges noted a deterioration in the victim's mental health, they also referred to medical certificates reporting anxio-depressive syndromes or psychological disorders without providing further detail. No PTSD-like symptomatology was mentioned among these cases, although several studies have shown that many victims of mental harassment at work have specific symptoms of PTSD. CONCLUSIONS: This study is the first study to be carried out on mental harassment at work and to refer to court decisions since the law was promulgated in France (2002). It appears that, in order to be recognised as a victim of mental harassment at work, numerous proofs of harassment or bullying need to be produced. It must have been repeated and have led to consequences in several domains. Several attestations and documents are required demonstrating clearly that harassment or bullying did indeed occur. Further to this, although to date judges have not considered PTSD to be an element contributing to the presumption of harassment, connections between bullying or harassment and clinical signs of PTSD have been attested by several studies that confirm that bullied victims can suffer from PTSD-like symptoms, although they do not necessarily match the strict DSM-IV criteria (absence of A1  criterion). It would seem advisable to request psychiatric examination in cases of harassment.

PMID: 18953560 [PubMed - as supplied by publisher]

 

Neuron. 2008 Oct 23;60(2):353-66.

Inducible and selective erasure of memories in the mouse brain via chemical-genetic manipulation.

Cao X, Wang H, Mei B, An S, Yin L, Wang LP, Tsien JZ.

Shanghai Institute of Brain Functional Genomics, Key Laboratory of Brain Functional Genomics, MOE & STCSM, East China Normal University, Shanghai, China.

Rapid and selective erasures of certain types of memories in the brain would be desirable under certain clinical circumstances. By employing an inducible and reversible chemical-genetic technique, we find that transient alphaCaMKII overexpression at the time of recall impairs the retrieval of both newly formed one-hour object recognition memory and fear memories, as well as 1-month-old fear memories. Systematic analyses suggest that excessive alphaCaMKII activity-induced recall deficits are not caused by disrupting the retrieval access to the stored information but are, rather, due to the active erasure of the stored memories. Further experiments show that the recall-induced erasure of fear memories is highly restricted to the memory being retrieved while leaving other memories intact. Therefore, our study reveals a molecular genetic paradigm through which a given memory, such as new or old fear memory, can be rapidly and specifically erased in a controlled and inducible manner in the brain.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18957226 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Oct 22. [Epub ahead of print]

The Relationship Between Type of Trauma Exposure and Posttraumatic Stress Disorder Among Urban Children and Adolescents.

Luthra R, Abramovitz R, Greenberg R, Schoor A, Newcorn J, Schmeidler J, Levine P, Nomura Y, Chemtob CM.

Mount Sinai School of Medicine, New York.

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses  are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.

PMID: 18945918 [PubMed - as supplied by publisher]

 

J Psychiatr Res. 2008 Oct 22. [Epub ahead of print]

The impact of posttraumatic stress disorder on impairment in the UK military at the time of the Iraq war.

Rona RJ, Jones M, Iversen A, Hull L, Greenberg N, Fear NT, Hotopf M, Wessely S.

King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London SE1 9RJ, UK.

The aims of this study were to assess: (1) the relationship between PTSD and impairment, (2) whether there is a threshold in the association of PTSD score and impairment, and (3) whether any of the PTSD criteria are more strongly associated with impairment. We studied 10,069 service personnel from a representative sample of the British Armed Forces to assess the effects of the Iraq war. Participants completed the PTSD checklist (PCL), the general health questionnaire-12 (GHQ-12), the alcohol use disorder identification test (AUDIT) and five questions to assess impairment. 78% of those with a PCL-score of 50 or more endorsed at least one impairment item in comparison to 27% of those with a score below 50. The odds ratio (OR) of impairment in the PCL group with a score of 50 or more was 16.7 (95% CI 12.9-21.6). There was an increasing risk of impairment with an increasing category of PCL-score without a noticeable threshold. For each PTSD subscale: intrusiveness, avoidance/numbing and hyper-arousal, divided into four score categories, there was an increased association with impairment, but the association of avoidance/numbing with impairment was the greatest and independent of the other two criteria (OR 7.2 (95% CI 4.8-10.9). Having a good relationship with a partner had minimal effect on the level of association between PTSD and impairment. Functional impairment is a serious problem for those with PTSD. The impairment is not confined to those with the highest PCL-score. Avoidance/numbing is the criterion which makes the greatest independent contribution to impairment.

PMID: 18950801 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Oct 21. [Epub ahead of print]

Hypothalamus-Pituitary-Adrenal Axis Hyperresponsiveness Is Associated with Increased Social Avoidance Behavior in Social Phobia.

Roelofs K, van Peer J, Berretty E, Jong PD, Spinhoven P, Elzinga BM.

Clinical Psychology Unit, Leiden University Institute for Psychological Research, Leiden, The Netherlands.

BACKGROUND: Social avoidance and inhibition in animals is associated with hyperresponsiveness of the glucocorticoid stress-system. In humans, the relation  between glucocorticoid stress-reactivity and social avoidance behavior remains largely unexplored. We investigated whether increased cortisol stress-responsiveness is linked to increased social avoidance behavior in patients with social anxiety disorder (SAD). METHODS: Patients with SAD (n = 18)  as well as two control groups of healthy participants (n = 22) and patients with  posttraumatic stress disorder (PTSD; n = 17), respectively, performed a social approach-avoidance task (AA-task) in a baseline condition and in a social stress  condition (provided by the Trier Social Stress Test). The AA-task is a computerized reaction-time task measuring the speed of manual approach and avoidance responses to visually presented social threat cues (angry faces). Salivary cortisol, blood pressure, and subjective anxiety were assessed throughout the experiment. RESULTS: Patients with SAD showed larger cortisol responses to the social stress test, as compared with healthy and PTSD control subjects. Most crucially, these increased cortisol responses were significantly correlated to the increase in social avoidance behavior measured by the AA-task in the social stress condition in SAD. An additional regression analysis showed that the cortisol responses predicted the stress-induced increase in social avoidance tendencies over and above the effects of blood pressure and subjective  anxiety. CONCLUSIONS: These findings provide the first evidence for a direct link between increased cortisol stress-responsiveness and social avoidance behavior in patients with SAD. The results support animal models of social avoidance and inhibition and might have important treatment implications.

PMID: 18947821 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Oct 15;64(8):681-90. Epub 2008 Jul 17.

Functional activation and neural networks in women with posttraumatic stress disorder related to intimate partner violence.

Simmons AN, Paulus MP, Thorp SR, Matthews SC, Norman SB, Stein MB.

Department of Psychiatry, University of California San Diego, and VA San Diego Healthcare System, San Diego, California 92037, USA. ansimmons@ucsd.edu

BACKGROUND: Intimate partner violence (IPV) is one of the most common causes of posttraumatic stress disorder (PTSD) in women. Victims of IPV are often preoccupied by the anticipation of impending harm. This investigation tested the  hypothesis that IPV-related PTSD individuals show exaggerated insula reactivity to the anticipation of aversive stimuli. METHODS: Fifteen women with a history of IPV and consequent PTSD (IPV-PTSD) and 15 non-traumatized control (NTC) women performed a task involving cued anticipation to images of positive and negative events during functional magnetic resonance imaging. RESULTS: Both groups showed  increased activation of bilateral anterior insula during anticipation of negative images minus anticipation of positive images. Activation in right anterior/middle insula was significantly greater in the IPV-PTSD relative to the NTC group. Functional connectivity analysis revealed that changes in activation in right middle insula and bilateral anterior insula were more strongly associated with amygdala activation changes in NTC than in IPV-PTSD subjects. CONCLUSIONS: This study revealed increased activation in the anterior/middle insula during negative anticipation in women with IPV-related PTSD. These findings in women with IPV could be a consequence of the IPV exposure, reflect pre-existing differences in insular function, or be due to the development of PTSD. Thus, future longitudinal studies need to examine these possibilities.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18639236 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2008 Oct 15;64(8):708-17. Epub 2008 Jul 17.

Early post-stressor intervention with high-dose corticosterone attenuates posttraumatic stress response in an animal model of posttraumatic stress disorder.

Cohen H, Matar MA, Buskila D, Kaplan Z, Zohar J.

Ministry of Health Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. hagitc@bgu.ac.il

BACKGROUND: The therapeutic value of corticosteroids in the aftermath of traumatic experience has been questioned. We used an animal model of posttraumatic stress disorder (PTSD) to assess long-term behavioral effects of a  single administration of various doses of corticosterone (CORT), administered immediately after exposure to psychogenic stress. METHODS: Animals were exposed to predator scent stress and treated 1 hour later with various doses of CORT or saline. The outcome measures included behavior in an elevated plus-maze (EPM) and acoustic startle response (ASR) 30 days after the initial exposure and freezing behavior upon exposure to a trauma-related cue on day 31. Pre-set cut-off behavioral criteria (CBC) classified exposed animals according to behavioral responses in EPM and ASR paradigms as those with "extreme behavioral response," "minimal behavioral response," or "intermediate response." Non-spatial memory task and 24-hour locomotor activity were assessed immediately after injection with CORT or vehicle. RESULTS: Early treatment with high-dose CORT reduced the prevalence of PTSD-like behavioral responses relative to saline-control treatment. Cue-induced freezing was significantly lower in the high-dose CORT-treated group. Lower doses of CORT significantly increased anxiety-like behavior, mean startle amplitude, and prevalence of PTSD-like behavioral disruptions, compared with saline-control treatment. The attenuated cue-responsiveness and impaired performance on a memory task imply that one key factor in this effect is the disruption of traumatic memory consolidation. CONCLUSIONS: Single treatment with high-dose CORT immediately after stressful exposure reduces the prevalence rate of extreme behavioral disruption 30 days later. Corticosterone might disrupt the consolidation of aversive or fearful memories.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18635156 [PubMed - indexed for MEDLINE]

 

Acta Psychiatr Scand. 2008 Oct 14. [Epub ahead of print]

Memory and prefrontal functions in earthquake survivors: differences between current and past post-traumatic stress disorder patients.

Eren-Koçak E, Kılıç C, Aydın I, Hızlı FG.

Institute of Neurological Sciences and Psychiatry, Faculty of Medicine, Hacettepe University, Ankara.

Many studies reported deficits in cognitive functions in post-traumatic stress disorder (PTSD). Most were, however, conducted on man-made trauma survivors. The  high comorbidity of alcohol use and depression with PTSD in these studies further complicated the interpretation of their results. We compared prefrontal lobe functions and memory in three earthquake survivor groups: current PTSD, past PTSD and no PTSD. We hypothesized that prefrontal performances of the current and past PTSD groups would be worse than that of control group. Method: Survivors of the 1999 earthquakes in Turkey were evaluated for current and lifetime PTSD. Memory and prefrontal functions were assessed by a neuropsychological test battery. Results: Current PTSD patients performed worse on attention, verbal memory, verbal fluency, and psychomotor speed. Past PTSD group was similar to the controls on most cognitive measures, except for their vulnerability to proactive  interference and low performance in verbal fluency for animal names. Conclusion:  Our findings indicate that the prefrontal organization and monitorization of verbally processed information are defective in earthquake-related PTSD patients, more so in the current PTSD group.

PMID: 18853946 [PubMed - as supplied by publisher]

 

J Affect Disord. 2008 Oct 7. [Epub ahead of print]

Is tonic immobility the core sign among conventional peritraumatic signs and symptoms listed for PTSD?

Rocha-Rego V, Fiszman A, Portugal LC, Garcia Pereira M, de Oliveira L, Mendlowicz MV, Marques-Portella C, Berger W, Freire Coutinho ES, Mari JJ, Figueira I, Volchan E.

Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (IBCCF-UFRJ), Brazil.

BACKGROUND: Previous studies suggested the importance of peritraumatic reactions  as predictors of PSTD symptoms severity. Despite mounting evidence that tonic immobility occurs under intense life threats its role as predictor of PTSD severity remains by and large understudied. The objective of this study was to investigate the role of peritraumatic reactions (tonic immobility, panic and dissociation) as predictors of PTSD symptoms severity. METHODS: Participants were 32 victims of urban violence with PTSD diagnosed through the SCID-I. In order to  evaluate PTSD symptoms at baseline, we used the Post-Traumatic Stress Disorder Checklist - Civilian Version. To assess peritraumatic reactions we employed the Physical Reactions Scale, the Peritraumatic Dissociative Experiences Questionnaire and Tonic Immobility questions. As confounding variables, we considered negative affect (measured by the Positive and Negative Affect Schedule - Trait Version), sex and time elapsed since trauma. RESULTS: Tonic immobility was the only predictor of PTSD symptoms severity that kept the statistical significance after controlling for potential confounders. LIMITATIONS: This study was based on a relatively small sample recruited in a tertiary clinic, a fact that may limit the generalizability of its findings. The retrospective design may have predisposed to recall bias. CONCLUSIONS: Our study provides good reason to conduct more research on tonic immobility in PTSD with other samples and with different time frames in an attempt to replicate these stimulating results.

PMID: 18845342 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Oct 6. [Epub ahead of print]

Hippocampal N-acetylaspartate Levels Before Trauma Predict the Development of Long-Lasting Posttraumatic Stress Disorder-like Symptoms in Mice.

Siegmund A, Kaltwasser SF, Holsboer F, Czisch M, Wotjak CT.

Max Planck Institute of Psychiatry, Munich, Germany.

BACKGROUND: Only a certain proportion of individuals develop posttraumatic stress disorder (PTSD) in the aftermath of a trauma. Biomarkers of individual susceptibility are not yet known but would enable selected primary and secondary  prevention of PTSD. METHODS: Hippocampal N-acetylaspartate (NAA) levels were assessed by proton magnetic resonance spectroscopy ((1)H-MRS) in C57BL/6N mice prior to the perception of a 1.5 mA electric footshock. Associative (freezing to  trauma context) and nonassociative (freezing to a neutral tone; i.e., hyperarousal) symptoms of PTSD-like fear were assessed 4, 5, 18, and 32 weeks after trauma. RESULTS: Low NAA levels in the left dorsal hippocampus predicted persistent PTSD-like symptoms (both contextual freezing and hyperarousal), while  animals with pretraumatic high levels of NAA decreased their fear reactions to control levels in consequence of re-exposure to associative and nonassociative cues. N-AA levels in the right dorsal hippocampus, in contrast, were only partially predictive of the individual susceptibility to develop PTSD-like symptoms. CONCLUSIONS: Left hippocampal NAA levels might be a predictor of an increased susceptibility to develop PTSD after trauma.

PMID: 18842254 [PubMed - as supplied by publisher]

 

Soc Psychiatry Psychiatr Epidemiol. 2008 Oct 4. [Epub ahead of print]

Posttraumatic stress disorder six months after an earthquake : Findings from a community sample in a rural region in Italy.

Priebe S, Grappasonni I, Mari M, Dewey M, Petrelli F, Costa A.

Unit for Social and Community Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health,  London, E13 8SP, UK, s.priebe@qmul.ac.uk.

BACKGROUND AND AIMS: Various studies assessed rates of post-traumatic stress disorder (PTSD) following natural disasters including earthquakes. Yet, samples were often non-representative or small or both. This study aims to assess the prevalence of PTSD and predictors of PTSD 6 months after an earthquake in a rural region of Italy. METHODS: A questionnaire was handed out to a representative sample of approximate 3,000 people in the region of Molise in Italy 6 months after an earthquake in October/November 2002. The questionnaire assessed socio-demographic characteristics, aspects of the event, the experience of symptoms immediately after the earthquake, and symptoms of PTSD. RESULTS: Questionnaires of 2,148 people were returned, representing a response rate of 73.7%. The final analysis was based on 1,680 people. The screening tool provided  a PTSD prevalence rate of 14.5%. Male gender, age under 55 years, and better school education predicted lower rates of PTSD. More variance was explained when  psychological symptoms of immediately after the event were also included as predictors. CONCLUSION: The findings on predictors are consistent with the literature. Whilst personal characteristics explain only a small variance of PTSD six months after the event, early psychological distress allows a better prediction of who is likely to have PTSD 6 months later.

PMID: 18836882 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2008 Oct 2. [Epub ahead of print]

The DRD2 gene 957C>T polymorphism is associated with posttraumatic stress disorder in war veterans.

Voisey J, Swagell CD, Hughes IP, Morris CP, van Daal A, Noble EP, Kann B, Heslop  KA, Young RM, Lawford BR.

Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.

Background: Variations in genes related to the dopaminergic pathway have been implicated in neuropsychiatric disorders such as schizophrenia, substance misuse, Alzheimer's disease and Post Traumatic Stress Disorder (PTSD). A single nucleotide polymorphism (SNP) (957C>T) and a deletion polymorphism (-141delC) in  the DRD2 gene and a SNP (Taq1A) in a gene directly downstream of DRD2 have all been implicated in dopamine functioning in the brain. Methods: To test the importance of these three polymorphisms in PTSD susceptibility, a genetic screen  was performed in 127 war veterans diagnosed with PTSD and 228 control individuals without a history of PTSD. Results: No significant association was found between  PTSD and the Taq1A or -141delC polymorphisms. However, a significant association  was observed with PTSD and the 957C>T polymorphism. PTSD individuals were more likely to carry the C allele compared to the controls (P=0.021). Conclusions: Our findings suggest that the 957C>T polymorphism in the DRD2 gene is one of the genetic factors for susceptibility to PTSD. Depression Anxiety 0:1-6, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 18833581 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Oct 2. [Epub ahead of print]

PTSD symptoms in response to traumatic and non-traumatic events: The role of respondent perception and A2 criterion.

Boals A, Schuettler D.

University of North Texas, Denton, TX 76203, United States.

The current study attempted to replicate the unexpected findings by Gold, Marx, Soler-Baillo, and Sloan [Gold, S. D., Marx, B. P., Soler-Baillo, J. M., & Sloan,  D. M. (2005). Is life stress more traumatic than traumatic stress? Journal of Anxiety Disorders, 19, 687-698] that non-traumatic events were associated with greater levels of PTSD symptoms than traumatic events. The current study had two  notable methodological differences. First, we included A2 trauma criteria (a response of intense fear, helplessness, or horror) in addition to A1 trauma criteria (the event is life-threatening) in defining traumatic events. Second, A1 and A2 trauma criteria were based on participants' ratings, as opposed to classification by coders. Using this alternative methodology, results obtained were opposite of Gold et al. PTSD symptoms were greater for DSM-defined traumatic events in comparison to non-traumatic events. In addition, A1 trauma criterion had little to no relationship to PTSD symptoms when A2 criterion was considered.  These results call into question the role of A1 trauma criterion and the definition of traumatic events.

PMID: 19013754 [PubMed - as supplied by publisher]

 

Acta Psychiatr Scand. 2008 Oct;118(4):281-90. Epub 2008 Aug 27.

Amygdala and hippocampal volumes and cognition in adult survivors of childhood abuse with dissociative disorders.

Weniger G, Lange C, Sachsse U, Irle E.

Department of Social and General Psychiatry, University of Zürich, Zürich, Switzerland.

OBJECTIVE: Trauma-exposed individuals with post-traumatic stress disorder (PTSD)  display reduced amygdala and hippocampal size and impaired cognition. However, studies on trauma-exposed individuals with dissociative amnesia (DA) or dissociative identity disorder (DID) are lacking. METHOD: Twenty-three young women who had experienced severe childhood sexual/physical abuse, diagnosed with  DA/DID or PTSD, and 25 healthy control subjects were subjected to 3D structural magnetic resonance imaging of amygdala and hippocampus and a clinical and neuropsychological investigation. RESULTS: Compared with controls, trauma-exposed subjects with PTSD (n = 10) displayed significantly reduced amygdala and hippocampal size and significantly impaired cognition. By contrast, trauma-exposed subjects with DA or DID (n = 13) displayed normal amygdala and hippocampal size and normal cognition. CONCLUSION: We report for the first time volumetric results in subjects with DA/DID without PTSD as comorbid diagnosis. Our results indicate preserved amygdala and hippocampal size and preserved cognition in subjects with these disorders.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18759808 [PubMed - indexed for MEDLINE]

 

Adv Neonatal Care. 2008 Oct;8(5):276-84.

Assessing the feasibility and acceptability of an intervention to reduce anxiety  and enhance sensitivity among mothers of very low birth-weight infants.

Feeley N, Zelkowitz P, Charbonneau L, Cormier C, Lacroix A, Marie CS, Papageorgiou A.

1Sir Mortimer B. Davis Jewish General Hospital; 2McGill University; 3GRISIM (Groupe de recherche interuniversitaire en soins infirmiers de Montréal); 4Charles Lemoinge Hospital; and 5St Justine's Hospital, Montreal, Quebec, Canada.

PURPOSE: A pilot study was conducted to assess the feasibility and acceptability  of an intervention program for mothers of very low birth-weight infants in the neonatal intensive care unit (NICU). SUBJECTS: Thirty-three mothers of infants born weighing less than 1500 g. DESIGN: A single-group, pretest-posttest design was used. METHODS: Preintervention mothers completed self-report questionnaires and their interaction with their infant was observed. Mothers then received the intervention program. Mothers were assessed twice postintervention, first when the infant was 1/2 months old and again at 6 months. At the postintervention assessments, mothers completed the same questionnaires and interaction was observed. MAIN OUTCOME MEASURES: Mothers completed the State-Trait Anxiety Inventory, the revised Parental Stress Scale: Neonatal Intensive Care Unit, the NICU Parental Beliefs Scale, and the Perinatal PTSD Questionnaire. Interactions between mothers and infants were rated by trained research staff using the Index  of Parental Behaviour in the NICU. Postintervention mothers also responded to a questionnaire that assessed their perceptions of the intervention program. RESULTS: It was feasible to enroll mothers because 62% of eligible mothers agreed to participate. However, 39% of mothers who enrolled withdrew. Most of the mothers who withdrew did so before even beginning the intervention, and many of these women were mothers of multiples. It was also feasible to provide the intervention because more than 80% of mothers who began the intervention received all 6 teaching sessions. Mothers found both the content and the format of the program to be acceptable. There were nonetheless several challenges in conducting an intervention study with mothers early in the NICU hospitalization. CONCLUSIONS: The results of this pilot study are encouraging. It was found to be  both feasible and acceptable to provide the intervention program to mothers during the NICU hospitalization. The effectiveness of this program needs to be assessed in a randomized controlled trial.

PMID: 18827517 [PubMed - in process]

 

Am J Geriatr Psychiatry. 2008 Oct;16(10):804-12.

Pharmacotherapy for older veterans diagnosed with posttraumatic stress disorder in Veterans Administration.

Mohamed S, Rosenheck R.

New England Mental Illness, Research, Education and Clinical Center, Department of Psychiatry, Yale Medical School, West Haven, CT 06516, USA. somaia.mohamed@yale.edu

OBJECTIVES: Despite increasing numbers of older veterans diagnosed with posttraumatic stress disorder (PTSD) in veterans administration (VA), limited research has focused on pharmacotherapy of PTSD among the elderly. DESIGN: The authors examined pharmacotherapy provided to patients carrying a clinical diagnosis of PTSD in VA. SETTING: Data on outpatients treated at VA nationally were utilized. PARTICIPANTS: Patients were veterans over 45 years of age diagnosed with PTSD in FY 2004 (N = 244,947) grouped into five age cohorts with patients 45-55 as the reference group. MEASURES: Psychotropic prescriptions were  examined. Descriptive statistics and multivariable logistic regression adjusting  for confounding characteristics, including receipt of VA service connected disability benefits which may create incentives to artificially maintain historical diagnoses, were used to identify the relationship of age to receipt of psychotropic medications net of these factors. All analyses were repeated using data only from nonservice connected veterans. RESULTS: Most older veterans received psychotropic medication and among these, 88.3% were prescribed antidepressants, 61.2% anxiolytics/sedative hypnotics, and 32.9% antipsychotics.  A pronounced monotonic trend showed decrease use of any psychotropic medication and of each subclass with age. Medication use was higher among those treated in specialty mental health clinics than among those treated exclusively in primary care or medical clinics and interaction analysis of age by clinic type showed significantly more steeply declining use of medications with age among patients treated in specialty mental health clinics. Data from nonservice connected veterans revealed the same patterns. CONCLUSION: Diverse psychotropic medication  classes are used to treat veterans diagnosed with PTSD in VA with declining use among older veterans. Medication utilization is greater in mental health clinics  but declined more steeply with age, perhaps reflecting the greater sensitivity of specialists to the risks of elderly veterans. Older veterans diagnosed with PTSD  appear to receive conservative, cautious treatment although observed patterns of  care may reflect some degree of undertreatment.

PMID: 18827226 [PubMed - in process]

 

Am J Geriatr Psychiatry. 2008 Oct;16(10):853-6. Epub 2008 May 12.

Trauma exposure and posttraumatic stress disorder in the elderly: a community prevalence study.

Creamer M, Parslow R.

Department of Psychiatry, University of Melbourne, Australian Centre for Posttraumatic Mental Health, Heidelberg, Victoria, Australia. markcc@unimelb.edu.au

OBJECTIVE: Little prevalence data exist on trauma exposure and posttraumatic stress disorder (PTSD) in the elderly. The authors examined lifetime exposure to  trauma and 12-month PTSD in a large community sample. METHOD: Data were drawn from the Australian National Survey of Mental Health. Of the total 10,641 participants, 1,792 were over the age of 65. The Composite International Diagnostic Interview provided trauma exposure and diagnostic status. RESULTS: A curvilinear pattern of lifetime exposure to trauma across the lifespan was obtained for women, whereas men showed a linear increase. This difference was explained by combat exposure. PTSD prevalence reduced with age and participants over 65 reported negligible rates. Around 10% of the elderly reported reexperiencing symptoms. CONCLUSIONS: PTSD rates are lower in older age cohorts,  although reasons for this are unclear. With 10% reporting reexperiencing symptoms associated with past events, however, greater awareness of treatments that target traumatic memories may be beneficial.

PMID: 18474685 [PubMed - in process]

 

Am J Ind Med. 2008 Oct;51(10):758-68.

Shift-work and suicide ideation among police officers.

Violanti JM, Charles LE, Hartley TA, Mnatsakanova A, Andrew ME, Fekedulegn D, Vila B, Burchfiel CM.

Department of Social & Preventive Medicine, School of Public Health & Health Professions, State University of NY at Buffalo, Buffalo, New York.

BACKGROUND: This cross-sectional study assessed the association of shift work with suicide ideation among police officers. METHODS: Shift work was based on daily payroll records over 5 years (41 women, 70 men). Standardized psychological measures were employed. ANOVA and Poisson regression were used to evaluate associations. RESULTS: Among policewomen with increased depressive symptoms, prevalence of suicide ideation increased by 116% for every 10-unit increase in percentage of hours worked on day shift (prevalence ratio (PR) = 2.16; 95% confidence interval (CI) = 1.22-3.71). Among policemen with higher (but not lower) posttraumatic stress disorder (PTSD) symptoms, prevalence of suicide ideation increased by 13% with every 10-unit increase in the percentage of hours  worked on afternoon shift (PR = 1.13; 95% CI = 1.00-1.22). CONCLUSION: Prevalence of suicide ideation significantly increased among policewomen with higher depressive symptoms and increasing day shift hours, and among policemen with higher PTSD symptoms with increasing afternoon shift hours. Published 2008 Wiley-Liss, Inc.

Publication Types:      Research Support, U.S. Gov't, P.H.S.

PMID: 18704914 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Oct;165(10):1237-9.

Comment on:     Am J Psychiatry. 2008 Oct;165(10):1326-37.

Developmental considerations for diagnosing PTSD and acute stress disorder in preschool and school-age children.

Scheeringa MS.

Publication Types:      Comment     Editorial

PMID: 18829877 [PubMed - indexed for MEDLINE]

 

Am J Psychiatry. 2008 Oct;165(10):1326-37. Epub 2008 Aug 1.

Comment in:     Am J Psychiatry. 2008 Oct;165(10):1237-9.

The posttraumatic stress disorder diagnosis in preschool- and elementary school-age children exposed to motor vehicle accidents.

Meiser-Stedman R, Smith P, Glucksman E, Yule W, Dalgleish T.

Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE58AF, UK. r.meiser-stedman@iop.kcl.ac.uk

OBJECTIVE: Increasingly, children are being diagnosed with psychiatric disorders, including preschool-age children. These diagnoses in young children raise questions pertaining to 1) how diagnostic algorithms for individual disorders should be modified for young age groups, 2) how psychopathology is best detected  at an early stage, and 3) how to make use of multiple informants. The authors examined these issues in a prospective longitudinal assessment of preschool- and  elementary school-age children who were exposed to a traumatic event. METHOD: Participants were 114 children (age range: 2-10 years) who had experienced a motor vehicle accident. Parents and older children (age range: 7-10 years) completed structured interviews 2-4 weeks (initial assessment) and 6 months (6-month follow-up) after the traumatic event. A recently proposed alternative symptom algorithm for diagnosing posttraumatic stress disorder (PTSD) was utilized and compared with the standard DSM-IV algorithms for diagnosing PTSD and acute stress disorder. RESULTS: At the 2- to 4-week assessment, 11.5% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria per parent report, and 13.9% met criteria for this diagnosis at the 6-month follow-up. These percentages were much higher than those for DSM-IV diagnoses of acute stress disorder and PTSD. Among 7- to 10-year-old subjects, the use of combined parent- and child-reported symptoms to derive a diagnosis resulted in an increased number of children in this age group who were  identified with psychiatric illness relative to the use of parent report alone. Agreement between parent and child on symptoms for 1) a diagnosis of PTSD based on the alternative algorithm criteria and 2) diagnoses of DSM-IV acute stress disorder and PTSD in this age group was poor. Among 2- to 6-year-old subjects, the alternative algorithm PTSD diagnosis per parent report was a more sensitive predictor of later onset psychopathology relative to a diagnosis of DSM-IV acute  stress disorder or PTSD per parent report. However, among 7- to 10-year-old subjects, a combined symptom report (from both parent and child) was optimal in predicting posttraumatic psychopathology. CONCLUSIONS: These findings support the use of the proposed alternative algorithm for assessing PTSD in young children and suggest that the diagnosis of PTSD based on the alternative algorithm criteria is stable from the acute phase onward. When both parent- and child-reported symptoms are utilized for the assessment of PTSD among 7- to 10-year-old children, the alternative algorithm and DSM-IV criteria have broad comparable validity. However, in the absence of child-reported symptoms, the alternative algorithm criteria per parent report appears to be an optimal diagnostic measure of PTSD among children in this age group, relative to the standard DSM-IV algorithm for diagnosing the disorder.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18676592 [PubMed - indexed for MEDLINE]

 

Ann N Y Acad Sci. 2008 Oct;1141:148-62.

An update on substance use and treatment following traumatic brain injury.

Graham DP, Cardon AL.

Houston Center for Quality of Care and Utilization Studies, Health Services Research, Houston, TX 77030, USA. david.graham@med.va.gov

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity among  young adults. Substance abusers constitute a disproportionate percentage of these patients. A history of substance abuse predicts increased disability, poorer prognosis, and delayed recovery. While consensus in the literature indicates that substance-abuse rates decline following injury, conflicting literature shows a significant history of brain injury in addicts. We reviewed the literature on substance abuse after TBI to explore the state of knowledge on TBI as a risk factor for substance abuse. While recent reviews regarding substance abuse in TBI patients concur that substance-abuse rates decline even after mild TBI, an emerging literature suggests mild TBI may cause subtle impairments in cognitive,  executive, and decision-making functions that are often poorly recognized in early diagnosis and treatment. When combined with difficulties in psychosocial adjustment and coping skills, these impairments may increase the risk for chronic substance abuse in a subset of TBI patients. Preliminary results from veterans indicate these patterns hold in a combat-related post-traumatic stress disorder population with TBI. This increasingly prevalent combination presents a specific  challenge in rehabilitation. While this comorbidity presents a challenge for the  successful treatment and rehabilitation of both disorders, there is sparse evidence to recommend any specific treatment strategy for these individuals. Mild TBI and substance abuse are bidirectionally related both for risks and treatment. Further understanding the neuropsychiatric pathology and different effects of different types of injuries will likely improve the implementation of effective treatments for each of these two conditions.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.     Review

PMID: 18991956 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Oct;21(4):337-58.

Dispositional and situational coping and mental health among Palestinian political ex-prisoners.

Punamaki RL, Salo J, Komproe I, Qouta S, El-Masri M, De Jong JT.

Department of Psychology, University of Tampere, Finland. raija-leena.punamaki@uta.fi

We examined, first, differences in dispositional and situational coping, and psychological distress between political ex-prisoners and their matched controls, and second, coping effectiveness in protecting mental health from impacts of imprisonment and military trauma. Thirdly, we tested the hypothesis that compatibility ("goodness of fit") between dispositional and situational coping would predict low psychological distress. Participants were 184 men recruited from a Palestinian community sample, 92 were former political prisoners and 92 non-prisoners. The dispositional coping was assessed as a general response style  to hypothetical stressors and situational coping as responses to their own traumatic experiences. Psychological distress was measured by SCL-90-R, and posttraumatic stress disorder, depression and somatoform symptoms by scales based on CIDI 2.1 diagnostic interview. The results showed that, compared to non-prisoners, the political ex-prisoners employed less avoidant, denying, and emotion-focused coping strategies. Military trauma was associated with avoidant and denying coping only among non-prisoners. The ex-prisoners showed more mental  health and medical problems, especially when exposed to military trauma. None of  the coping styles or strategies were effective in protecting the mental health in general or in either groups. However, main effect results revealed that the high  level of active and constructive and low level of emotion-focused coping were associated with low levels of psychiatric symptoms and psychological distress.

PMID: 18686054 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Oct;21(4):325-35.

Parental support, family conflict, and overprotectiveness: predicting PTSD symptom levels of adolescents 28 months after a natural disaster.

Bokszczanin A.

Department of Psychology, Opole University, Poland. Anna.Bokszczanin@uni.opole.pl

The purpose of this study was to evaluate the role of family factors as predictors of posttraumatic stress disorder (PTSD) symptoms among adolescents, a  substantial period of time after a natural disaster. It was hypothesized that a lack of parental support, family conflict, and overprotectiveness are all risk factors with regard to levels of PTSD symptoms. A group of 533 schoolchildren and high-school students was investigated 28 months after a huge flood, which was one of the most devastating disasters in Poland. The results of a hierarchical regression analysis indicate that the extent of traumatic exposure, parental support, family conflict, and overprotectiveness, all predicted levels of PTSD symptoms in the group investigated. Furthermore, parental overprotectiveness moderated the effect of trauma, thus augmenting the impact of stress experienced  during the disaster on the level of PTSD symptoms. The findings suggest that excessive parental control and infantilization of children for a long time after  a disaster are harmful for adolescents' health and could be an obstacle in the recovery process. The results highlight the importance of studying parental ways  of coping in order to predict how adolescents cope with a traumatic event.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18686053 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Oct;21(4):377-86.

Factors associated with traumatic symptoms and internalizing problems among adolescents who experienced a traumatic event.

Maja Deković, Koning IM, Stams GJ, Buist KL.

Department of Child and Adolescent Studies, Utrecht University, The Netherlands.  M.Dekovic@fss.uu.nl

The aim of the present study was to identify factors that are related to the traumatic symptoms and problem behavior among adolescents who experienced the New Years fire in 2001 in Volendam, The Netherlands. Three groups of factors were considered: pre-trauma (personality and coping), trauma-related (physical and emotional proximity to disaster), and post-trauma factors (received social support). Forty-five adolescents completed the questionnaire. Two years after the disaster, these adolescents experienced significant traumatic stress reaction (70% within the clinical range) and showed clinically significant levels of internalizing problems (37%). Pre-trauma, individual factors were identified as the most important predictors of distress, followed by received social support. The indicators of physical and emotional proximity to disaster explained little variance in distress.

PMID: 18608136 [PubMed - indexed for MEDLINE]

 

Arch Gen Psychiatry. 2008 Oct;65(10):1205-12.

Estimating clinically relevant mental disorders in a rural and an urban setting in postconflict Timor Leste.

Silove D, Bateman CR, Brooks RT, Fonseca CA, Steel Z, Rodger J, Soosay I, Fox G,  Patel V, Bauman A.

Centre for Population Mental Health Research, Sydney South West Area Health Service and School of Psychiatry, The University of New South Wales, Australia. d.silove@unsw.edu.au

CONTEXT: Epidemiologic studies undertaken in postconflict countries have focused  primarily on trauma-related disorders. There is a need to include disabling psychotic disorders in order to plan clinical services in these settings. OBJECTIVES: To estimate the prevalence of key clinical disorders in Timor Leste (East Timor), and to assess cultural factors that may influence help-seeking patterns. DESIGN, SETTING, PARTICIPANTS: A 2-phase total population survey of 1544 adults in an urban and a rural area of Timor Leste. Phase 1 involved a household informant survey using indigenous terms to detect psychosis and a screen of all adults for posttraumatic stress disorder (PTSD) and symptoms of psychologic distress, including depression and anxiety. In phase 2, clinicians interviewed all those identified by household informants and half of those who screened positive in order to assign DSM-IV diagnoses. Disability, explanatory models, and perceived needs were also assessed. MAIN OUTCOME MEASURES: Phase 1: Demographic characteristics; trauma events and PTSD (Harvard Trauma Questionnaire); psychologic distress (Kessler-10 scale). Phase 2: Structured Clinical Interview for relevant DSM-IV diagnoses; the Global Assessment of Functioning Scale and the World Health Organization Disability Assessment Scales; and the modified Short Explanatory Model Interview. RESULTS: The household informant method in phase 1 detected mainly psychotic disorders, and the screen method detected PTSD and depression. Phase 2 yielded a DSM-IV point prevalence estimate of 5.1% (including psychosis, 1.35%; and PTSD, 1.47%). Psychotic disorders were most disabling, primarily attributed to supernatural causes and treated mainly by traditional healers. Those with depression and PTSD experienced substantial disability but had received little treatment. They attributed their mental problems to social and traumatic causes. CONCLUSIONS: Our 2-phase method proved effective for identifying the range of disorders relevant to planning clinical services in postconflict developing countries. The unmet needs of the mentally ill in countries such as Timor Leste pose a major challenge to psychiatry.

Publication Types:      Case Reports     Comparative Study

PMID: 18838637 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2008 Oct;46(10):1181-6. Epub 2008 Jun 27.

The self-concept of traumatized children and adolescents with or without PTSD.

Saigh PA, Yasik AE, Oberfield R, Halamandaris PV.

Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA. ps2121@columbia.edu

This study compared the Piers-Harris 2 scores of youth with PTSD (n=30) to the scores of traumatized youth without PTSD (n=60) and a non-traumatized comparison  group (n=39). In the absence of major comorbid disorders, youth with PTSD evidenced significantly lower scores than the traumatized PTSD negatives and controls on five of six Piers-Harris 2 scales. With the exception of scores on an index of perceived parental acceptance of child behavior, trauma exposure in the  absence of PTSD was not associated with lower Piers-Harris 2 scores.

PMID: 18707677 [PubMed - in process]

 

Biol Psychol. 2008 Oct;79(2):223-33. Epub 2008 Jun 10.

An event-related potential study of attention deficits in posttraumatic stress disorder during auditory and visual Go/NoGo continuous performance tasks.

Shucard JL, McCabe DC, Szymanski H.

Division of Cognitive and Behavioral Neurosciences, Department of Neurology/The Jacobs Neurological Institute, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA. shucard@buffalo.edu

Posttraumatic stress disorder (PTSD) is characterized by disturbances in attention, such as increased arousal and hypervigilance. This study examined the  event-related potential (ERP) P3 component to target detection (Go), response inhibition (NoGo) and irrelevant nontarget stimuli during auditory and visual A-X continuous performance tasks. NoGo N2 amplitude effects were also analyzed. Participants were 23 Vietnam veterans with PTSD and 13 civilian controls. No group differences were present for N2 or P3 amplitude to Go and NoGo stimuli. The PTSD group, however, had longer P3 latency to NoGo stimuli than controls, regardless of modality. The PTSD group also had greater frontal P3 amplitude to irrelevant nontarget stimuli than controls. Significant P3 amplitude and latency  findings were associated with higher hyperarousal and reexperiencing scores from  the Clinician-Administered PTSD Scale. The findings suggest that attentional problems in PTSD are related to slowed central processing when response inhibition is required, and to an impaired ability to screen irrelevant information. This study provides further evidence that the attentional impairments in PTSD are not confined to trauma-related stimuli. Heightened arousal appears to enhance the attentional dysregulation seen in PTSD.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18590795 [PubMed - in process]

 

Brain Behav Immun. 2008 Oct;22(7):1108-14. Epub 2008 Jun 17.

Reducing post-traumatic anxiety by immunization.

Lewitus GM, Cohen H, Schwartz M.

Department of Neurobiology, The Weizmann Institute of Science, Rehovot 76100, Israel.

Trafficking of T lymphocytes to specific organs, such as the skin and lungs, is part of the body's defense mechanism following acute psychological stress. Here we demonstrate that T lymphocytes are also trafficking to the brain in response to psychological stress and are needed to alleviate its negative behavioral consequences. We show that short exposure of mice to a stressor (predator odor) enhanced T-cell infiltration to the brain, especially to the choroid plexus, and  that this infiltration was associated with increased ICAM-1 expression by choroid plexus cells. Systemic administration of corticosterone could mimic the effects of psychological stress on ICAM-1 expression. Furthermore, we found that the ability to cope with this stress is interrelated with T-cell trafficking and with the brain and hippocampal BDNF levels. Immunization with a CNS-related peptide reduced the stress-induced anxiety and the acoustic startle response, and restored levels of BDNF, shown to be important for stress resilience. These results identified T cells as novel players in coping with psychological stress,  and offers immunization with a myelin-related peptide as a new therapeutic approach to alleviate chronic consequences of acute psychological trauma, such as those found in posttraumatic stress disorder.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18562161 [PubMed - indexed for MEDLINE]

 

CNS Neurosci Ther. 2008 Fall;14(3):171-81.

Post-traumatic stress disorder in Canada.

Van Ameringen M, Mancini C, Patterson B, Boyle MH.

Anxiety Disorders Clinic, McMaster University Medical Centre, Department of Psychiatry and Behavioural Neurociences, McMaster University, Hamilton, Ontario,  Canada. vanamer@mcmaster.ca

Post-traumatic stress disorder (PTSD) has become a global health issue, with prevalence rates ranging from 1.3% to 37.4%. As there is little current data on PTSD in Canada, an epidemiological study was conducted examining PTSD and related comorbid conditions. Modified versions of the Composite International Diagnostic  Interview (CIDI) PTSD module, the depression, alcohol and substance abuse sections of the Mini International Neuropsychiatric Interview (MINI), as well as  portions of the Childhood Trauma Questionnaire (CTQ) were combined, and administered via telephone interview in English or French. Random digit dialing was used to obtain a nationally representative sample of 2991, aged 18 years and  above from across Canada. The prevalence rate of lifetime PTSD in Canada was estimated to be 9.2%, with a rate of current (1-month) PTSD of 2.4%. Traumatic exposure to at least one event sufficient to cause PTSD was reported by 76.1% of  respondents. The most common forms of trauma resulting in PTSD included unexpected death of a loved one, sexual assault, and seeing someone badly injured or killed. In respondents meeting criteria for PTSD, the symptoms were chronic in nature, and associated with significant impairment and high rates of comorbidity. PTSD is a common psychiatric disorder in Canada. The results are surprising, given the comparably low rates of violent crime, a small military and few natural disasters. Potential implications of these findings are discussed.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18801110 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2008 Oct;13(10):872-80.

Challenges in the Implementation of Manualized Psychotherapy in Combat-Related PTSD.

Linden M, Golier J.

The Mount Sinai School of Medicine, New York, NY, USA.

PMID: 18955942 [PubMed - in process]

 

Community Ment Health J. 2008 Oct;44(5):367-76. Epub 2008 May 1.

Client-level measures of services integration among chronically homeless adults.

Mares AS, Greenberg GA, Rosenheck RA.

College of Social Work, The Ohio State University, Columbus, OH 43210, USA. mares.2@osu.edu

INTRODUCTION: While several major studies have examined services integration at the system or interagency level, there has been far less effort to measure the integration of services at the client-level and its correlates. METHODS: This study presents three client-level measures of services integration, two objective measures, representing the proportion of needed services received and the number  of outpatient services received by each client, and one subjective measure, a five-item scale measuring perceived coordination of care among clients' service providers. Data from the evaluation of the collaborative initiative to help end chronic homelessness (CICH) are used to examine bivariate and multivariate relationships of these three client-level measures to two system-level measures of services integration, one addressing interagency services coordination/planning and the other interagency trust/respect as well as to baseline client characteristics among 734 chronically homeless adults in 11 cities. RESULTS: Client-level measures of service integration were not strongly associated to each other or to the system-level measures, except for weak associations (r = 0.10) between one objective client measure and the system-level measure of service coordination and planning, and another between client-level use of outpatient mental health services and system-level trust and respect. Multivariate analysis showed that clients who received a greater array of needed  services received more service overall and were more likely to have a diagnosis of PTSD and more medical problems, but less serious alcohol problems. Clients who reported more outpatient mental health and substance abuse visits were significantly more likely to be married, to be veterans, to have more serious drug problems, and to be dually diagnosed. Clients with more serious drug problems reported poorer coordination among their service providers on the subjective measure of client-level service integration. CONCLUSION: Three client-level measures of services integration were, at best, weakly associated with measures of system-level integration. Positive associations between client-level measures of integration and health status, outpatient service use and negative relationships with indicators of substance abuse suggest they may usefully represent the experiences of chronically homeless clients, even though they are not strongly related to system-level measures.

PMID: 18449640 [PubMed - in process]

 

Crit Care Clin. 2008 Oct;24(4):875-87, ix-x.

Posttraumatic stress disorder following critical illness.

Kross EK, Gries CJ, Curtis JR.

Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, School of Medicine, University of Washington, Seattle, WA 98104-2499, USA.

Posttraumatic stress disorder (PTSD) is a common psychiatric condition that can occur after a traumatic event. Individuals exposed to traumatic events are at risk for PTSD and other psychologic morbidity, such as depression, panic disorder, generalized anxiety disorder, and substance abuse. The burden of PTSD can be high, with inability to work or return to prior levels of functioning. Emerging literature suggests a significantly increased risk for symptoms of PTSD  among survivors of critical illness and the families of patients who survive or die after critical illness. This review summarizes these studies and provides suggestions for current clinical implications and for future research.

Publication Types:      Review

PMID: 18929945 [PubMed - indexed for MEDLINE]

 

Crit Care Med. 2008 Oct;36(10):2945-6.

Comment on:     Crit Care Med. 2008 Oct;36(10):2801-9.

The intensive care experience: what really matters?

Griffiths RD.

Publication Types:      Comment     Editorial

PMID: 18812804 [PubMed - indexed for MEDLINE]

 

Crit Care Med. 2008 Oct;36(10):2801-9.

Comment in:     Crit Care Med. 2008 Oct;36(10):2945-6.

Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis.

Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, Costa-Pereira A; JMIP Study Group.

Collaborators: Amaro A, Gomes E, Paixão AI, Esteves F, Amaro P, Coutinho P, Silva E, Moniz I, Vaz J, Ribeiro O, Pereira AC.

Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. cristina.granja@hph.min-saude.pt

OBJECTIVE: To assess the factual and delusional memories reported by intensive care unit survivors and its relationship with the development of Posttraumatic Stress Syndrome (PTSS). DESIGN: Multicenter observational cohort study. SETTING:  Nine Portuguese intensive care units, as part of a multicenter study. METHODS AND PATIENTS: Between January and June 2005, 1,174 patients were admitted across the  nine intensive care units. Two hundred thirty-nine patients were excluded, 14 with < 18 yrs old and 225 with a length of intensive care stay < or = 48 hrs. Thus a total of 935 patients were included in the study. One hundred ninety (20%) patients died in the intensive care unit, 90 (12%) patients died on the ward (30% in-hospital mortality rate), and another 56 (9%) died in the next 6 months after  intensive care unit discharge. RESULTS: From the 599 survivors at 6 months, 313 patients answered the questionnaires (52% response rate). From the 313 respondents, 58% (n = 183) were men, median age was 59. The median Simplified Acute Physiology Score II was 37, median intensive care unit length of stay was 8 days, 57% (n = 177) of the patients were admitted for medical reasons. Forty percent (n = 116) of the respondents did not remember their admission to hospital, 48% (n = 142) did not remember the time in the hospital before intensive care unit admission, 73% (n = 220) had factual memories and 39% (n = 118) had delusional memories. Twenty-three percent (n = 66) stated that they had  had intrusive memories. A higher number of "adverse" experiences were significantly associated with a higher PTSS-14 score. Eighteen percent (n = 54) of patients had a PTSS-14 score > 49, indicating a higher risk of developing posttraumatic stress disorder. A PTSS-14 score > 49 was significantly associated  with not remembering the hospital stay before intensive care unit admission. CONCLUSION: Amnesia for the early period of critical illness (early amnesia) was  positively associated with the level of posttraumatic stress disorder-related symptoms, which may be a proxy for severity of disease at the time of intensive care unit admission.

Publication Types:      Multicenter Study

PMID: 18766108 [PubMed - indexed for MEDLINE]

 

Cultur Divers Ethnic Minor Psychol. 2008 Oct;14(4):344-52.

Ethnic differences in the effects of spiritual well-being on long-term psychological and behavioral outcomes within a sample of homeless women.

Douglas AN, Jimenez S, Lin HJ, Frisman LK.

Mount Holyoke College, Department of Psychology, South Hadley, MA 01075, USA. adouglas@mtholyoke.edu

The present study examines ethnicity as a moderator variable between spiritual well-being (SWB) and psychological and behavioral outcomes. Participants included in this analysis were 88 African American (46.6%) and 101 non-African American (total N = 189) homeless mothers. Through structured interviews conducted at 3-month intervals over a period of 15 months, data were collected on spiritual well-being, mental health, trauma symptoms, substance use, parenting, and child behavior. Hierarchical linear model and general estimating equation results indicated that ethnicity moderates the relationship between SWB and anxiety, trauma symptoms, child behavior, and parenting outcomes. On average, African Americans reported significantly higher SWB than non-African Americans, indicating the relative importance of spirituality in their lives. These findings support previous research indicating a difference in the role that SWB plays in the lives of African Americans compared to non-African Americans.

Publication Types:      Research Support, U.S. Gov't, P.H.S.

PMID: 18954170 [PubMed - indexed for MEDLINE]

 

Dev Psychopathol. 2008 Fall;20(4):1145-59.

The development of antisocial behavior: what can we learn from functional neuroimaging studies?

Crowe SL, Blair RJ.

National Institute of Mental Health, National Institutes of Health, Bethesda, MD  20892, USA.

The recent development of low-risk imaging technologies, such as functional magnetic resonance imaging (fMRI), have had a significant impact on the investigation of psychopathologies in children and adolescents. This review considers what we can infer from fMRI work regarding the development of conduct disorder (CD) and oppositional defiant disorder (ODD). We make two central assumptions that are grounded in the empirical literature. First, the diagnoses of CD and ODD identify individuals with heterogeneous pathologies; that is, different developmental pathologies can receive a CDD or ODD diagnosis. This is indicated by the comorbidities associated with CD/ODD, some of which appear to be mutually exclusive at the biological level (e.g., posttraumatic stress disorder [PTSD] and psychopathic tendencies). Second, two populations of antisocial individuals can be identified: those that show an increased risk for only reactive aggression and those that show an increased risk for both reactive and instrumental aggression. We review the fMRI data indicating that particular comorbidities of CD/ODD (i.e., mood and anxiety conditions such as childhood bipolar disorder and PTSD) are associated with either increased responsiveness of neural regions implicated in the basic response to threat (e.g., the amygdala) or decreased responsiveness in regions of frontal cortex (e.g., ventromedial frontal cortex) that are implicated in the regulation of the basic threat response. We suggest why such pathology would increase the risk for reactive aggression and, in turn, lead to the association with a CD/ODD diagnosis. We also review the literature on psychopathic tendencies, a condition where the individual is at significantly elevated risk for both reactive and instrumental aggression. We show that in individuals with psychopathic tendencies, the functioning of the amygdala in stimulus-reinforcement learning and of the ventromedial frontal cortex in the representation of reinforcement expectancies is impaired. We suggest why such pathology would increase the risk for reactive and instrumental  aggression and thus also lead to the association with a CD/ODD diagnosis.

Publication Types:      Research Support, N.I.H., Intramural

PMID: 18838035 [PubMed - in process]

 

Expert Rev Neurother. 2008 Oct;8(10):1449-55.

Repetitive transcranial magnetic stimulation as treatment for anxiety disorders.

Pigot M, Loo C, Sachdev P.

School of Psychiatry, University of New South Wales, Black Dog Institute, Prince  of Wales Hospital, Randwick, NSW 2031, Australia. m.pigot@unsw.edu.au

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and generally well-tolerated method of focally stimulating brain regions. It has been shown to be efficacious in the treatment for depression, but only to a limited degree. It has also been investigated for the treatment of some anxiety disorders, particularly obsessive-compulsive disorder, post-traumatic stress disorder and panic disorder. While anecdotal reports and open studies have suggested a therapeutic role for rTMS in anxiety disorders, controlled studies, which have varied greatly in terms of rTMS administration, have not shown it to be superior to placebo. Furthermore, reports in animal models of anxiety have not been consistent. Therefore, to date, there is no convincing evidence for the clinical role of rTMS in anxiety disorders. Further research is needed, drawing on advances in our understanding of pathological neurocircuitry in anxiety disorders and the mechanisms of action by which rTMS may alter that neurocircuitry. With advances in neuroimaging technology, this understanding is likely to be more accessible than it has been in the past.

Publication Types:      Meta-Analysis     Research Support, Non-U.S. Gov't     Review

PMID: 18928340 [PubMed - indexed for MEDLINE]

 

Harefuah. 2008 Oct;147(10):763-7, 839-40.

[Sleep spindles in post traumatic stress disorder: significant importance of selective serotonin reuptake inhibitors]

[Article in Hebrew]

Dotan Y, Suraiya S, Pillar G.

Sleep Laboratory, Rambam Hospital, Medicine Faculty, Technion Institute, Haifa, Israel. yanivdotan@gmail.com

BACKGROUND: Sleep spindles (SS) are conducted by the thalamus during sleep and have an inhibitory effect on information rising through the thalamus to the cortex, probably representing the mechanism called Arousal Inhibitory Mechanism.  They appear during sleep stage 2 but also in stages 3, 4 and REM (Rapid Eye Movements). Patients with post traumatic stress disorder (PTSD) complain of insomnia, although objective studies have revealed that their sleep is deeper and their awakening threshold is higher. The relationships between PTSD or selective  serotonin reuptake inhibitors (SSRI) to SS density are not described in the literature. GOALS: This study aimed to examine the hypothesis that the higher awakening threshold reflects an active defense process which would be manifested  in increased sleep spindles in patients with PTSD. METHODS: A total of 15 PTSD patients (36.3 +/- 11.4 years) comprised the research group and 15 healthy students (27.3 +/- 2.18 years) comprised the control group. Participants underwent a polysomnography study in the sleep laboratory at 'Rambam' Hospital, Haifa, Israel. RESULTS: There was no difference in the sleep spindles density per minute during stage 2 between the research group (2.54 +/- 1.14) and the control  group (2.86 +/- 1.3). However, sleep spindles density was highly affected by selective serotonin reuptake inhibitors, such that PTSD patients treated with SSRI's had significantly higher spindles density than the remaining PTSD patients (3.25 +/- 1.1 vs 1.72 +/- 0.46, p=0.0044). Stage 2 was shorter in the research group (47% +/- 8.75%) compared to the control group (58% +/- 8.5%, p=0.0014), while stages 3, 4 were longer (32% +/- 8% vs 18% +/- 6.26%, p<0.001). CONCLUSIONS: Sleep spindle density was generally not increased in patients with PTSD, thus other mechanisms are probably responsible for their stabilization of sleep. SSRI's were found to have an important role in spindles density, which supports a serotonergic mechanism in the stabilization of sleep, although it requires further research.

Publication Types:      English Abstract

PMID: 19039901 [PubMed - indexed for MEDLINE]

 

Int J Group Psychother. 2008 Oct;58(4):567-74.

Comment on:     Int J Group Psychother. 2008 Oct;58(4):441-54.

On the development of practice guidelines for evidence-based group approaches following disaster.

Foy DW.

Graduate School of Education & Psychology, Pepperdine University, 16830 Venture Boulevard, Encino, CA 91436, USA. David.Foy@pepperdine.edu

Publication Types:      Comment

PMID: 18837665 [PubMed - indexed for MEDLINE]

 

Int J Law Psychiatry. 2008 Oct-Nov;31(5):385-93. Epub 2008 Sep 21.

Physical victimization in prison: the role of mental illness.

Blitz CL, Wolff N, Shi J.

Center for Mental Health Services & Criminal Justice Research, Rutgers University, New Brunswick, N.J., USA. clblitz@rci.rutgers.edu

This study compares prison physical victimization rates (inmate-on-inmate and staff-on-inmate) for people with mental disorder to those without mental disorder in a state prison system. Inmate subjects were drawn from 14 adult prisons operated by a single mid-Atlantic State. A sample of 7,528 subjects aged 18 or older (7,221 men and 564 women) completed an audio-computer administered survey instrument. Mental disorder was based on self-reported mental health treatment ever for particular mental disorders. Approximately one-quarter of the sample reported some prior treatment for schizophrenia, bipolar disorder, depression, PTSD, or anxiety disorder. Rates of physical victimization for males with any mental disorder were 1.6 times (inmate-on-inmate) and 1.2 times (staff-on-inmate) higher than that of males with no mental disorder. Female inmates with mental disorder were 1.7 times more likely to report being physically victimized by another inmate than did their counterparts with no mental disorder. Overall, both males and females with mental disorder are disproportionately represented among victims of physical violence inside prison.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural

PMID: 18809210 [PubMed - indexed for MEDLINE]

 

Int Psychogeriatr. 2008 Oct;20(5):1014-8. Epub 2008 Mar 17.

Trauma and post-traumatic stress symptoms in former German child soldiers of World War II.

Kuwert P, Spitzer C, Rosenthal J, Freyberger HJ.

Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt University Greifswald, Germany. kuwert@uni-greifswald.de

BACKGROUND: The aim of the study was to determine the amount of trauma impact and significant post-traumatic stress symptoms, which can indicate a possible post-traumatic stress disorder (PTSD), in a sample of former German child soldiers of World War II. METHODS: 103 participants were recruited through the press, then administered a modified Post-traumatic Diagnostic Scale (PDS). RESULTS: Subjects reported a high degree of trauma exposure, with 4.9% reporting  significant post-traumatic stress symptoms after WW II, and 1.9% reporting that these symptoms persist to the present. CONCLUSION: In line with other studies on  child soldiers in actual conflict settings, our data document a high degree of trauma exposure during war. Surprisingly, the prevalence of significant post-traumatic stress symptoms indicating a possible PTSD was low compared to other groups of aging, long-term survivors of war trauma. Despite some limitations our data highlight the need for further studies to identify resilience and coping factors in traumatized child soldiers.

Publication Types:      Comparative Study

PMID: 18341750 [PubMed - indexed for MEDLINE]

 

Int Rev Psychiatry. 2008 Oct;20(5):441-4.

Mental health and the psychosocial consequences of natural disasters in Asia.

Udomratn P.

Faculty of Medicine, Department of Psychiatry, Prince of Songkla University, Thailand. upichet@medicine.psu.ac.th

This article presents an overview of natural disasters in Asia, as well as mental disorders and psychosocial interventions related to disasters. Although most of the top ten worst natural disasters occurred in Asia over the past century, little is known about the mental health and psychosocial aspects. After the tsunami incident in 2004, research reports in international journals related to Asian disasters have been growing. The prevalence rate of post-traumatic stress disorder related to natural disasters is currently between 8.6% and 57.3% depending on assessment methodologies, instruments and timing. Cognitive behaviour therapy has been found to be effective with Asian survivors but needs to be adapted for cultural and local sensitivities. Further research is needed in the areas of epidemiology for mental disorders and suitable psychosocial interventions for disaster survivors in Asia.

PMID: 19012129 [PubMed - in process]

 

J Adv Nurs. 2008 Oct;64(1):2-13. Epub 2008 Aug 21.

Emotional outcome after intensive care: literature review.

Rattray JE, Hull AM.

School of Nursing and Midwifery, University of Dundee, Ninewells Hospital, UK. j.z.rattray@dundee.ac.uk

AIM: This paper is a report of a literature review to identify (a) the prevalence of emotional and psychological problems after intensive care, (b) associated factors and (c) interventions that might improve this aspect of recovery. BACKGROUND: Being a patient in intensive care has been linked to both short- and  long-term emotional and psychological consequences. DATA SOURCES: The literature  search was conducted during 2006. Relevant journals and databases were searched,  i.e. Medline and CINAHL, between the years 1995 and 2006. REVIEW METHODS: The search terms were 'anxiety', 'depression', posttraumatic stress', 'posttraumatic  stress disorder' and 'intensive care'. RESULTS: Fifteen papers were reviewed representing research studies of anxiety, depression and posttraumatic stress, and seven that represented intensive care follow-up clinics and patient diaries.  Being in intensive care can result in significant emotional and psychological problems for a number of patients. For the majority of patients, symptoms of distress will decrease over time but for a number these will endure for some years. Current evidence indicates that emotional problems after intensive care are related to both subjective and objective indicators of a patient's intensive  care experience. Evidence suggests some benefit in an early rehabilitation programme, daily sedation withdrawal and the use of patient diaries. However, additional research is required to support such findings. CONCLUSION: Our understanding of the consequences of intensive care is improving. Psychological care for intensive care patients has lagged behind care for physical problems. We now need to focus on developing and evaluating appropriate interventions to improve psychological outcome in this patient group.

Publication Types:      Review

PMID: 18721158 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1244-54. Epub 2008 Jan 11.

An investigation of whether patients with post-traumatic stress disorder overestimate the probability and cost of future negative events.

White M, McManus F, Ehlers A.

Lowestoft Community Mental Health Team, Norfolk & Waverley NHS Foundation Trust,  Victoria House, 28 Alexandra Road, Lowestoft, UK.

This study compared estimations of the probability and cost of negative events occurring made by patients with post-traumatic stress disorder (PTSD) (n=43), patients with other anxiety disorders (n=29) and non-patients' (n=35). Prior to treatment PTSD patients overestimated the probability and cost of all types of traumatic events occurring relative to non-patients, and overestimated the probability and cost of the specific type of traumatic event that they had been traumatized by relative to the anxious controls as well as non-patients. These judgment biases were specific to traumatic events and did not generalise to all negative events. PTSD patients' estimations of the probability and cost of traumatic events were significantly reduced following treatment, and were no longer significantly different from those of non-patients. Results suggest that patients with PTSD show specific judgment biases in the estimation of probability and cost, which can be successfully modified by cognitive therapy.

PMID: 18316175 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1264-71. Epub 2008 Jan 18.

Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)--results of a preliminary investigation.

Sack M, Lempa W, Steinmetz A, Lamprecht F, Hofmann A.

Klinikum rechts der Isar, Department of Psychosomatic Medicine, Technical University Munich, Langerstrasse 3, 81675 Munich, Germany. m.sack@tum.de

EMDR combines stimuli that evoke divided attention--e.g. eye movements--with exposure to traumatic memories. Our objective was to investigate psycho-physiological correlates of EMDR during treatment sessions. A total of 55  treatment sessions from 10 patients with PTSD was monitored applying impedance cardiography. Onset of every stimulation/exposure period (n=811) was marked and effects within and across stimulation sets on heart rate (HR), heart rate variability (HRV), pre-ejection period (PEP) and respiration rate were examined.  At stimulation onsets a sharp increase of HRV and a significant decrease of HR was noticed indicating de-arousal. During ongoing stimulation, PEP and HRV decreased significantly while respiration rate significantly increased, indicating stress-related arousal. However, across entire sessions a significant  decrease of psycho-physiological activity was noticed, evidenced by progressively decreasing HR and increasing HRV. These findings suggest that EMDR is associated  with patterns of autonomic activity associated with substantial psycho-physiological de-arousal over time.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18314305 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1214-26. Epub 2008 Jan 11.

Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology.

Marshall EC, Zvolensky MJ, Vujanovic AA, Gibson LE, Gregor K, Bernstein A.

Department of Psychology, University of Vermont, 2 Cholchester Avenue, Burlington, VT 05405, USA.

The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; C) in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences  were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.

Publication Types:      Evaluation Studies     Research Support, N.I.H., Extramural

PMID: 18282685 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1255-63. Epub 2008 Jan 18.

Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors.

Long ME, Elhai JD, Schweinle A, Gray MJ, Grubaugh AL, Frueh BC.

Disaster Mental Health Institute, Department of Psychology, The University of South Dakota, Vermillion, SD 57069, USA.

This study addresses the ongoing controversy regarding the definition of DSM-IV posttraumatic stress disorder's (PTSD) traumatic stressor criterion (A1). A sample of 119 college students completed the PTSD Symptom Scale separately in relation to both Criterion A1 and non-Criterion A1 stressful events, using a mixed between-groups (administration order) and within-subjects (stressor type) design. Contrary to what was expected, analyses revealed that non-Criterion A1 events were associated with greater likelihood of "probable" PTSD diagnoses and a greater PTSD symptom frequency than Criterion A1 events. Symptom frequency relationships, however, were moderated by the order in which the measures were administered. The non-Criterion A1 PTSD scores were only higher when non-Criterion A1 measures were presented first in the administration order. Similar patterns of differences in PTSD scores between stressor types were also found across the three PTSD symptom criteria. Implications are discussed as to the ongoing controversy of the PTSD construct.

Publication Types:      Randomized Controlled Trial

PMID: 18281192 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1137-45. Epub 2007 Dec 8.

The structure of post-traumatic stress disorder symptoms in three female trauma samples: a comparison of interview and self-report measures.

Scher CD, McCreary DR, Asmundson GJ, Resick PA.

Department of Psychology, California State University-Fullerton, Fullerton, CA 92834, USA. cscher@fullerton.edu

Empirical research increasingly suggests that post-traumatic stress disorder (PTSD) is comprised of four factors: re-experiencing, avoidance, numbing, and hyperarousal. Nonetheless, there remains some inconsistency in the findings of factor analyses that form the bulk of this empirical literature. One source of such inconsistency may be assessment measure idiosyncrasies. To examine this issue, we conducted confirmatory factor analyses of interview and self-report data across three trauma samples. Analyses of the interview data indicated a good fit for a four-factor model across all samples; analyses of the self-report data  indicated an adequate fit in two of three samples. Overall, findings suggest that measure idiosyncrasies may account for some of the inconsistency in previous factor analyses of PTSD symptoms.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18206346 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Oct;22(7):1110-9. Epub 2007 Nov 21.

The posttraumatic cognitions inventory-Chinese revised: validation and refinement with a traumatized college sample in Taiwan.

Su YJ, Chen SH.

Department of Psychology, National Taiwan University, No. 1 Sec. 4 Roosevelt Road, Taipei 106, Taiwan.

The posttraumatic cognitions inventory (PTCI) is a 33-item self-report measure assessing dysfunctional beliefs following trauma. This study reported the factor  structure and psychometric properties of the Chinese version of the PTCI (PTCI-C), as well as its relationship with PTSD symptoms. Study participants consisted of 240 traumatized college students in Taiwan. Confirmatory factor analyses indicated adequate replication of the original three-factor structure of the PTCI after eliminating four cross-loaded items. The 29-item PTCI-C was thus developed and its psychometric data were evaluated. This measure displays good internal consistency, test-retest stability, concurrent validity, and discriminative validity. The study findings are discussed in terms of intercultural differences in attribution style and the possible contribution of negative cognitions to PTSD development.

Publication Types:      Historical Article     Research Support, Non-U.S. Gov't

PMID: 18162364 [PubMed - indexed for MEDLINE]

 

J Fam Psychol. 2008 Oct;22(5):659-66.

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans.

Solomon Z, Dekel R, Zerach G.

Bob Shappell School of Social Work, Tel Aviv University, Israel. Solomon@post.tau.ac.il

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD  avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of  219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs. Copyright 2008 APA, all rights reserved.

PMID: 18855502 [PubMed - indexed for MEDLINE]

 

J Immigr Minor Health. 2008 Oct;10(5):407-14.

Smoking patterns within a primary care sample of resettled Bosnian refugees.

Weaver TL, Cajdrić A, Jackson ER.

Department of Psychology, Saint Louis University, 221 North Grand Blvd, Saint Louis, MO 63103, USA. weavert@slu.edu

The interconnections among smoking status, severity of nicotine related physical  dependence (NRPD), posttraumatic stress disorder (PTSD)-related physiological arousal and subjective health were explored within a sample of 66 resettled Bosnian refugees seeking primary healthcare services. Fifty-nine percent (n = 39/66) of the participants reported that they were current smokers and 44% (n = 29/66) indicated that they had smoked prior to the war. Both pre-war smoking and  PTSD arousal independently predicted current smoking. In addition, total PTSD arousal and individual symptoms of sleep difficulties, irritability, concentration, and hypervigilance were significantly and positively associated with NRPD. Severity of PTSD arousal and age uniquely predicted NRPD. While poorer subjective health was significantly associated with positive current smoking status, neither poorer subjective health nor severity of PTSD arousal was significantly associated with interest in quitting/reducing smoking. Findings were discussed within the context of culture and stressor-related issues.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18071902 [PubMed - indexed for MEDLINE]

 

J Immigr Minor Health. 2008 Oct;10(5):389-96.

The "lost boys" of Sudan: use of health services and functional health outcomes of unaccompanied refugee minors resettled in the U.S.

Geltman PL, Grant-Knight W, Ellis H, Landgraf JM.

Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA,  pgeltman@bu.edu

To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire  (CHQ) scales and questions regarding care for symptoms or problems associated with behavioral disorders, i.e. somatization. Posttraumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire (HTQ). Health services questions derived from the National Health Interview Survey. Minors reported high rates of counseling (45%); however no differences were noted in counseling use by those with PTSD compared with others. Counseling was not associated with health outcomes. The majority (76%) reported seeking medical care for symptoms or problems often associated with behavioral and emotional problems; however such care-seeking was more common among those with PTSD (OR = 2.5, 95% CI = 1.004-6.26). Through the efforts of the URMP, the Sudanese unaccompanied minors received high levels of psychosocial support despite the absence of their biological parents. Those with worse functional health were no more likely than others to have received mental health counseling while being more likely to seek  care from any health professional. This was also the case for those with PTSD compared to those without it. In linear regression analyses, reported receipt of  mental health counseling did not impact either positively or negatively on the score of any CHQ scale.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18071901 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Oct;23(10):1323-42. Epub 2008 Feb 21.

Partner's stake in conformity and abused wives' psychological trauma.

Demaris A, Kaukinen C.

Bowling Green State University, Bowling Green, OH 43403, USA. ademari@bgnet.bgsu.edu

This study investigates the potential buffering effect of help-seeking in the association between intimate partner assault and women's psychological trauma, and how this, in turn, may depend on the partner's stake in conformity. The sample consists of 374 women reporting the experience of domestic violence from a current intimate partner, drawn from the larger survey Violence and Threats of Violence Against Women and Men in the United States, 1994-1996. Help-seeking did  not appear to buffer the impact of assault severity, contrary to expectation. However, the partner's stake in conformity did condition the effect of his or her having been arrested. Victims had higher levels of posttraumatic stress disorder  (PTSD) when police arrested partners of average or below-average stake in conformity. But victims of partners characterized by higher than average stake in conformity did not show elevated PTSD due to their partners having been arrested. On the other hand, PTSD was higher among women experiencing more emotional abuse  from the partner.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18292403 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Oct;196(10):772-5.

The long-term psychosocial impact of a surprise chemical weapons attack on civilians in Halabja, Iraqi Kurdistan.

Dworkin J, Prescott M, Jamal R, Hardawan SA, Abdullah A, Galea S.

Internal Medicine Residency Program, University of Hawaii, Honolulu, Hawaii, USA.

War and human rights abuses contribute to increased prevalence of posttraumatic stress (PTS) disorder and low social functioning among populations affected. There is relatively little evidence, however about the long-term mental health impact of war on general populations. We examined the prevalence of PTS symptoms  and poor social functioning in Halabja, Iraqi Kurdistan, 18 years after a chemical attack on civilians in that town. We systematically sampled 291 persons  representative of the population of Halabja from the city emergency department and 4 outpatient clinical sites. PTS symptoms and poor social functioning were common. After adjustment for covariates, female gender, older age, and cumulative exposure to multiple traumas, all were associated with higher PTS scores and worse social functioning. Exposure to human rights abuses and warlike conditions  seem to continue to be risks for psychiatric and social dysfunction even decades  after the initial incident.

Publication Types:      Comparative Study     Multicenter Study

PMID: 18852622 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Oct;196(10):735-42.

Depressive symptoms after trauma: is self-esteem a mediating factor?

David M, Ceschi G, Billieux J, Van der Linden M.

Cognitive Psychopathology and Neuropsychology Unit, University of Geneva, Geneva, Switzerland. Melissa.David@unige.ch

Traumatic events have predicted depressive symptoms. Despite this consensus, it remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. This study tested these relationships while considering depressive symptom types. One hundred thirty-two students reported the number of traumatic events experienced and self-esteem and depression levels. Results indicated 2 depressive symptom types: "cognitive-affective" and "somatic." Structural Equation Modeling tested an unmediated path from trauma to depressive symptoms and a path mediated by self-esteem. Results supported the unmediated relationship between trauma and "cognitive-affective" depressive symptoms, and did not support mediation by self-esteem. Findings are discussed in view of a dimensional rather than categorical approach to depression, and in consideration of alternative symptom clusters resulting from trauma in addition to those captured by posttraumatic stress disorder.

Publication Types:      Comparative Study

PMID: 18852617 [PubMed - indexed for MEDLINE]

 

J Postgrad Med. 2008 Oct-Dec;54(4):294-300.

Women survivors of intimate partner violence and post-traumatic stress disorder:  Prediction and prevention.

Dejonghe ES, Bogat GA, Levendosky AA, Eye A.

Department of Psychology and Sociology, California State Polytechnic University Pomona, Pomona, CA, USA. esdejonghe@csupomona.edu.

A considerable body of research has demonstrated that women who are abused by their male romantic partners are at substantially elevated risk for the development of post-traumatic stress disorder (PTSD). This article reviews recent literature regarding intimate partner violence (IPV) and resultant PTSD symptoms. The article is intended to be an introduction to the topic rather than an exhaustive review of the extensive literature in this area. Factors that enhance  and reduce the risk for PTSD, including social support, coping styles, and types  of abusive behavior experienced, are described. In addition, the unique risks associated with IPV for women who have children are discussed. Prevention efforts and treatment are briefly reviewed.

PMID: 18953149 [PubMed - in process]

 

J Psychiatr Res. 2008 Oct;42(14):1185-8. Epub 2008 Mar 14.

Blunted ACTH response to dexamethasone suppression-CRH stimulation in posttraumatic stress disorder.

Ströhle A, Scheel M, Modell S, Holsboer F.

Max Planck Institute of Psychiatry, Munich, Germany. andreas.stroehle@charite.de

Previous studies have suggested that patients with posttraumatic stress disorder  (PTSD) have an enhanced negative feedback sensitivity of the hypothalamic-pituitary-adrenal (HPA) system and a blunted ACTH response to corticotropin releasing hormone (CRH). The effects of two dexamethasone dosages (0.75 and 1.5 mg) on the ACTH and cortisol concentrations after CRH stimulation (100 microg) were studied in eight patients with PTSD and matched healthy control subjects. Compared to healthy subjects, patients with PTSD have a blunted ACTH response to CRH. Cortisol concentrations were only significantly influenced by dexamethasone dosage. Our results give further evidence for a central role of the pituitary in reflecting changes of the negative feedback sensitivity of the HPA system in patients with PTSD.

Publication Types:      Clinical Trial     Research Support, Non-U.S. Gov't

PMID: 18342888 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Oct;42(13):1112-21. Epub 2008 Mar 4.

Post-combat invincibility: violent combat experiences are associated with increased risk-taking propensity following deployment.

Killgore WD, Cotting DI, Thomas JL, Cox AL, McGurk D, Vo AH, Castro CA, Hoge CW.

Walter Reed Army Institute of Research, Silver Spring, MD, United States. Killgore@mclean.harvard.edu

Combat exposure is associated with increased rates of mental health problems such as post-traumatic stress disorder, depression, and anxiety when Soldiers return home. Another important health consequence of combat exposure involves the potential for increased risk-taking propensity and unsafe behavior among returning service members. Survey responses regarding 37 different combat experiences were collected from 1252 US Army Soldiers immediately upon return home from combat deployment during Operation Iraqi Freedom. A second survey that  included the Evaluation of Risks Scale (EVAR) and questions about recent risky behavior was administered to these same Soldiers 3 months after the initial post-deployment survey. Combat experiences were reduced to seven factors using principal components analysis and used to predict post-deployment risk-propensity scores. Although effect sizes were small, specific combat experiences, including  greater exposure to violent combat, killing another person, and contact with high levels of human trauma, were predictive of greater risk-taking propensity after homecoming. Greater exposure to these combat experiences was also predictive of actual risk-related behaviors in the preceding month, including more frequent and greater quantities of alcohol use and increased verbal and physical aggression toward others. Exposure to violent combat, human trauma, and having direct responsibility for taking the life of another person may alter an individual's perceived threshold of invincibility and slightly increase the propensity to engage in risky behavior upon returning home after wartime deployment. Findings highlight the importance of education and counseling for returning service members to mitigate the public health consequences of elevated risk-propensity associated with combat exposure.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18291419 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Oct;42(13):1104-11. Epub 2008 Feb 20.

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors.

Yehuda R, Bell A, Bierer LM, Schmeidler J.

Traumatic Stress Studies Division, Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, OOMH, 130 West Kingsbridge Road, Bronx, NY 10468, United States. Rachel.Yehuda@va.gov

BACKGROUND: A significant association between parental PTSD and the occurrence of PTSD in offspring has been noted, consistent with the idea that risk for the development of PTSD is transmitted from parent to child. Two recent reports linking maternal PTSD and low offspring cortisol prompted us to examine the relative contributions of maternal vs. paternal PTSD in the prediction of PTSD and other psychiatric diagnoses in offspring. METHODS: One hundred seventeen men  and 167 women, recruited from the community, were evaluated using a comprehensive psychiatric battery designed to identify traumatic life experiences and lifetime  psychiatric diagnoses. 211 of these subjects were the adult offspring of Holocaust survivors and 73 were demographically comparable Jewish controls. Participants were further subdivided based on whether their mother, father, neither, or both parents met diagnostic criteria for lifetime PTSD. RESULTS: A higher prevalence of lifetime PTSD, mood, anxiety disorders, and to a lesser extent, substance abuse disorders, was observed in offspring of Holocaust survivors than controls. The presence of maternal PTSD was specifically associated with PTSD in adult offspring of Holocaust survivors. However, other psychiatric diagnoses did not show specific effects associated with maternal PTSD. CONCLUSION: The tendency for maternal PTSD to make a greater contribution than paternal PTSD to PTSD risk suggests that classic genetic mechanisms are not  the sole model of transmission, and paves way for the speculation that epigenetic factors may be involved. In contrast, PTSD in any parent contributes to risk for  depression, and parental traumatization is associated with increased anxiety disorders in offspring.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18281061 [PubMed - indexed for MEDLINE]

 

J Psychosoc Nurs Ment Health Serv. 2008 Oct;46(10):12; author reply 12, 53.

Veterans, PTSD, & access to care.

Reeves RR.

Publication Types:      Comment     Letter

PMID: 18935931 [PubMed - in process]

 

J Subst Abuse Treat. 2008 Oct;35(3):304-11. Epub 2008 Feb 21.

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment.

Killeen T, Hien D, Campbell A, Brown C, Hansen C, Jiang H, Kristman-Valente A, Neuenfeldt C, Rocz-de la Luz N, Sampson R, Suarez-Morales L, Wells E, Brigham G,  Nunes E.

Clinical Neuroscience, Medical University of South Carolina, Charleston, SC 29451, USA. killeent@musc.edu

A substantial number of women who enter substance abuse treatment have a history  of trauma and meet criteria for posttraumatic stress disorder (PTSD). Fear regarding the extent to which PTSD treatment can evoke negative consequences remains a research question. This study explored adverse events related to the implementation of an integrated treatment for women with trauma and substance use disorder (Seeking Safety) compared with a nontrauma-focused intervention (Women's Health Education). Three hundred fifty-three women enrolled in community substance abuse treatment were randomized to 1 of the 2 study groups and monitored weekly for adverse events. There were no differences between the two intervention groups in the number of women reporting study-related adverse events (28 [9.6%] for the Seeking Safety group and 21[7.2%] for the Women's Health Education group). Implementing PTSD treatment in substance abuse treatment programs appears to be safe, with minimal impact on intervention-related adverse  psychiatric and substance abuse symptoms. More research is needed on the efficacy of such interventions to improve outcomes of PTSD and substance use.

Publication Types:      Comparative Study     Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 18294804 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Oct;21(5):497-500.

A pilot study of meditation for mental health workers following Hurricane Katrina.

Waelde LC, Uddo M, Marquett R, Ropelato M, Freightman S, Pardo A, Salazar J.

Pacific Graduate School of Psychology, Redwood City, CA 94063, USA. lwaelde@pgsp.edu

This pilot study examined the effects of a manualized meditation intervention (called Inner Resources) for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms among 20 African American and Caucasian mental health workers in New Orleans beginning 10 weeks after Hurricane Katrina. They participated in a 4-hour workshop followed by an 8-week home study program. Complete follow-up data were available for 15 participants. Results of intention-to-treat analyses indicated that participants' PTSD and anxiety symptoms significantly decreased over the 8 weeks of the intervention; these improvements were significantly correlated with the total number of minutes of daily meditation practice. The majority of participants reported good treatment adherence and improvements in well-being. These findings suggest that meditation  may be a feasible, acceptable, and effective postdisaster intervention.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18956453 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):492-6.

Posttraumatic growth in adolescence: examining its components and relationship with PTSD.

Levine SZ, Laufer A, Hamama-Raz Y, Stein E, Solomon Z.

Department of Criminology, Bar Ilan University, Ramat Gan, Israel.

To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures  included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth  Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest  at moderate posttraumatic stress levels.

PMID: 18956452 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):471-8.

Avoidance symptoms and assessment of posttraumatic stress disorder in Arab immigrant women.

Norris AE, Aroian KJ.

College of Nursing, University of Central Florida, Orlando, FL 32816-2210, USA. anorris@mail.ucf.edu

This study investigates whether the avoidance symptom criterion required for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD) is overly conservative. Arab immigrant women (N = 453), many of whom reported experiencing multiple traumatic events, completed the Posttraumatic Diagnostic Scale in Arabic as part of a face to face interview. Analyses indicated all but one avoidance symptom was reported less frequently than reexperiencing and arousal symptoms. However, those who fully met reexperiencing, avoidance, and arousal symptom criteria had worse symptom severity and functioning than those who fully met reexperiencing and arousal symptom criteria, but only partially met avoidance symptom criterion. Study findings support importance of the PTSD avoidance symptom criterion.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18956451 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):433-9.

Noninferiority and equivalence designs: issues and implications for mental health research.

Greene CJ, Morland LA, Durkalski VL, Frueh BC.

National Center for PTSD-Pacific Islands Division, of Veterans Affairs Pacific Islands Healthcare System, Honolulu, HI 96819, USA. Carolyn.Greene3@va.gov

The terms noninferiority and equivalence are often used interchangeably to refer  to trials in which the primary objective is to show that a novel intervention is  as effective as the standard intervention. The use of these designs is becoming increasingly relevant to mental health research. Despite the fundamental importance of these designs, they are often poorly understood, improperly applied, and subsequently misinterpreted. In this article, the authors explain noninferiority and equivalence designs and key methodological and statistical considerations. Decision points in using these designs are discussed, such as choice of control condition, determination of the noninferiority margin, and calculation of sample size and power. With increasing utilization of these designs, it is critical that researchers understand the methodological issues, advantages, disadvantages, and related challenges.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18956449 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):487-91.

Adolescents' and parents' agreement on posttraumatic stress disorder symptoms and functioning after adolescent injury.

Ghesquiere A, Fan MY, Berliner L, Rivara FP, Jurkovich GJ, Russo J, Katon W, Zatzick DF.

Department of Psychiatry & Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104-2499, USA.

Few investigations have simultaneously assessed concordance between youth and parent ratings of posttraumatic stress disorder (PTSD) symptoms and functioning.  Randomly sampled adolescent injury survivors ages 12-18 and their parents were assessed on the inpatient ward and again at 2, 5, and 12-months postinjury (N = 99). Adolescent PTSD symptoms and functioning were rated by both adolescents and  parents. Parent PTSD was also assessed; 27% of parents endorsed symptoms consistent with a diagnosis of PTSD over the course of the year after adolescent  injury. The PTSD positive parents demonstrated significantly greater discordance  in ratings of adolescent PTSD symptoms, family cohesion, and mental health functioning. These findings suggest caution in clinical and policy applications of parental ratings of adolescent symptomatic and functional outcomes after injury.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, P.H.S.

PMID: 18956447 [PubMed - in process]

 

J Trauma Stress. 2008 Oct;21(5):455-62.

Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey.

Darves-Bornoz JM, Alonso J, de Girolamo G, de Graaf R, Haro JM, Kovess-Masfety V, Lepine JP, Nachbaur G, Negre-Pages L, Vilagut G, Gasquet I; ESEMeD/MHEDEA 2000 Investigators.

Collaborators: Alonso J, Angermeyer M, Bernert S, Bruffaerts R, Brugha TS, de Girolamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC,  Kovess V, Lépine JP, Ormel J, Vilagut G.

Hôpital Henri-Ey, 15 Avenue de la Porte de Choisy, 75013 Paris, France.

A potentially traumatic event (PTE) contributes to trauma through its frequency,  conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18956444 [PubMed - in process]

 

Memory. 2008 Oct;16(7):788-96.

"Hotspots" in trauma memories in the treatment of post-traumatic stress disorder: a replication.

Grey N, Holmes EA.

South London & Maudsley NHS Trust, King's College London, UK. n.grey@iop.kcl.ac.uk

"Hotspots" refer to memories of detailed moments of peak emotional distress during a traumatic event. This study investigates hotspot frequency, and the emotions and cognitions contained in hotspots of memory for trauma, to replicate  a previous study in this area (Holmes, Grey, & Young, 2005). Participants were patients receiving treatment for post-traumatic stress disorder (PTSD) at a specialist outpatient clinic after experiencing a range of traumatic events. The  main finding was that, after fear, the most common emotions reported were anger and sadness. Cognitions related to psychological threat to the self were more common than those related to physical threat.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18720224 [PubMed - indexed for MEDLINE]

 

Memory. 2008 Oct;16(7):669-77.

Does overgeneral autobiographical memory result from poor memory for task instructions?

Yanes PK, Roberts JE, Carlos EL.

University at Buffalo, The State University of New York, NY 14260, USA.

Considerable previous research has shown that retrieval of overgeneral autobiographical memories (OGM) is elevated among individuals suffering from various emotional disorders and those with a history of trauma. Although previous theories suggest that OGM serves the function of regulating acute negative affect, it is also possible that OGM results from difficulties in keeping the instruction set for the Autobiographical Memory Test (AMT) in working memory, or  what has been coined "secondary goal neglect" (Dalgleish, 2004). The present study tested whether OGM is associated with poor memory for the task's instruction set, and whether an instruction set reminder would improve memory specificity over repeated trials. Multilevel modelling data-analytic techniques demonstrated a significant relationship between poor recall of instruction set and probability of retrieving OGMs. Providing an instruction set reminder for the AMT relative to a control task's instruction set improved memory specificity immediately afterward.

Publication Types:      Randomized Controlled Trial

PMID: 18608978 [PubMed - indexed for MEDLINE]

 

Neuropsychopharmacology. 2008 Oct;33(11):2595-604. Epub 2008 Jan 9.

Variation in mouse basolateral amygdala volume is associated with differences in  stress reactivity and fear learning.

Yang RJ, Mozhui K, Karlsson RM, Cameron HA, Williams RW, Holmes A.

Section on Behavioral Science and Genetics, Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, NIH, Rockville, MD 20852-9411, USA.

A wealth of research identifies the amygdala as a key brain region mediating negative affect, and implicates amygdala dysfunction in the pathophysiology of anxiety disorders. Although there is a strong genetic component to anxiety disorders such as posttraumatic stress disorder (PTSD) there remains debate about whether abnormalities in amygdala function predispose to these disorders. In the  present study, groups of C57BL/6 x DBA/2 (B x D) recombinant inbred strains of mice were selected for differences in volume of the basolateral amygdala complex  (BLA). Strains with relatively small, medium, or large BLA volumes were compared  for Pavlovian fear learning and memory, anxiety-related behaviors, depression-related behavior, and glucocorticoid responses to stress. Strains with relatively small BLA exhibited stronger conditioned fear responses to both auditory tone and contextual stimuli, as compared to groups with larger BLA. The  small BLA group also showed significantly greater corticosterone responses to stress than the larger BLA groups. BLA volume did not predict clear differences in measures of anxiety-like behavior or depression-related behavior, other than greater locomotor inhibition to novelty in strains with smaller BLA. Neither striatal, hippocampal nor cerebellar volumes correlated significantly with any behavioral measure. The present data demonstrate a phenotype of enhanced fear conditioning and exaggerated glucocorticoid responses to stress associated with small BLA volume. This profile is reminiscent of the increased fear processing and stress reactivity that is associated with amygdala excitability and reduced amygdala volume in humans carrying loss of function polymorphisms in the serotonin transporter and monoamine oxidase A genes. Our study provides a unique  example of how natural variation in amygdala volume associates with specific fear- and stress-related phenotypes in rodents, and further supports the role of  amygdala dysfunction in anxiety disorders such as PTSD.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural     Research Support, N.I.H., Intramural

PMID: 18185497 [PubMed - in process]

 

Psychiatr Serv. 2008 Oct;59(10):1184-90.

Pharmacologic treatment of posttraumatic stress disorder among privately insured  Americans.

Harpaz-Rotem I, Rosenheck RA, Mohamed S, Desai RA.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA. ilan.harpaz-rotem@yale.edu

OBJECTIVE: Although psychological trauma affects millions of Americans, few studies have examined treatment of posttraumatic stress disorder (PTSD) in real-world service environments. This study explored pharmacological treatment of PTSD among privately insured individuals. METHODS: Data were from the MarketScan  database, which compiles claims from private health insurance plans nationwide. Descriptive statistics and multivariate logistic regression were used to identify predictors of any use of a psychotropic medication and use of three medication classes: antidepressants, anxiolytics or sedative-hypnotics, and antipsychotics.  RESULTS: Of 860,090 adult mental health care users in 2005, only 10,636 (1.2%) had a diagnosis of PTSD. Sixty percent of PTSD patients received any psychotropic medication: 74.3% of those received antidepressants, 73.7% received anxiolytics or sedative-hypnotics, and 21.3% received antipsychotics. Greater likelihood of any medication use was associated with greater use of mental health services and  with several comorbid psychiatric disorders. Having a comorbid diagnosis of an indicated disorder was the most robust predictor of use of each of the three medication classes: major depressive disorder and dysthymia were most strongly associated with antidepressant use, schizophrenia and bipolar disorder were associated with antipsychotic use, and anxiety disorders were associated with use of anxiolytics or sedative-hypnotics. CONCLUSIONS: Psychotropic medications were  frequently used in the treatment of PTSD among privately insured clients. Although use targeted specifically to PTSD and to comorbid disorders was common,  substantial use appeared to be unrelated to diagnosis and may be targeted at specific symptoms rather than diagnosed illnesses. Further research is needed to  determine symptom-specific responses to medications across diagnoses.

PMID: 18832505 [PubMed - in process]

 

Psychiatry. 2008 Fall;71(3):234-45.

Ethnic/Racial diversity and posttraumatic distress in the acute care medical setting.

Santos MR, Russo J, Aisenberg G, Uehara E, Ghesquiere A, Zatzick DF.

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98104, USA.

Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma-focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages  or compared variations in early posttraumatic distress in representative samples  of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non-English speaking with 16 languages represented. English speaking, inpatients  were screened for posttraumatic stress disorder, peritraumatic dissociative, and  depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%,  and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy-relevant clinical investigations that combine evidence-based treatments, bilingual/bicultural care-management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality  of mental health care for diverse injured trauma survivors.

Publication Types:      Comparative Study     Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 18834274 [PubMed - indexed for MEDLINE]

 

Psychol Med. 2008 Oct;38(10):1427-34. Epub 2008 Feb 7.

Complex trauma of war captivity: a prospective study of attachment and post-traumatic stress disorder.

Solomon Z, Dekel R, Mikulincer M.

The Adler Research Center for Child Welfare and Protection, Tel Aviv University,  Israel. Solomon@post.tau.ac.il

BACKGROUND: Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation. METHOD: The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were  assessed at two points in time, 18 years and 30 years after the war. RESULTS: Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted  later attachment better than early attachment predicted later PTSD symptoms. CONCLUSIONS: The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18257940 [PubMed - in process]

 

Psychol Med. 2008 Oct;38(10):1409-17. Epub 2008 Jan 4.

The relationship between trauma and beliefs about hearing voices: a study of psychiatric and non-psychiatric voice hearers.

Andrew EM, Gray NS, Snowden RJ.

Psychology Department, Royal Glamorgan Hospital, Llantrisant, UK. AndrewL1@cf.ac.uk

BACKGROUND: Cognitive models suggest that distress associated with auditory hallucinations is best understood in terms of beliefs about voices. What is less  clear is what factors govern such beliefs. This study aimed to explore the way in which traumatic life events contribute towards beliefs about voices and any associated distress. METHOD: The difference in the nature and prevalence of traumatic life events and associated psychological sequelae was compared in two groups of voice hearers: psychiatric voice hearers with predominantly negative beliefs about voices (PVH) and non-psychiatric voice hearers with predominantly positive beliefs about voices (NPVH). The data from the two groups were then combined in order to examine which factors could significantly account for the variance in beliefs about voices and therefore levels of distress. RESULTS: Both  groups reported a high prevalence of traumatic life events although significantly more PVH reported trauma symptoms sufficient for a diagnosis of post-traumatic stress disorder (PTSD). Furthermore, significantly more PVH reported experiencing childhood sexual abuse. Current trauma symptoms (re-experiencing, avoidance and hyperarousal) were found to be a significant predictor of beliefs about voices. Trauma variables accounted for a significant proportion of the variance in anxiety and depression. CONCLUSIONS: The results suggest that beliefs about voices may be at least partially understood in the context of traumatic life events.

PMID: 18177529 [PubMed - in process]

 

Psychol Rev. 2008 Oct;115(4):1084-98; discussion 1099-107.

Comment on:     Psychol Rev. 2008 Oct;115(4):985-1011.

Placing the mnemonic model in context: diagnostic, theoretical, and clinical considerations.

Monroe SM, Mineka S.

Department of Psychology, University of Notre Dame, Notre Dame, IN 46556, USA. smonroe1@nd.edu

The mnemonic model of posttraumatic stress disorder (PTSD) proposed by D. C. Rubin, D. Berntsen, and M. K. Bohni presents some provocative and potentially insightful ideas about this mental disorder. D. C. Rubin et al. suggested that PTSD is caused and maintained through a "pathogenic memory" (D. C. Rubin et al.,  2008, p. 985) of a negative event rather than by exposure to a traumatic event per se. The present authors examine the mnemonic model in the context of relevant diagnostic, theoretical, and clinical considerations. Specifically, to evaluate the arguments and evidence provided in support of the mnemonic model of PTSD, the present authors focus on 4 issues: (a) problems inherent with comparing a theoretical model (i.e., the mnemonic model) with a diagnostic model (i.e., the DSM-IV-TR model), (b) problems with not comparing the mnemonic model with relevant cognitive and memory models of PTSD, (c) problems with the degree to which the research reviewed provides support for the mnemonic model, and (d) concerns that memory in PTSD is confounded with the basic disorder, rather than causing PTSD. The present authors conclude with suggestions for future theory and research to help differentiate between memory's role in the origins of PTSD and memory's role in the clinical course of the disorder.

Publication Types:      Comment

PMID: 18954216 [PubMed - indexed for MEDLINE]

 

Psychol Rev. 2008 Oct;115(4):985-1011.

Comment in:     Psychol Rev. 2008 Oct;115(4):1084-98; discussion 1099-107.

A memory-based model of posttraumatic stress disorder: evaluating basic assumptions underlying the PTSD diagnosis.

Rubin DC, Berntsen D, Bohni MK.

Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA. david.rubin@duke.edu

In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can  have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate  with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Review

PMID: 18954211 [PubMed - indexed for MEDLINE]

 

Psychoneuroendocrinology. 2008 Oct;33(9):1183-97. Epub 2008 Jul 25.

TRH and TRH-like peptide expression in rat following episodic or continuous corticosterone.

Pekary AE, Sattin A, Blood J, Furst S.

Research Services, VA Greater Los Angeles Healthcare System, USA. Eugene.Pekary@va.gov

Sustained abnormalities of glucocorticoid levels have been associated with neuropsychiatric illnesses such as major depression, posttraumatic stress disorder (PTSD), panic disorder, and obsessive compulsive disorder. The pathophysiological effects of glucocorticoids may depend not only on the amount of glucocorticoid exposure but also on its temporal pattern, since it is well established that hormone receptors are down-regulated by continuously elevated cognate hormones. We have previously reported that TRH (pGlu-His-Pro-NH2) and TRH-like peptides (pGlu-X-Pro-NH2) have endogenous antidepressant-like properties and mediate or modulate the acute effects of a single i.p. injection of high dose corticosterone (CORT) in rats. For these reasons, two accepted methods for inducing chronic hyperglucocorticoidemia have been compared for their effects on  brain and peripheral tissue levels of TRH and TRH-like peptides in male, 250 g, Sprague-Dawley rats: (1) the dosing effect of CORT hemisuccinate in drinking water, and (2) s.c. slow-release pellets. Overall, there were 93% more significant changes in TRH and TRH-like peptide levels in brain and 111% more in  peripheral tissues of those rats ingesting various doses of CORT in drinking water compared to those with 1-3 s.c. pellets. We conclude that providing rats with CORT in drinking water is a convenient model for the pathophysiological effects of hyperglucocorticoidemia in rodents.

Publication Types:      Comparative Study     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18657370 [PubMed - indexed for MEDLINE]

 

Qual Health Res. 2008 Oct;18(10):1312-22.

Long-term effects of political violence: narrative inquiry across a 20-year period.

Dillenburger K, Fargas M, Akhonzada R.

School of Education, The Queen's University of Belfast, Belfast, United Kingdom.  k.dillenburger@qub.ac.uk

The study of long-term effects of political violence generally concentrates on effects of a single event or period of violence on individuals or groups of individuals and commonly relies on recollections from those who experienced violence a long time after the event. Against the backdrop of Northern Ireland's  Troubles, in this article we use narrative inquiry methodology to explore the long-term effects of violence across a 20-year period on a different level. Using two sets of interview data, one collected 20 years ago during a period of intense violence and the other collected recently, after the ceasefires when levels of community violence had decreased, we allow for comparisons of contemporaneous experiences and personal narratives that illustrate differences and similarities  across a 20-year period. Personal accounts of violent experiences, individual coping and psychological health, social support needs and provision, and political and cultural change mirrored fluctuating levels of community violence across time, showed growing levels of societal awareness of victims' issues and increasing levels of service provision, and illustrated the effects of postceasefire violence.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18832765 [PubMed - indexed for MEDLINE]

 

Rev Med Suisse. 2008 Oct 1;4(173):2115-9.

[Individual and community psychological consequences of terrorism]

[Article in French]

Carron PN, Vetter S, Reigner P, Yersin B.

Centre Interdisciplinaire des Urgences, CHUV, Lausanne. Pierre-Nicolas.Carron@chuv.ch

PMID: 18959081 [PubMed - indexed for MEDLINE]

 

Soc Sci Med. 2008 Oct;67(8):1208-16. Epub 2008 Jul 28.

The psychological impact of the Israel-Hezbollah War on Jews and Arabs in Israel: the impact of risk and resilience factors.

Palmieri PA, Canetti-Nisim D, Galea S, Johnson RJ, Hobfoll SE.

Summa Health System, Psychiatry, St. Thomas Hospital, 4th Floor, Ambulatory Care  Building, 444 North Main Street, Akron, OH 44310, USA. palmierp@summa-health.org

Although there is abundant evidence that mass traumas are associated with adverse mental health consequences, few studies have used nationally representative samples to examine the impact of war on civilians, and none have examined the impact of the Israel-Hezbollah War, which involved unprecedented levels of civilian trauma exposure from July 12 to August 14, 2006. The aims of this study  were to document probable post-traumatic stress disorder (PTSD), determined by the PTSD Symptom Scale and self-reported functional impairment, in Jewish and Arab residents of Israel immediately after the Israel-Hezbollah War and to assess potential risk and resilience factors. A telephone survey was conducted August 15-October 5, 2006, following the cessation of rocket attacks. Stratified random  sampling methods yielded a nationally representative population sample of 1200 adult Israeli residents. The rate of probable PTSD was 7.2%. Higher risk of probable PTSD was associated with being a woman, recent trauma exposure, economic loss, and higher psychosocial resource loss. Lower risk of probable PTSD was associated with higher education. The results suggest that economic and psychosocial resource loss, in addition to trauma exposure, have an impact on post-trauma functioning. Thus, interventions that bolster these resources might prove effective in alleviating civilian psychopathology during war.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18667263 [PubMed - in process]

 

Soc Sci Med. 2008 Oct;67(8):1199-207. Epub 2008 Jul 25.

Post-traumatic stress and psychiatric disorders in Palestinian adolescents following intifada-related injuries.

Khamis V.

College of Education, Department of Special Education, United Arab Emirates University, P.O. Box 17551, Al-Ain, Abu Dhabi, United Arab Emirates. vkhamis@uaeu.ac.ae

This study was designed to assess the occurrence of post-traumatic stress disorder (PTSD) and psychiatric disorders (i.e., anxiety and depression) in Palestinian adolescents following intifada-related injuries. It was hypothesized  that a combination of pre-trauma variables (e.g., age, geographic location), trauma-specific variables such as trauma recency, type of trauma (deliberately violent vs. accidental), and post-trauma variables (e.g., social support, coping  strategies, belief in fate) would be predictive of these psychological sequelae.  The participants were 179 boys who were injured during Al-Aqsa intifada and as a  result sustained a permanent physical disability. They ranged in age from 12 to 18 years (M=16.30, SD=1.64). Questionnaires were administered in an interview format with adolescents at home. Approximately 76.5% of the injured victims qualify as having PTSD and that the disorder had a heterogeneous course, with excess risk for chronic symptoms and comorbidity with other psychiatric disorders such as anxiety and depression. Among all the predictors in the PTSD, anxiety and depression models, only geographical location, fatalism, and negative coping were significant predictors. In conclusion, post-traumatic reactions and psychiatric disorders in adolescents involved in armed conflict injuries can persist for several months. Given the apparent significant relationship between psychological sequelae of intifada-related injuries and certain predictors (i.e., negative coping style and fatalism), treatments such as trauma-focused cognitive behaviour therapy may yield positive results. Negative coping and fatalism should be addressed more directly during therapy.

PMID: 18657343 [PubMed - in process]

 

J Pharm Biomed Anal. 2008 Sep 30. [Epub ahead of print]

Analytical methodologies for the determination of sertraline.

Bosch ME, Sánchez AJ, Rojas FS, Ojeda CB.

Department of Pharmacy, General Hospital, University Hospital "Virgen del Rocío", Manuel Siurot s/n, 41013 Sevilla, Spain.

Sertraline is a widely used antidepressant belonging to the selective serotonin reuptake inhibitor class; its efficacy has been demonstrated not only in the treatment of major depression, obsessive compulsive and panic disorders, but also for eating, premenstrual dysphoric and post-traumatic stress disorders. Several methods have been published for the determination of sertraline in pharmaceuticals, biological materials and environmental samples. The purpose of the current review is to provide a systematic survey of the latest analytical techniques for the determination of sertraline covering the period from 1987 until 2008.

PMID: 18980823 [PubMed - as supplied by publisher]

 

Psychiatry Res. 2008 Sep 30;160(3):327-34. Epub 2008 Aug 20.

Assessing reliability and validity of the Arabic language version of the Post-traumatic Diagnostic Scale (PDS) symptom items.

Norris AE, Aroian KJ.

Boston College, William F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 0246, United States. norrisa@bc.edu

Arab immigrant women are vulnerable to post-traumatic stress disorder (PTSD) because of gender, higher probability of being exposed to war-related violence, traditional cultural values, and immigration stressors. A valid and reliable screen is needed to assess PTSD incidence in this population. This study evaluated the reliability and validity of an Arabic language version of the symptom items in Foa et al.'s [Foa, E.B., Cashman, L., Jaycox, L., and Perry, K.  1997. The validation of a self report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale. Psychological Assessment 9(4), 445-451]. Post-traumatic Diagnostic Scale (PDS) in a sample of Arab immigrant women (n=453). Reliability was supported by Cronbach's alpha values for the Arabic language version (0.93) and its subscales (0.77-0.91). Results of group comparisons supported validity: Women who had lived in a refugee camp or emigrated from Iraq - a country where exposure to war and torture is common - were exhibiting depressive symptoms (Center for Epidemiological Studies-Depression Scale (CES-D) score above 18), or reported moderately to severely impaired functioning had significantly higher mean PDS total and symptom subscale scores than women who had not had these experiences or were not exhibiting depressive symptoms. Scores on the PDS and its subscales were also positively correlated with the Profile of Mood States (POMS) depression and anxiety subscales and negatively correlated with the POMS vigor subscale (r=-.29  to-.39).

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18718671 [PubMed - indexed for MEDLINE]

 

Law Hum Behav. 2008 Sep 26. [Epub ahead of print]

Correlates of Joining a Sexual Harassment Class Action.

Wright CV, Fitzgerald LF.

Summa-Kent State Center for the Treatment and Study of Traumatic Stress, 444 North Main St., Ambulatory Bldg, 4th Floor, Akron, OH, 44319, USA, wrightcv@summa-health.org.

Researchers have proposed a variety of factors that influence the decision to seek legal relief in response to sexual harassment, but have generally failed to  test these proposals empirically. The present study aims to address this gap by investigating the decision to join a class-action lawsuit. Participants were female professionals at a nationally based financial services firm, who either participated in or opted out of a sexual harassment class-action proceeding against the company. Five variables emerged as significant correlates of joining  the class: organizational climate, turnover, financial dependence, PTSD, and primary appraisal. Dominance analysis identified contextual factors as the most important correlate. Theoretical and practical implications for the role of these factors in joining a class action are discussed.

PMID: 18818993 [PubMed - as supplied by publisher]

 

BMC Psychiatry. 2008 Sep 19;8:81.

Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: a systematic review and meta-analysis.

Kornør H, Winje D, Ekeberg Ø, Weisaeth L, Kirkehei I, Johansen K, Steiro A.

Norwegian Knowledge Centre for the Health Services, Box 7004 St, Olavplass, 0130  Oslo, Norway. hege.kornor@fhi.no

BACKGROUND: Early trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD  in high risk populations. METHODS: We performed a systematic literature search in international electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, ISI and PILOTS) and included randomised controlled trials comparing TFCBT delivered within 3 months of trauma, to alternative interventions. All included studies were critically appraised using a standardised checklist. Two independent reviewers selected studies for inclusion and assessed study quality. Data extraction was performed by one reviewer and controlled by another. Where appropriate, we entered study results into meta-analyses. RESULTS: Seven articles reporting the results of five RCTs were included. All compared TFCBT to supportive counselling (SC). The study population was patients with acute stress  disorder (ASD) in four trials, and with a PTSD diagnosis disregarding the duration criterion in the fifth trial. The overall relative risk (RR) for a PTSD  diagnosis was 0.56 (95% CI 0.42 to 0.76), 1.09 (95% CI 0.46 to 2.61) and 0.73 (95% CI 0.51 to 1.04) at 3-6 months, 9 months and 3-4 years post treatment, respectively. A subgroup analysis of the four ASD studies only resulted in RR = 0.36 (95% CI 0.17 to 0.78) for PTSD at 3-6 months. Anxiety and depression scores  were generally lower in the TFCBT groups than in the SC groups. CONCLUSION: There is evidence for the effectiveness of TFCBT compared to SC in preventing chronic PTSD in patients with an initial ASD diagnosis. As this evidence originates from  one research team replications are necessary to assess generalisability. The evidence about the effectiveness of TFCBT in traumatised populations without an ASD diagnosis is insufficient.

PMID: 18801204 [PubMed - in process]

 

J Anxiety Disord. 2008 Sep 18. [Epub ahead of print]

Understanding the interpersonal impact of trauma: Contributions of PTSD and depression.

Beck JG, Grant DM, Clapp JD, Palyo SA.

Department of Psychology, University at Buffalo, SUNY, USA.

To build on the growing literature on interpersonal relationships among individuals with PTSD, this study examined the separate influences of PTSD symptoms and depression on functioning with friends, romantic partners, and family. To examine the influence of measurement, both interviewer-rated assessment of interpersonal functioning and self-reported assessment of perceived social support were included. The sample included 109 community members who sought help for mental health problems in the aftermath of a serious motor vehicle accident. Building on previous research, hierarchical regression models were used to examine the impact of re-experiencing, avoidance, emotional numbing, and hyperarousal on relationship functioning, followed by depression. Results suggest that assessment modality makes a difference in understanding factors contributing to interpersonal strain. When assessed by an interviewer, depression seems to play a larger role in interpersonal strain, relative to PTSD symptoms. When assessed via self-reported perceived social support, weaker associations were observed, which highlighted the role of emotional numbing. Results are discussed in light of the possible role that PTSD comorbidity with depression plays in interpersonal functioning following a traumatic event, with implications for future research.

PMID: 18986792 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2008 Sep 17. [Epub ahead of print]

Neuropsychological performance is related to current social and occupational functioning in veterans with posttraumatic stress disorder.

Geuze E, Vermetten E, de Kloet CS, Hijman R, Westenberg HG.

Research Centre-Military Mental Health, Ministry of Defense, Utrecht, The Netherlands.

Background: Several studies have reported deficits in both immediate and delayed  recall of verbal memory in patients with posttraumatic stress disorder (PTSD). However, most of these studies had several methodological disadvantages. None of  these studies assessed parameters related to social or occupational functioning.  Methods: Fifty Dutch veterans of UN peacekeeping missions (25 with PTSD and 25 without PTSD) were assessed with a comprehensive neuropsychological test battery  consisting of four subtests of the Wechsler Adult Intelligence Scale-III, California Verbal-Learning Test, and the Rey Auditory Verbal-Learning Test. Veterans with PTSD were free of medication and substance abuse. Results: Veterans with PTSD had similar total intelligence quotient scores compared to controls, but displayed deficits of figural and logical memory. Veterans with PTSD also performed significantly lower on measures of learning and immediate and delayed verbal memory. Memory performance accurately predicted current social and occupational functioning. Conclusions: Deficits of memory performance were displayed in a sample of medication- and substance abuse-free veterans with PTSD. Deficits in memory performance were not related to intelligence quotient, length  of trauma exposure, or time since trauma exposure. This study showed that cognitive performance accurately predicted current social and occupational functioning in veterans with PTSD. Depression and Anxiety 0:1-9, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 18800372 [PubMed - as supplied by publisher]

 

Depress Anxiety. 2008 Sep 17. [Epub ahead of print]

Acute stress reactions among medical and non-medical personnel in a general hospital under missile attacks.

Koren D, Caspi Y, Leiba R, Bloch D, Vexler B, Klein E.

Psychology Department, University of Haifa, Haifa, Israel.

Background: Recent mass level traumatic events further boosted the growing interest in understanding the effects of primary (direct) and secondary (indirect) traumatic exposure on "helping professionals." The objectives of this  study are: (1) to assess the rates and severity of PTSD symptoms (PS) among hospital workers operating under fire while treating war-related injured patients, (2) to explore the effect of PS on level of functioning in real time, and (3) to estimate the added effect of secondary traumatization over and above that of primary traumatization. Methods: Rates of PS, level of psychological distress, and level of functioning were assessed in 412 medical and non-medical personnel working in a hospital that was under missile attacks during the Second  Lebanon War in the summer of 2006. The Posttraumatic Stress Disorder Scale (PSS)  was used to assess severity of PS, as well as to estimate probable DSM-IV diagnosis of PTSD. Results: The mean number of reported PS was 8.6 (SD=4.4). Forty-three (10.2%) of the participants met the symptom and severity threshold for a probable diagnosis of PTSD, however only 13 of these 43 reported impaired level of functioning. There were no significant differences between personnel who had direct exposure to injured or traumatized casualties of the war and those who were not on PS severity and frequency of probable PTSD. Conclusions: These findings suggest that hospital workers operating under prolonged life-threatening conditions are at moderate risk for PTSD. However, they do not support an incremental effect of secondary traumatic exposure. Depression and Anxiety 0:1-6, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 18800369 [PubMed - as supplied by publisher]

 

Br J Clin Psychol. 2008 Sep 16. [Epub ahead of print]

The development of a clinically useful tool for predicting the development of psychological disorder following injury.

Mason S, Farrow TF, Fawbert D, Smith R, Bath PA, Hunter M, Woodruff PW, Turpin G.

Objectives To identify factors significantly associated with post-traumatic stress disorder (PTSD), anxiety, and depression at 3 months post-injury; to develop a generic model to predict the occurrence of PTSD, anxiety, and depression at 3 months post-injury; and to validate this model in a test data set of patients. Design Prospective cohort study. Methods Participants were 823 patients attending an emergency department (ED) following accidental injury. Baseline questionnaires were completed, with 1 and 3 months postal follow-ups. Predictor variables demonstrating significant associations with two of the three  outcome measures (3-month HAD anxiety and depression scores and PTSD symptoms) were included in multivariate regression models for each outcome. Non-significant predictor variables were removed until all remaining independent variables made the most significant contribution to each of the three models. Models were validated using a test dataset. Results Previous history of mental health problems, neuroticism score and having PTSD symptoms at 1 month predicted adverse outcomes at 3 months. When used on the test datasets, the areas under the receiver operating curve (ROC) curve for the models predicting outcomes at 3 months were: PTSD=0.91 (sensitivity=88.5%); anxiety=0.87 (sensitivity=93.7%); and depression=0.87 (sensitivity=96.7%). Conclusions The final model performed moderately well across the three outcomes and may be useful clinically as a generic rule-out tool to identify those who will not require follow up, watchful  waiting or intervention.

PMID: 18799023 [PubMed - as supplied by publisher]

 

Psychophysiology. 2008 Sep 16. [Epub ahead of print]

Event-related potentials to auditory stimuli in monozygotic twins discordant for  combat: Association with PTSD.

Metzger LJ, Clark CR, McFarlane AC, Veltmeyer MD, Lasko NB, Paige SR, Pitman RK,  Orr SP.

Veterans Affairs Medical Center, Manchester, New Hampshire, USA.

Studies have demonstrated ERP abnormalities related to concentration difficulties in post-traumatic stress disorder (PTSD). We used an identical-twin, case-control design to investigate whether these abnormalities reflect pre-trauma vulnerability or the acquired consequence of PTSD. Vietnam combat veterans and their non-combat-exposed, identical twins completed a three-tone oddball task. Veterans with PTSD had delayed target N2 latencies compared to veterans without PTSD. In a small nonmedicated, nonsmoking subsample, veterans with PTSD also had  significantly diminished target P3b amplitudes. A mixed-model, random-effects analysis on the nonmedicated, nonsmoking subsample that included the combat-unexposed co-twins showed a significant Diagnosis x Combat Exposure interaction for target P3b amplitude. Results replicate increased N2 latency and  diminished P3b amplitude in PTSD and suggest that diminished P3b amplitude is an  acquired condition in PTSD.

PMID: 18803598 [PubMed - as supplied by publisher]

 

Neurobiol Learn Mem. 2008 Sep 12. [Epub ahead of print]

Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men.

Tollenaar MS, Elzinga BM, Spinhoven P, Everaerd W.

Clinical, Health and Neuropsychology Unit, Institute for Psychological Research,  Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands.

BACKGROUND: While acute cortisol administration has been found to impair retrieval of emotional memories in healthy subjects, the duration of this memory  impairment is still unknown. Propranolol, on the other hand, may impair the reconsolidation of emotional memories during reactivation, although human studies examining such effects are scarce. The present investigation was therefore undertaken to examine the immediate and prolonged effects of a single administered dose of cortisol or propranolol on memory retrieval in a double-blind placebo controlled design. METHODS: Eighty-five healthy male participants were asked to retrieve previously learned emotional and neutral information after ingestion of 35mg cortisol, 80mg propranolol or placebo. After  a washout period of 1 week, recall was again tested. RESULTS: Memory retrieval of neutral and emotional information was impaired by a single dose of cortisol compared to placebo. The memory impairment due to cortisol remained, even after a washout period of 1 week. No immediate or prolonged effects of propranolol on memory retrieval were found, despite significant reductions in sympathetic arousal. CONCLUSIONS: These results lend support to the hypothesis that cortisol  is able to attenuate (emotional) memory recall in men over longer time spans and  may therefore augment the treatment of disorders like post-traumatic stress disorder and phobias, but do not clarify the mechanism(s) through which propranolol exerts its therapeutic effects.

PMID: 18761097 [PubMed - as supplied by publisher]

 

Br J Health Psychol. 2008 Sep 11. [Epub ahead of print]

A preliminary study of negative appraisals and dysfunctional coping associated with post-traumatic stress disorder symptoms following myocardial infarction.

Ayers S, Copland C, Dunmore E.

Objectives To investigate associations between post-traumatic stress disorder (PTSD) symptoms following myocardial infarction (MI) and subjective experience of MI, negative perception of consequences, negative appraisals of symptoms, and use of dysfunctional coping strategies, as described by Ehlers and Clark's (2000) model of PTSD. Design Cross-sectional questionnaire study of people who experienced a MI within the previous 12 weeks (N=74; 51% response rate). Methods  Participants completed questionnaires assessing PTSD symptoms, subjective experience of MI, perception of consequences, appraisal of symptoms, and dysfunctional coping strategies. Results Of the participants, 16% met DSM-IV criteria for PTSD and a further 18% reported moderate to severe PTSD symptoms. People with PTSD symptoms also had more somatic symptoms, anxiety, depression, and social dysfunction. PTSD symptoms were associated with perceived severity and danger of MI, a history of psychological problems, previous trauma, negative appraisal of symptoms, perceived severe consequences, and dysfunctional coping strategies. These variables were entered into a regression with MI and past history variables on Step 1, and appraisal and coping variables on Step 2. This showed that perceived consequences and dysfunctional coping were strongly associated with PTSD symptoms after controlling for MI and past history variables. Conclusion The results of this preliminary study suggest perception of consequences and dysfunctional coping may be important in PTSD symptoms following MI.

PMID: 18789186 [PubMed - as supplied by publisher]

 

Tidsskr Nor Laegeforen. 2008 Sep 11;128(17):1939-43.

[Tsunami--impact on survivors and next of kin]

[Article in Norwegian]

Ekeberg Ø, Skogstad L, Myhrer SH.

Akuttmedisinsk avdeling, Ullevål universitetssykehus, 0407 Oslo. oivind.ekeberg@uus.no

BACKGROUND: Survivors from the Tsunami in South East Asia 2004 and their next of  kin were examined during the first year after the event with respect to trauma, symptoms and function, and satisfaction with the help they had been offered. MATERIAL AND METHODS: Patients admitted to a surgical department (n = 20), patients self-selected to a psychiatric outpatient unit (n = 10) and relatives (n = 17) completed the anxiety and depression scale [HADS] (sumscore 0-21) and recorded posttraumatic symptoms in the Impact of Event Scale [IES] (sumscore 0-75) at one, three, eight and 13 months after the Tsunami. RESULTS: Both patients (IES scores fell from 31.7 to 22.7) and relatives (IES scores fell from  38.0 to 23.2) had lower levels of posttraumatic symptoms after 13 months. Patients' anxiety (HAD-scale) was reduced from 8.7 to 7.5 and depression (HAD-scale) from 9.5 to 7.3. For relatives, the corresponding figures were 8.2 to 5.4 for anxiety and 6.5 to 4.1 for depression. After 13 months, 45-65% of the patients had regained at least 80% of their normal function at work, in the family, with friends and during leisure time. 50% had been on sick leave for at least half a year, and 55% were still consulting a psychiatrist/psychologist. The satisfaction with follow-up from Norwegian authorities in the first phase was very low, but medical treatment and psychosocial follow-up in Norway afterwards received high scores. INTERPRETATION: Survivors after the Tsunami experienced substantial psychological distress at 13 months follow-up. Their relatives had similar levels of symptoms, but functioned better in general.

Publication Types:      English Abstract

PMID: 18787568 [PubMed - indexed for MEDLINE]

 

Aliment Pharmacol Ther. 2008 Sep 10. [Epub ahead of print]

Irritable bowel syndrome and dyspepsia among women veterans: prevalence and association with psychological distress.

Savas LS, White DL, Wieman M, Daci K, Fitzgerald S, Laday Smith S, Tan G, Graham  DP, Cully JA, El-Serag HB.

Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, TX, USA.

Background The burden of functional GI disorders and their associations with psychological distress in women veterans is unclear. Aim To examine one-year prevalence of IBS and dyspepsia symptoms and their associations with anxiety, depression and PTSD among women veterans receiving primary care at a Veteran Affairs Medical Center Women's Clinic Methods IBS, dyspepsia and psychological distress were assessed using the validated self-administered Bowel Disorder Questionnaire, the Beck Depression and Anxiety Inventories, as well as the Mississippi Scale for Combat-Related posttraumatic stress disorder (PTSD) questionnaire. Results. We enrolled 248 women (84% participation rate). Ninety-three (38%) reported IBS and 51 (21%) dyspepsia symptoms. Women with IBS and dyspepsia reported higher mean scores of anxiety (IBS: 24 vs. 12, p<.0005 and dyspepsia: 26 vs. 12, p <.0005), depression (IBS: 22 vs. 11, p=.0005 and dyspepsia: 23 vs. 11, p <.0005), and PTSD (IBS: 87 vs. 69, P<.001 and dyspepsia:  86 vs. 69, p <.0005). Age- and ethnicity-adjusted logistic regression analyses showed a 3- to 46-fold increase in odds of IBS and dyspepsia among women with anxiety, depression, or PTSD. Conclusions. Women veterans have high prevalence of IBS and dyspepsia symptoms, both of which are highly associated with presence of  depression, anxiety and PTSD.

PMID: 18785989 [PubMed - as supplied by publisher]

 

CMAJ. 2008 Sep 9;179(6):518-9.

Veterans' health system blazing trails.

Brooks JR.

Publication Types:      News

PMID: 18779523 [PubMed - indexed for MEDLINE]

 

Depress Anxiety. 2008 Sep 9. [Epub ahead of print]

Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder.

Rauch SA, Grunfeld TE, Yadin E, Cahill SP, Hembree E, Foa EB.

Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan.

Background: Postraumatic stress disorder (PTSD) is associated with significant health risk, illness, and functional impairment, e.g., Green and Kimerling [2004: Physical Health Consequences of Exposure to Extreme Stress. Washington, DC: American Phychological Association] Kimerling et al. [2000: Trauma and Health: J  Trauma Stress 13:115-128]. Methods: These analyses examined whether negative health perceptions and general social functioning change with treatment of chronic PTSD among women from a randomized controlled study comparing prolonged exposure (PE; n=48) or PE combined with cognitive restructuring (PE/CR; n=40) to  waitlist (n=19; Foa et al., 2005: J Consult Clin Psychol 73:953-964]. Results: Self- reported physical health difficulties were significantly reduced in the PE  and PE/CR conditions compared to the waitlist condition. These reductions did not demonstrate significant change during the 12 month follow-up period. Self-reported discomfort associated with physical health difficulties did not demonstrate significant change over treatment. No difference was detected between the active treatment and waitlist conditions. Both the PE and PE/CR groups reported improved social functioning at post treatment compared to the waitlist.  Additional improvement in general social functioning was found between 3 and 12 month follow-up assessments. Changes in PTSD and depressive symptoms over treatment accounted for 29% of the variance in reduction of reported health problems and 30% of the variance in improvement of general social functioning. Importantly, only changes in PTSD symptoms significantly contribute to the model  predicting change in physical health problems with depression associated only at  a trend level. However, collinearity between PTSD and depression makes interpretation difficult. Conclusions: Negative health perceptions and general social function improve with PE. Changes in depression and PTSD with treatment are related to these changes. Depression and Anxiety 0: 1-7, 2008. (c) 2008 Wiley-Liss, Inc.

PMID: 18781660 [PubMed - as supplied by publisher]

 

J Behav Ther Exp Psychiatry. 2008 Sep 9. [Epub ahead of print]

Individual differences in experiencing intrusive memories: The role of the ability to resist proactive interference.

Verwoerd J, Wessel I, de Jong PJ.

Department of Clinical and Developmental Psychology, University of Groningen, Grote Kruisstraat 2-1, 9712 TS Groningen, The Netherlands.

This study explored whether a relatively poor ability to resist or inhibit interference from irrelevant information in working memory is associated with experiencing undesirable intrusive memories. Non-selected participants (N=91) completed a self-report measure of intrusive memories, and carried out experimental tasks intended to measure two different types of inhibition: resistance to proactive interference and response inhibition (i.e., the ability to prevent automatically triggered responses). The results showed a significant relationship between inhibition at the cognitive level (i.e., resistance to proactive interference) and the frequency of intrusive memories (especially in the group of female participants) whereas no such relationship with measures of response inhibition emerged. These findings are consistent with the idea that deficient inhibitory control reflects a vulnerability factor for experiencing intrusive memories. Implications for research investigating risk factors for the  development of posttraumatic stress disorder (PTSD) are discussed.

PMID: 18929357 [PubMed - as supplied by publisher]

 

Acta Psychiatr Scand. 2008 Sep 8. [Epub ahead of print]

Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors.

Yehuda R, Schmeidler J, Labinsky E, Bell A, Morris A, Zemelman S, Grossman RA.

Division of Traumatic Stress Studies, Department of Psychiatry, Mount Sinai School of Medicine, New York, USA.

Objective: We performed a longitudinal study of holocaust survivors with and without post-traumatic stress disorder (PTSD) by assessing symptoms and other measures at two intervals, approximately 10 years apart. Method: The original cohort consisted of 63 community-dwelling subjects, of whom 40 were available for follow-up. Results: There was a general diminution in PTSD symptom severity over  time. However, in 10% of the subjects (n = 4), new instances of delayed onset PTSD developed between time 1 and time 2. Self-report ratings at both assessments revealed a worsening of trauma-related symptoms over time in persons without PTSD at time 1, but an improvement in those with PTSD at time 1. Conclusion: The findings suggest that a nuanced characterization of PTSD trajectory over time is  more reflective of PTSD symptomatology than simple diagnostic status at one time. The possibility of delayed onset trajectory complicates any simplistic overall trajectory summarizing the longitudinal course of PTSD.

PMID: 18785948 [PubMed - as supplied by publisher]

 

Nervenarzt. 2008 Sep 6. [Epub ahead of print]

[Psychological consequences of patient assaults on mental health staff : Prospective and retrospective data.]

[Article in German]

Richter D, Berger K.

LWL-Klinik Münster, Münster, Deutschland, dirk.richter@bfh.ch.

BACKGROUND: Psychological consequences of patient assaults on staff members have  rarely been examined with instruments established for post-traumatic stress disorder (PTSD) research. In prior studies, self-defined questionnaires and outcomes were used instead. METHODS: We conducted two studies, one prospective study with two follow-ups and one retrospective. Forty-six and 88 mental health care workers were interviewed, respectively, for psychological consequences after a patient assault. Validated instruments from post-traumatic stress disorder (PTSD) research were used (PCL-C, IES-R). RESULTS: In the first weeks following patient assault, 17% of respondents of the prospective study fulfilled the diagnostic criteria for PTSD according to DSM-IV. After further 2 and 6 months in the respective studies, the PTSD rates had decreased to 11%. In the retrospective study 3% of respondents still had a PTSD diagnosis on average 1.5 years after the assault. CONCLUSIONS: Patient assaults can cause PTSD in staff members of mental  health institutions. Institutions need to organise adequate care for their staff  affected by assault.

PMID: 18806980 [PubMed - as supplied by publisher]

 

JAMA. 2008 Sep 3;300(9):1011-3.

Katrina's mental health impact lingers: patients face shortages of facilities, clinicians.

Lamberg L.

Publication Types:      News

PMID: 18768406 [PubMed - indexed for MEDLINE]

 

Aging Ment Health. 2008 Sep;12(5):670-3.

Validation of a screening instrument for post-traumatic stress disorder in a clinical sample of older adults.

Hudson SA, Beckford LA, Jackson SD, Philpot MP.

Mental Health of Older Adults, South London & Maudsley NHS Foundation Trust, London, UK.

OBJECTIVES: To determine the diagnostic validity of the Post Traumatic Disorder Checklist (PCL) against the 'gold standard' of the Clinician Administered PTSD Scale (CAPS) in a clinical sample of older adults. METHODS: A cross-sectional validation study: participants were patients (65 years and over) being treated for medical and/or psychiatric conditions in a hospital setting. Participants completed the PCL, measures of mood, cognition, physical health, alcohol use and  the CAPS. A receiver operating characteristics curve was constructed to determine the optimal cut-point of the PCL. Analysis of variance was used to examine clinical differences between PTSD cases, sub-threshold cases and the remainder of the sample. RESULTS: Using the recommended cut-point of 50, the PCL had a sensitivity of 0.40, specificity of 0.97 and positive predictive value of 0.57. However, these values changed to 0.90, 0.87 and 0.45, respectively, when the optimal cut-point of 36 was used. CONCLUSION: With an adjusted cut-point the PCL  is an acceptable and brief screening instrument for PTSD in older adults.

PMID: 18855184 [PubMed - in process]

 

Aging Ment Health. 2008 Sep;12(5):630-8.

Diurnal cortisol patterns and stress reactivity in child Holocaust survivors reaching old age.

van der Hal-Van Raalte EA, Bakermans-Kranenburg MJ, van Ijzendoorn MH.

AMCHA-the National Israel Center for Psycho-Social Support of Survivors of the Holocaust and Second Generation, Israel.

OBJECTIVES: Late-life implications of early traumatic stress for the adreno-cortical system were examined in a sample of 133 child survivors of the Holocaust, who were subjected to Nazi persecution during infancy. METHOD: In a non-convenience sample of child survivors, born between 1935 and 1944, basal circadian cortisol release and cortisol reactivity to a stressor were assessed. RESULTS: Age, parental loss during the Holocaust, current depression, post-traumatic stress disorder (PTSD) and physical illness were not associated with differences in basal diurnal cortisol levels. Neuro-endocrine effects, however, were found in stress reactivity through elevated cortisol levels in male respondents in the youngest age group (born 1941-1945), and in male respondents suffering from PTSD-related functional impairment. CONCLUSION: The youngest survivors of Nazi persecution show late-life effects of traumatic stress during early childhood, evidenced by the early onset of differential neuroendocrine pathways to stress-regulating strategies.

PMID: 18855179 [PubMed - in process]

 

Am J Prev Med. 2008 Sep;35(3):314-6.

Comment in:     Am J Prev Med. 2008 Oct;35(4):398-400.

Recommendations to reduce psychological harm from traumatic events among children and adolescents.

Task Force on Community Preventive Services.

PMID: 18692746 [PubMed - indexed for MEDLINE]

 

Am J Prev Med. 2008 Sep;35(3):287-313.

Comment in:     Am J Prev Med. 2008 Oct;35(4):398-400.

The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review.

Wethington HR, Hahn RA, Fuqua-Whitley DS, Sipe TA, Crosby AE, Johnson RL, Liberman AM, Mościcki E, Price LN, Tuma FK, Kalra G, Chattopadhyay SK; Task Force on Community Preventive Services.

National Center for Health Marketing, CDC, Atlanta, Georgia 30333, USA.

Children and adolescents in the U.S. and worldwide are commonly exposed to traumatic events, yet practitioners treating these young people to reduce subsequent psychological harm may not be aware of-or use-interventions based on the best available evidence. This systematic review evaluated interventions commonly used to reduce psychological harm among children and adolescents exposed to traumatic events. Guide to Community Preventive Services (Community Guide) criteria were used to assess study design and execution. Meta-analyses were conducted, stratifying by traumatic exposures. Evaluated interventions were conducted in high-income economies, published up to March 2007. Subjects in studies were <or=21 years of age, exposed to individual/mass, intentional/unintentional, or manmade/natural traumatic events. The seven evaluated interventions were individual cognitive-behavioral therapy, group cognitive behavioral therapy, play therapy, art therapy, psychodynamic therapy, and pharmacologic therapy for symptomatic children and adolescents, and psychological debriefing, regardless of symptoms. The main outcome measures were  indices of depressive disorders, anxiety and posttraumatic stress disorder, internalizing and externalizing disorders, and suicidal behavior. Strong evidence (according to Community Guide rules) showed that individual and group cognitive-behavioral therapy can decrease psychological harm among symptomatic children and adolescents exposed to trauma. Evidence was insufficient to determine the effectiveness of play therapy, art therapy, pharmacologic therapy,  psychodynamic therapy, or psychological debriefing in reducing psychological harm. Personnel treating children and adolescents exposed to traumatic events should use interventions for which evidence of effectiveness is available, such as individual and group cognitive-behavior therapy. Interventions should be adapted for use in diverse populations and settings. Research should be pursued on the effectiveness of interventions for which evidence is currently insufficient.

Publication Types:      Research Support, Non-U.S. Gov't     Review

PMID: 18692745 [PubMed - indexed for MEDLINE]

 

Am J Prev Med. 2008 Sep;35(3):284-6.

Social and clinical interventions after conflict or other large disaster.

van Ommeren M, Morris J, Saxena S.

Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. vanommerenm@who.int

PMID: 18692744 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2008 Sep;98(9):1671-7. Epub 2008 Jul 16.

Mental health in Sumatra after the tsunami.

Frankenberg E, Friedman J, Gillespie T, Ingwersen N, Pynoos R, Rifai IU, Sikoki B, Steinberg A, Sumantri C, Suriastini W, Thomas D.

Duke University, Sanford Institute of Public Policy, 286 Rubenstein Hall, 302 Towerview Dr, Durham, NC 27708-0239, USA. e.frankenberg@duke.edu

OBJECTIVES: We assessed the levels and correlates of posttraumatic stress reactivity (PTSR) of more than 20,000 adult tsunami survivors by analyzing survey data from coastal Aceh and North Sumatra, Indonesia. METHODS: A population-representative sample of individuals interviewed before the tsunami was traced in 2005 to 2006. We constructed 2 scales measuring PTSR by using 7 symptom items from the Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version. One scale measured PTSR at the time of interview, and the other measured PTSR at the point of maximum intensity since the disaster. RESULTS: PTSR scores were highest for respondents from heavily damaged areas. In all areas, scores declined over time. Gender and age were significant predictors of PTSR; markers of socioeconomic status before the tsunami were not. Exposure to traumatic events, loss of kin, and property damage were significantly associated with higher PTSR scores. CONCLUSIONS: The tsunami produced posttraumatic stress reactions across a wide region of Aceh and North Sumatra. Public health will be enhanced by the provision of counseling services that reach not only people directly affected by the tsunami but also those living beyond the area of immediate impact.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18633091 [PubMed - indexed for MEDLINE]

 

Am J Public Health. 2008 Sep;98(9):1542; author reply 1542-3. Epub 2008 Jul  16.

Comment on:     Am J Public Health. 2008 Apr;98(4):714-20.

The case for postdeployment mental health screening was not made.

Rona RJ.

Publication Types:      Comment     Letter

PMID: 18633071 [PubMed - indexed for MEDLINE]

 

Ann Surg. 2008 Sep;248(3):429-37.

A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury.

Zatzick D, Jurkovich GJ, Rivara FP, Wang J, Fan MY, Joesch J, Mackenzie E.

Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. dzatzick@u.washington.edu

OBJECTIVE: To examine factors other than injury severity that are likely to influence functional outcomes after hospitalization for injury. SUMMARY BACKGROUND DATA: This study used data from the National Study on the Costs and Outcomes of Trauma investigation to examine the association between posttraumatic stress disorder (PTSD), depression, and return to work and the development of functional impairments after injury. METHOD: A total of 2707 surgical inpatients  who were representative of 9374 injured patients were recruited from 69 hospitals across the US. PTSD and depression were assessed at 12 months postinjury, as were the following functional outcomes: activities of daily living, health status, and return to usual major activities and work. Regression analyses assessed the associations between PTSD and depression and functional outcomes while adjusting  for clinical and demographic characteristics. RESULTS: At 12 months after injury, 20.7% of patients had PTSD and 6.6% had depression. Both disorders were independently associated with significant impairments across all functional outcomes. A dose-response relationship was observed, such that previously working patients with 1 disorder had a 3-fold increased odds of not returning to work 12  months after injury odds ratio = 3.20 95% (95% confidence interval = 2.46, 4.16), and patients with both disorders had a 5-6 fold increased odds of not returning to work after injury odds ratio = 5.57 (95% confidence interval = 2.51, 12.37) when compared with previously working patients without PTSD or depression. CONCLUSIONS: PTSD and depression occur frequently and are independently associated with enduring impairments after injury hospitalization. Early acute care interventions targeting these disorders have the potential to improve functional recovery after injury.

Publication Types:      Multicenter Study     Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, P.H.S.

PMID: 18791363 [PubMed - indexed for MEDLINE]

 

Arch Womens Ment Health. 2008 Sep;11(4):269-76. Epub 2008 Sep 2.

Adjustment to trauma exposure in refugee, displaced, and non-displaced Bosnian women.

Schmidt M, Kravic N, Ehlert U.

Department of Psychiatry, Outpatient Clinic for victims of torture and war, University Hospital Zurich, Culmannstrasse 8, Zurich, Switzerland.

The war in Bosnia resulted in the displacement of millions of civilians, most of  them women. Ten years after the civil war, many of them are still living as refugees in their country of origin or abroad. Research on different refugee groups has continuously reported persistent levels of posttraumatic stress disorder (PTSD) and other mental-health problems in this population. The present  study compared PTSD and self-concept in Bosnian refugee women (n = 29) with women who were internally displaced (IDP; n = 26) and non-displaced women (n = 32). Data were collected using the Bosnian Trauma Questionnaire and four scales assessing self-esteem, perceived incompetence, externality of control attribution, and persistence. IDPs scored significantly higher on PTSD symptoms,  externality of control attribution and perceived incompetence, and lower on self-esteem than both refugee and non-displaced women. The level of education most strongly predicted PTSD symptom severity, followed by the type of displacement, and exposure to violence during the war. Associations of self-concept with displacement and psychopathology were inconsistent, with type of displacement predicting control attributions but not other aspects of self-concept and PTSD symptoms being partly related to perceived incompetence and self-esteem. These results support previous findings stating that, in the long run, refugees show better mental health than IDPs, and that witnessing violence is a traumatic experience strongly linked to the development of PTSD symptoms. Results further indicate that education plays an important role in the development of PTSD symptoms. Associations of control attributions and type of displacement were found; these results have not been previously documented in literature.

PMID: 18802740 [PubMed - in process]

 

Aust N Z J Psychiatry. 2008 Sep;42(9):837-8.

Persisting visual phenomena following acute fear experiences: a possible visual state marker for post-traumatic stress disorder.

Tym R, Veness H, Beaumont P, Lioulios T, Corcoran J, O'Brien M, Crispin TL.

Publication Types:      Letter

PMID: 18705074 [PubMed - indexed for MEDLINE]

 

Behav Modif. 2008 Sep;32(5):611-21. Epub 2008 Feb 29.

Changes in women's sexual behavior following sexual assault.

Deliramich AN, Gray MJ.

University of Wyoming, USA.

The present study examines changes in women's sexual activity and behavior following sexual assault and the relationship between alcohol abuse and postassault promiscuity. Although many researchers have focused on avoidance of sexual activity following an assault, some have suggested that women may exhibit  an increase in sexual activity postassault. Such outcomes are not mutually exclusive possibilities but may instead reflect subtypes of sexual assault victims. A significant percentage of assault survivors did report increases in sexual activity following trauma. Assault survivors also reported increases in posttraumatic alcohol consumption relative to a comparison sample of motor vehicle accident survivors. In both groups, increases in posttraumatic alcohol usage predicted increases in posttraumatic sexual activity, suggesting that use of alcohol as a coping strategy may result in an increased likelihood of engaging in risky sexual behavior. If true, this maladaptive coping mechanism could help to account for some instances of revictimization.

Publication Types:      Comparative Study

PMID: 18310604 [PubMed - indexed for MEDLINE]

 

Behav Res Ther. 2008 Sep;46(9):1040-6. Epub 2008 Jun 27.

Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder.

Samuels JF, Bienvenu OJ, Pinto A, Murphy DL, Piacentini J, Rauch SL, Fyer AJ, Grados MA, Greenberg BD, Knowles JA, McCracken JT, Cullen B, Riddle MA, Rasmussen SA, Pauls DL, Liang KY, Hoehn-Saric R, Pulver AE, Nestadt G.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 4-181, Baltimore, MD 21287-7228, USA. jacks@jhmi.edu

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18692168 [PubMed - in process]

 

Behav Res Ther. 2008 Sep;46(9):993-1000. Epub 2008 Jun 27.

Are expressive suppression and cognitive reappraisal associated with stress-related symptoms?

Moore SA, Zoellner LA, Mollenholt N.

University of Washington, Department of Psychology, Seattle, WA, USA. sally.moore2@va.gov

Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we  examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was  associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally,  based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than  cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion  regulation strategies may not lead to changes in the other.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18687419 [PubMed - in process]

 

Behav Res Ther. 2008 Sep;46(9):1062-9. Epub 2008 Jun 28.

The utility of the A1 and A2 criteria in the diagnosis of PTSD.

Bedard-Gilligan M, Zoellner LA.

University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA. mab29@u.washington.edu

In the field of posttraumatic stress disorder (PTSD), the revisions to the DSM-IV definition of a potentially traumatic event are contentious. Proponents praise the subjective emphasis, while others contend that the changes to the criterion broadened the conceptualization of PTSD. This study examined the predictive utility of Criterion A events, examining the stressor (A1) and subjective emotional response (A2) components of the definition of a traumatic event. Rates  of Criterion A events and PTSD were calculated for three diverse samples, and predictive power, sensitivity, specificity, and ROC curves were computed to determine the predictive utility of Criterion A requirements for PTSD symptom, duration, and functional impairment diagnostic criteria. Across all samples, the  current Criterion A requirements did not predict much better than chance. Specifically, A2 reports added little to the predictive ability of an A1 stressor, though the absence of A2 predicted the absence of PTSD-related symptoms, their duration, and impairment. Notably, the combination of three A1 and A2 criteria showed the best prediction. Confronted events also showed less predictive ability than experienced events, with more variable performance across samples. These results raise fundamental questions about the threshold or "gate"  that Criterion A ought to play in our current nosology.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18675397 [PubMed - in process]

 

Behav Ther. 2008 Sep;39(3):262-76. Epub 2008 Mar 4.

The impact of pretrauma analogue GAD and posttraumatic emotional reactivity following exposure to the September 11 terrorist attacks: a longitudinal study.

Farach FJ, Mennin DS, Smith RL, Mandelbaum M.

Department of Psychology, Yale University, Box 208205, New Haven, CT 06520, USA.  francisco.farach@yale.edu

The relation between analogue generalized anxiety disorder (GAD) assessed the day before the events of September 11, 2001 (9/11) and long-term outcome was examined in 44 young adults who were directly exposed the following day to the terrorist attacks in New York City. After controlling for high exposure to the attacks, preattack analogue GAD was associated with greater social and work disability, loss of psychosocial resources, anxiety and mood symptoms, and worry, but not symptoms of posttraumatic stress, assessed 12 months after 9/11. Fear and avoidance of emotions assessed 4 months after 9/11 statistically mediated the relation between preattack analogue GAD and social and work disability, loss of psychosocial support, mood and anxiety symptoms, and worry at 12-month follow-up. Avoidance of emotions 4 months after 9/11 also mediated the relation between preattack analogue GAD and posttraumatic stress symptoms 12 months after 9/11.

PMID: 18721640 [PubMed - indexed for MEDLINE]

 

Behav Ther. 2008 Sep;39(3):251-61. Epub 2008 Feb 1.

An experimental investigation of the effect of worry on responses to a discrimination learning task.

Salters-Pedneault K, Suvak M, Roemer L.

National Center for PTSD, Behavioral Sciences Division, VA Boston HealthcareSystem (116B-5), 150 South HuntingtonAvenue, Boston, MA 02130, USA. kristalyn.salters@va.gov

The current study examined the impact of both the tendency to worry (trait worry) and the process of worry (state worry) on subsequent behavioral responding in a schedule discrimination learning task. High and low trait worriers were randomly  assigned to a state worry or relaxation incubation condition and completed a test of executive functioning and a dual contingency learning task that utilized neutral discriminative cues over the course of 2 contingency phases. Although state and trait worry did not impact executive functioning, the state worry condition was associated with diminished sensitivity to learning task contingencies over the course of the first contingency learning trials in comparison to the relaxation condition. This relationship was unique to the state worry condition above and beyond shared variance with subjective anxiety level. Results suggest that state worry may lead to a decrement in selective behavioral  responding to neutral discriminative cues in the environment. The findings suggest that the process of worry may lead to less adaptive responding to neutral cues and interfere with adaptive behaviors, which may thereby contribute to and maintain anxiety.

Publication Types:      Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 18721639 [PubMed - indexed for MEDLINE]

 

Behav Ther. 2008 Sep;39(3):232-41. Epub 2008 Jan 29.

The relative contribution of abuse severity and PTSD severity on the psychiatric  and social morbidity of battered women in shelters.

Johnson DM, Zlotnick C, Perez S.

Summa-Kent State Center for the Treatment and Study of Traumatic Stress, Akron, OH 44310, USA. johnsod@summahealth.org

Intimate partner violence (IPV) is a severe health problem associated with significant distress and impairment in women. The most common psychiatric difficulty in battered women is posttraumatic stress disorder (PTSD); however, no research to date has investigated the relative impact of the severity of IPV and  IPV-related PTSD symptoms on battered women's psychosocial functioning. In a sample of 177 sheltered battered women, PTSD severity was associated with considerable psychiatric morbidity, social maladjustment, and personal and social resource loss. Moreover, PTSD severity mediated the relationship between IPV severity and psychiatric severity and loss of personal and social resources. Results highlight the need for the assessment and treatment of IPV-related PTSD in battered women's shelters.

Publication Types:      Multicenter Study     Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18721637 [PubMed - indexed for MEDLINE]

 

Br J Clin Psychol. 2008 Sep;47(Pt 3):295-302. Epub 2008 Feb 2.

Low rates of PTSD in men attending childbirth: a preliminary study.

Bradley R, Slade P, Leviston A.

Department of Clinical Psychology, Derbyshire Children's Hospital, Derby, UK.

OBJECTIVES: To investigate whether men experience symptoms of post-traumatic stress disorder (PTSD) after attending their partner's labour and delivery and the prevalence and predictors of symptoms of PTSD, anxiety, and depression. DESIGN: This quantitative study involved a large sample, within-participants design with questionnaires completed at recruitment and six weeks follow-up. METHODS: Within 72 hours of attending their partner giving birth, 199 men provided demographic details and completed questions about their partner's pregnancy, labour and delivery. Six weeks later they completed a second questionnaire booklet containing measures of symptoms of post-traumatic stress, anxiety, and depression. RESULTS: No men reported symptoms at significant levels  on all three dimensions of PTSD (intrusions, avoidance, and hyperarousal) although 12% reported clinically significant symptoms on at least one dimension.  The dimension with the highest frequency was hyperarousal. Linear regression indicated more PTSD symptoms were predicted by trait anxiety, fewer children, the pregnancy being unplanned, being present at actual delivery, and feeling less confident about coping, less prepared, and more distressed during the process of  childbirth. Prevalence of clinically significant symptoms of depression and anxiety was 8 and 7%, respectively, and was predicted by higher trait anxiety. CONCLUSIONS: In this sample there was little evidence for the full constellation  of PTSD in men attending their partner giving birth. Using a trauma perspective in this context may not be supported. Those symptoms most commonly reported could be viewed primarily as anxiety and were linked with less previous experience of attending childbirth. Attendance at actual delivery was a key predictor of symptoms.

PMID: 18248694 [PubMed - indexed for MEDLINE]

 

Br J Clin Psychol. 2008 Sep;47(Pt 3):251-63. Epub 2007 Nov 24.

Behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis.

Vermunt LC, Buysse CM, Joosten KF, Hazelzet JA, Verhulst FC, Utens EM.

Sophia Children's Hospital, Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands.

OBJECTIVES: To assess the occurrence of a wide range of behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis (MSS). DESIGN: This study included  6- to 17-year-old patients who survived MSS and were admitted to the PICU of the  Medical Centre between 1988 and 2001. To assess behavioural, emotional, and post-traumatic stress problems, the Child Behaviour Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR) were used. METHODS:  Parents of 89 MSS children, aged 6-17 years, completed the CBCL. Teachers of 65 same-aged MSS children completed the TRF, and 45 11- to 17-year-old MSS children  completed the YSR. These data were compared with those from the normative reference groups. RESULTS: Overall, the proportions of MSS children scoring in the deviant range for problem behaviour were comparable to the proportions in the reference groups, according to parents', teachers', and self-reports. As to the level of emotional and behavioural problems, mothers of the MSS children reported more somatic complaints regarding their children in comparison with the reference groups. Severity of illness was not a significant predictor of behavioural, emotional, and post-traumatic stress problems. Age at the time of illness was a significant predictor of behavioural, emotional, and post-traumatic stress problems in MSS children, indicating that the younger the child at the time of illness, the more problems were reported by parents at follow-up. CONCLUSION: Overall, the results showed long-term behavioural, emotional, and post-traumatic  stress outcomes for MSS children, which were comparable to those in the general population.

Publication Types:      Comparative Study     Research Support, Non-U.S. Gov't

PMID: 18039432 [PubMed - indexed for MEDLINE]

 

Br J Psychiatry. 2008 Sep;193(3):254-5.

Verbal memory and treatment response in post-traumatic stress disorder.

Wild J, Gur RC.

King's College London, Department of Psychology, London SE5 8AF, UK. j.wild@iop.kcl.ac.uk

Post-traumatic stress disorder (PTSD) is often associated with verbal memory deficits, which could influence treatment outcome. We assessed neuropsychological functioning in individuals with PTSD and their response to cognitive-behavioural  therapy (CBT). Treatment non-responders had significantly poorer performance on measures of verbal memory compared with responders and demonstrated narrative encoding deficits. Differences were not explained by IQ, performance on tasks of  attention, initial PTSD severity, depression, time since trauma, or alcohol/substance misuse. Verbal memory deficits seem to diminish the effectiveness of CBT and should be considered in its implementation.

PMID: 18757989 [PubMed - in process]

 

Can J Psychiatry. 2008 Sep;53(9):594-600.

Posttraumatic stress disorder and health-related quality of life among a sample of treatment- and pension-seeking deployed Canadian Forces peacekeeping veterans.

Richardson JD, Long ME, Pedlar D, Elhai JD.

Department of Psychiatry, Univeristy of Western Ontario, London, Ontario. Don.Richardson@sjhc.london.on.ca

OBJECTIVES: To examine the health-related quality of life (HRQOL) in deployed Canadian Forces peacekeeping veterans, addressing associations with posttraumatic stress disorder (PTSD), and depression severity. METHODS: Participants (n = 125)  were consecutive male veterans who were referred for a psychiatric assessment. Instruments administered included the Clinician-Administered PTSD Scale, Hamilton Depression Scale, Short-Form-36 Health Survey, and sociodemographic characteristics. RESULTS: Mental HRQOL was significantly lower for peacekeepers with, than without, PTSD. Using univariate analyses, PTSD and depression severity were each significantly negatively related to mental HRQOL. In sequential regression analyses controlling for age, we found that PTSD and depression severity significantly predicted both mental and physical HRQOL. CONCLUSIONS: Veterans with PTSD have significant impairments in mental and physical HRQOL. This information is useful for clinicians and Veterans Affairs administrators working with the newer generation of veterans, as it stresses the importance of including measures of quality of life in the psychiatric evaluation of veterans to better address their rehabilitation needs.

PMID: 18801222 [PubMed - indexed for MEDLINE]

 

Child Psychiatry Hum Dev. 2008 Sep;39(3):247-60. Epub 2007 Oct 20.

Repressive adaptive style and self-reported psychological functioning in adolescent cancer survivors.

Erickson SJ, Gerstle M, Montague EQ.

Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA. erickson@unm.edu

Low levels of posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), and psychosocial distress have been reported in pediatric cancer survivors. One explanation is the relatively high prevalence of the repressive adaptive style (low distress, high restraint) in this population. We investigated the relationship between this adaptive style and PTSD, PTSS, and psychosocial functioning in 29 adolescent cancer survivors (12 through 18 years). Adolescents  categorized as repressors (n = 14) reported moderate/large effect size differences in PTSD, PTSS, and psychosocial distress (lower) as well as QOL (better) compared to non-repressors. Furthermore, repressors reported less PTSD and QOL variability. Thus, the repressive adaptive style, pronounced in this population, may obscure systematic and clinically meaningful adaptive style group differences across psychological measures.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 17952587 [PubMed - indexed for MEDLINE]

 

Clin Neuropsychol. 2008 Sep;22(5):879-95.

The effect of failure on cognitive and psychological symptom validity tests in litigants with symptoms of post-traumatic stress disorder.

Demakis GJ, Gervais RO, Rohling ML.

Department of Psychology, University of North Carolina at Charlotte, NC 29223-0001, USA. gdemakis@uncc.edu

This study examined the influence of performance on cognitive and psychological symptom validity tests on neuropsychological and psychological test performance in claimants evaluated in a medico-legal context (N = 301) with symptoms of PTSD. A second purpose of this study was to examine the influence of the severity of PTSD symptoms on cognitive test performance after excluding patients who failed to put forth adequate best effort and who exaggerated psychiatric symptoms. Patients were administered a battery of neuropsychological measures that were aggregated into a composite measure, the Cognitive-Test Battery Mean (C-TBM). Patients were also administered a battery of psychological tests that were aggregated into another composite measure, the Psychological-Test Battery Mean (P-TBM). We found that failure on cognitive symptom validity tests was associated with significantly poorer neuropsychological functioning, but there was not a significant effect on psychological symptoms. Conversely, failure on psychological symptom validity tests was associated with higher levels of psychopathology, but there was not a significant effect on cognitive ability. Finally, once patients were screened for adequate effort and genuine symptom reporting, the severity of PTSD symptoms did not appear to influence cognitive ability. This is the first study that assessed both types of symptom validity testing in PTSD claimants, which is important given that previous literature has  demonstrated cognitive impairment in PTSD and that individuals with PTSD tend to  claim cognitive impairment. Implications of these findings are discussed with regard to the existing literature and the relationship between these two types of symptom validity tests.

Publication Types:      Clinical Trial

PMID: 18756390 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 Sep-Oct;49(5):430-40. Epub 2008 Mar 28.

Comorbidity in posttraumatic stress disorder: a structural equation modelling approach.

Wittmann L, Moergeli H, Martin-Soelch C, Znoj H, Schnyder U.

Department of Psychiatry, University Hospital, CH-8091 Zurich, Switzerland. lutz.wittmann@usz.ch

OBJECTIVE: Posttraumatic stress disorder (PTSD) is associated with high rates of  psychiatric comorbidity. Existing theories consider comorbidity as a consequence  of PTSD (model 1), PTSD and comorbidity as a consequence of shared factors of vulnerability (model 2), and comorbidity as a consequence of trauma-type specific mechanisms (model 3). METHOD: To compare the explanatory value of these models, we assessed PTSD (model 1), sense of coherence (model 2) and satisfaction with health (model 3) and symptoms of anxiety and depression as indicators of comorbidity 5 days (t1) and 6 months (t2) postaccident in 225 injured accident survivors. Structural equation models representing models 1 to 3 were tested separately and combined. RESULTS: Combined, models 1 and 3 explained 82% of the variance of comorbid symptoms at t2. Posttraumatic stress disorder and satisfaction with health (t2) exerted strong influences on comorbid symptoms. CONCLUSION: Comorbidity besides PTSD is best described by an integration of competing explanatory models.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18702929 [PubMed - indexed for MEDLINE]

 

Cult Med Psychiatry. 2008 Sep;32(3):440-57.

Traumatic amputation: a case of Laotian indignation and injustice.

Dinh NM, Groleau D.

Department of Psychology, University of Montreal, Montreal, QC, Canada. mhn.dinh@umontreal.ca

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they  relieve patient distress by allowing the patient to create meaning for symptoms.  Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation  of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation ("Kwam khem keuang") as an explanatory model for his ailment.  He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of  the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient's perspective offers a reflexive stance on the clinician-patient interaction that allows for better patient care.

Publication Types:      Case Reports

PMID: 18561003 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2008 Sep;21(5):505-9.

Suicidality among police.

Stuart H.

Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada. heather.stuart@queensu.ca

PURPOSE OF REVIEW: This paper reviews recent international literature on suicide  among police officers. RECENT FINDINGS: Research examining the incidence and prevalence of suicide and suicidality among police, particularly the extent to which they constitute a high-risk group, has produced conflicting results. Police appear to be at greater risk of posttraumatic stress reactions (resulting from higher exposures to trauma) and job burnout (resulting from the way in which police work is organized), both of which increase the risk of psychosocial problems and suicide. SUMMARY: Though worker suicide is the result of a complex interaction of personal vulnerabilities, workplace stressors, and environmental factors, research into police suicide has largely emphasized only two of these components: workplace trauma as a determinant of posttraumatic stress reactions;  and organizational stressors as a determinant of job stress and burnout. Personality factors and coping styles have received less attention and there have been few attempts to understand the complex interactions between all of these factors. Prevention strategies have focused on psychological debriefing for traumatic incidents and organizational change designed to improve job commitment  and reduce job burnout.

Publication Types:      Review

PMID: 18650696 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2008 Sep;21(5):499-504.

Child sexual abuse in clinical and forensic psychiatry: a review of recent literature.

Werner J, Werner MC.

Medical School, Fluminense Federal University (UFF), Forensic Psychiatry, Rio de  Janeiro State Public Prosecutor's Office (MPRJ), Rio de Janeiro School of Judges  (EMERJ), Rio de Janeiro, Brazil. jairowerner@globo.com

PURPOSE OF REVIEW: To review papers from the recent literature on child sexual abuse and to highlight the clinical and forensic issues raised and how these have been addressed. Also, to identify new demands and recommend future research. RECENT FINDINGS: The validity of forensic evaluations depends on the quality of the protocols used and the training of the forensic mental health practitioners involved. Diagnosis of child sexual abuse still depends mainly on the child's allegation of abuse, while anogenital examination yields minimal medical evidence of sexual abuse. The relationship between child sexual abuse and victims' mental  health is increasingly being proven, underlining the importance of correct clinical and forensic diagnosis of abuse to permit preventive, therapeutic and legal measures. Sexual offences via the internet have raised new demands. SUMMARY: Forensic child and adolescent practitioners need to be very highly trained. Evaluation of sexually abused children and adolescents must be accurate  to ensure legal validity and be performed with diligence so that alleged victims  do not experience recurrence. Practitioners' actions must be referenced against appropriate instruments and they must be prepared for the ethical and forensic dilemmas and new demands that arise in this field.

Publication Types:      Review

PMID: 18650695 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2008 Sep;21(5):445-8.

Traumatic experiences and life events in people with intellectual disability.

Martorell A, Tsakanikos E.

Fundación Carmen Pardo-Valcarce, Spain. almudena.martorell@fcpv.es

PURPOSE OF REVIEW: The aim of this article is to present and critically evaluate  recent research on life events and traumatic experiences as predictors of psychopathology in people with intellectual disability. RECENT FINDINGS: The area has not developed significantly in the last years. Although life events have been associated with a range of mental health problems, only few studies have tried to clarify their role in psychopathology. It is often the case that differences between life events and traumatic experiences have been overlooked, mainly because establishing a clear cut-off point between the two types of events is not always possible. In addition, traumatic experiences per se, and as potential predictors of psychopathology, have been scarcely investigated in people with intellectual disability. SUMMARY: The role of recent life events and traumatic experiences across the life-span of people with intellectual disability deserves  more research. An outstanding question is whether these events are risk factors or triggering factors, as well as how to differentiate between traumatic and life events. Identifying possible protective factors for mental health seems to be a very promising line for future research with important clinical implications.

Publication Types:      Research Support, Non-U.S. Gov't     Review

PMID: 18650684 [PubMed - indexed for MEDLINE]

 

Encephale. 2008 Sep;34(4):419-26. Epub 2007 Dec 3.

[Clarifying the definition of bullying]

[Article in French]

Bonafons C, Jehel L, Hirigoyen MF, Coroller-Béquet A.

bonafons.claire@free.fr

INTRODUCTION: Bullying is a much discussed and studied concept and yet there is a huge amount of terms and definitions that describe it. The lack of unity and precision around bullying raises several questions, notably in the judicial field. Indeed, how can judges determine if a given situation comes close to bullying or not if they do not have a precise definition of what bullying consists in? The French law attempts to clarify this concept, but it still remains vague on several points, highlighting the effects of bullying without explaining its causes and nature. OBJECTIVE: This study aims at providing further precisions on the definition and bases itself on the analysis of law cases. These show which criteria the judges use to determine if the victim has been bullied or not. METHOD: In this study, we used the judgments published on the website of the French ministry of justice in which a situation of bullying had been proven. Seventy-two percent of the victims were women whereas 75% of the perpetrators were men. RESULTS: The great majority (91%) of the persons convicted of bullying  had a higher hierarchical position than their victims. No case from a subordinate to a superior could be found. Nine percent of the cases were bullying between colleagues. The average seniority was 15 years. The facts that influence the judges' decisions are always dignity-undermining facts, which are frequently combined with an alteration in the victim's health, an endangering of the victim's career and, less often, with the non-respect of the worker's rights. Dignity-undermining consists in humiliations (in 61% of the cases), insults or discourteous comments (27%), disrepute of the victim's work (24%), unjustified sanctions or reproaches, attacks on private life (15%), isolation (15%) and overload of work (12%). In half of the cases, alteration in health is held as the consequence of bullying. The judges mention some anxiodepressive syndroms or psychological problems without providing any supplementary details. No PTSD-like  symptomatology has, for now, been mentioned although since the end of the 1990s,  the relationship between bullying and clinical symptoms of PTSD has been proven by many researchers. In 31% of the cases, the judges mention some facts that endanger the victim's career and in 20%, the worker's rights have not been respected (wages not paid...). DISCUSSION: Very often, the judges use some other  criteria related to the conditions which caused the appearance of bullying, to the kind of bullying the victim had to face and to the circumstances that enabled the situation to continue. Moreover, the judges try to determine if the negative  acts described above have been repeated in time. The average number of the facts  that influence the judges to determine if a situation is or is not a bullying situation is seven. The criterion related to the conjunction of different kinds of consequences (dignity undermining, non-respect of rights, alteration in health and endangering the professional future) is found in 90% of the cases. The duration of bullying does not seem to be a determining factor. The shortest length we found was six months and the average was three years. The judges nearly always refer to written documents (medical certificates, affidavits by colleagues or former employees, contracts of employment, internal documents, etc.) that must be detailed and in agreement.

Publication Types:      English Abstract

PMID: 18922246 [PubMed - indexed for MEDLINE]

 

Environ Health Perspect. 2008 Sep;116(9):1248-53.

Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster.

Stellman JM, Smith RP, Katz CL, Sharma V, Charney DS, Herbert R, Moline J, Luft BJ, Markowitz S, Udasin I, Harrison D, Baron S, Landrigan PJ, Levin SM, Southwick S.

Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.

BACKGROUND: The World Trade Center (WTC) attacks exposed thousands of workers to  hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. OBJECTIVES:  Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children. METHODS: Ten to 61 months  after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. RESULTS: Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder,  and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. CONCLUSIONS: Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and  treatment programs continue to be needed.

Publication Types:      Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, P.H.S.

PMID: 18795171 [PubMed - indexed for MEDLINE]

 

Eur Neuropsychopharmacol. 2008 Sep;18(9):653-66. Epub 2008 Jun 5.

Brief post-stressor treatment with pregabalin in an animal model for PTSD: short-term anxiolytic effects without long-term anxiogenic effect.

Zohar J, Matar MA, Ifergane G, Kaplan Z, Cohen H.

The Chaim Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Israel.

BACKGROUND: The short- and long-term behavioral effects of a brief course of pregabalin, an antiepileptic structural analogue of alpha-aminobyturic acid with  analgesic and anxiolytic effects, were assessed in an animal model of post-traumatic stress disorder (PTSD). METHOD: Two-hundred thirty-three adult male Sprague-Dawley rats were employed. Behavioral responses to traumatic stress  exposure (predator urine scent) were assessed immediately after (1 h) and 30 days after treatment with saline or pregabalin (at doses of 30, 100 and 300 mg/kg) in  terms of behavior in the elevated plus maze (EPM) and the acoustic startle response (ASR) paradigms. At day 31 the freezing response to a trauma cue (clean  cat litter) was assessed. The same treatment regimen initiated at day 7 was assessed at day 30 and in response to the trauma cue on day 31 in a separate experiment. RESULTS: In the short term, doses of 100 mg/kg and 300 mg/kg of pregabalin effectively attenuated anxiety-like behaviors. In the longer-term, pregabalin did not attenuate the onset of PTSD-like behaviors or the prevalence rates of severe cue-responses, for either the immediate or the delayed treatment  regimens. CONCLUSION: Pregabalin may present an alternative compound for acute anxiolytic treatment after exposure to trauma, but has no long-term protective/preventive effects.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18534828 [PubMed - indexed for MEDLINE]

 

Eur Psychiatry. 2008 Sep;23(6):434-40. Epub 2008 Apr 18.

Psychiatric disorders after an accident: predictors and the influence of the psychiatric condition prior to an accident.

Wrenger M, Lange C, Langer M, Heuft G, Burgmer M.

Department of Psychosomatics and Psychotherapy, University Hospital Münster, Domagkstrasse 22, D-48149 Münster, Germany. marco.wrenger@ukmuenster.de

BACKGROUND: The goal of this study is to assess prevalence and incidence of psychiatric sequelae in a sample of inpatient accident survivors. Such an attempt to assess psychiatric conditions that originate due to an accident seems to be important; this does not include psychiatric conditions already present prior to  the accident. METHOD: 208 accident victims were consecutively examined over a period of 12months using DSM-IV diagnostic assessment, CAPS, and self-evaluating  questionnaires as well as ISS for injury severity. A predictor model for psychiatric disorders was set up. RESULTS: Incidence of newly developed Axis I disorders in our sample was 14.2% (6months) and 12.3% (12months). Incidence of PTSD was 5.9% (6months) and 2.5% (12months). Comorbidity was a general phenomenon. The psychiatric condition prior to the accident could be identified as a predictor for the development of Axis I disorders. The subjectively evaluated intensity of experienced threat to life and female gender were the main predictors for the development of PTSD. CONCLUSIONS: Accidents can lead to different psychiatric disorders. PTSD as a single diagnosis is rare. Without taking into account pre-existing disorders, the incidence may be overestimated. Two predictor models for the development of PTSD and other mental disorders are presented.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18374545 [PubMed - in process]

 

Gen Hosp Psychiatry. 2008 Sep-Oct;30(5):421-34. Epub 2008 Jul 30.

Posttraumatic stress disorder in general intensive care unit survivors: a systematic review.

Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ.

Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Box 356896, Seattle, WA 98104, USA.  ddavydo1@u.washington.edu

OBJECTIVE: Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD and the impact of post-ICU PTSD on health-related quality of life (HRQOL). METHODS: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO and a hand-search of 13 journals. RESULTS: Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained "clinically significant" PTSD symptoms was 22% (n=1,104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n=93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex  and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL. CONCLUSIONS: The prevalence of PTSD in ICU survivors is high and negatively impacts survivors' HRQOL. Future studies should comprehensively address how patient-specific factors (e.g., pre-ICU psychopathology), ICU management factors (e.g., administration of sedatives) and ICU clinical factors (e.g., in-ICU delirium) relate to one another and to post-ICU PTSD. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients' needs for early intervention.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18774425 [PubMed - in process]

 

Gen Hosp Psychiatry. 2008 Sep-Oct;30(5):391-7. Epub 2008 Jul 23.

Test of a single-item posttraumatic stress disorder screener in a military primary care setting.

Gore KL, Engel CC, Freed MC, Liu X, Armstrong DW 3rd.

Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA. kristie.gore@amedd.army.mil

BACKGROUND: Posttraumatic stress disorder (PTSD) is prevalent in primary care, frequently goes undetected and can be highly debilitating when untreated. OBJECTIVE: We assessed the operating characteristics of a single-item PTSD screener (SIPS) for primary care and compared it to a commonly used four-item primary care PTSD screener (PC-PTSD). The SIPS asks: "Were you recently bothered  by a past experience that caused you to believe you would be injured or killed ... not bothered, bothered a little, or bothered a lot?" METHODS: A total of 3,234 patients from three Washington, DC, area military primary care clinics completed the SIPS. Independent, blinded assessments using a structured diagnostic PTSD interview were completed in 213 of these patients. RESULTS: The SIPS yielded a reasonable range of likelihood ratios, suggesting capacity to discriminate between low- and high-probability PTSD patients. However, the SIPS sensitivity was only 76% for those reporting "bothered a little" and the four-item PC-PTSD yielded significantly better test characteristics on Receiver-Operator Curve analysis. CONCLUSION: A single, user-friendly primary care PTSD screening question with three response options, while sensible and worth further investigation, failed to offer sound test characteristics for PTSD  screening. Ways of improving SIPS performance are discussed.

PMID: 18774421 [PubMed - in process]

 

Int Clin Psychopharmacol. 2008 Sep;23(5):299-303.

Effects of venlafaxine extended release on resilience in posttraumatic stress disorder: an item analysis of the Connor-Davidson Resilience Scale.

Davidson J, Baldwin DS, Stein DJ, Pedersen R, Ahmed S, Musgnung J, Benattia I, Rothbaum BO.

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Trent Drive, 4th floor, Room 4082B, Durham, NC 27710, USA. david011@mc.duke.edu

The aim was to evaluate the efficacy of venlafaxine extended release (ER) on characteristics of resilience, measured by the Connor-Davidson Resilience Scale,  in patients with posttraumatic stress disorder (PTSD). Data were evaluated from a randomized, 6-month, international, multicenter study of adult outpatients with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD for >or=6 months, and 17-item Clinician-Administered PTSD Scale score >or=60. Patients were assigned randomly to treatment with flexible-dose venlafaxine ER (37.5-300 mg/day) or placebo. Changes from baseline  scores and effect sizes of response to treatment with venlafaxine ER compared with placebo were computed for each item, as well as for the newly developed 2-item and 10-item subscales. Effect sizes across items ranged from 0.41 (moderate) to 0.08 (very weak). The effect size for the Resilience Scale-2 (2-item subscale) was 0.32, which was comparable to the effect sizes of 0.35 for  the 25-item full scale and 0.34 for the 10-item subscale. Venlafaxine ER improved resilience on individual Connor-Davidson Resilience Scale items that reflect four factors (hardiness, persistence/tenacity, social support, and faith in a benevolent or meaningful world), to varying degrees in patients with PTSD. The findings suggest that assessment of treatment response might be enhanced by routine evaluation of resilience.

Publication Types:      Multicenter Study     Randomized Controlled Trial     Research Support, Non-U.S. Gov't

PMID: 18703940 [PubMed - indexed for MEDLINE]

 

Int J Soc Psychiatry. 2008 Sep;54(5):425-36.

Complex sequelae of psychological trauma among Kosovar civilian war victims.

Morina N, Ford JD.

University of Frankfurt, Department of Psychology, Varrentrappstr. 40-42, D-60486 Frankfurt am Main, Germany. morina@psych.uni-frankfurt.de

AIMS: The impact of war trauma on civilians may include, but also extend beyond,  post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified  (DESNOS). METHODS: In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression. RESULTS: Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24-42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD. CONCLUSION: The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18786904 [PubMed - in process]

 

Int J Soc Psychiatry. 2008 Sep;54(5):414-24.

Prevalence of mental disorder and associated factors in civilian Guatemalans with disabilities caused by the internal armed conflict.

Herrera Rivera W, Mari Jde J, Andreoli SB, Quintana MI, Ferraz MP.

Department of Psychiatry, Paulista School of Medicine, Universidade Federal de São Paulo, Brazil. walter@psiquiatria.epm.br

BACKGROUND: The 34-year-long, Guatemalan war left at least 1,841 persons disabled in the country. The aim of this study was to describe the prevalence of mental disorders in individuals who acquired their disability as a result of the war, and to identify probable risk factors. METHOD: A cross-sectional study was conducted of a group of 99 civilians with a disability in Guatemala. Participants were selected from four civilian organizations serving disabled persons in the municipality of Nebaj, Quiche. The diagnostic instrument was the computerized version of the Composite International Diagnostic Instrument 2.1 (CIDI 2.1). Data were collected from 2002 to 2004. RESULTS: Of the 99 disabled persons who completed the interview, 44 had some type of lifetime psychiatric disorder. Post-traumatic stress disorder (PTSD) was the most prevalent, with 34.34% (34 cases), followed by dysthymia, with 10.10% (10 cases), and depression, with 6.06% (6 cases). CONCLUSION: The traumatic events experienced during the conflict caused long-term psychological sequelae in people who were disabled as a result of the war. Increased exposure to traumatic events, being married, physical disability, illiteracy and advanced age were identified as probable risk factors  for mental disorders .

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18786903 [PubMed - in process]

 

J Am Acad Child Adolesc Psychiatry. 2008 Sep;47(9):1048-62.

Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial.

Layne CM, Saltzman WR, Poppleton L, Burlingame GM, Pasalić A, Duraković E, Musić  M, Campara N, Dapo N, Arslanagić B, Steinberg AM, Pynoos RS.

UCLA National Center for Child Traumatic Stress, 11150 West Olympic Boulevard, Suite 650, Los Angeles, CA 90064, USA. CMLayne@mednet.ucla.edu

OBJECTIVE: To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group treatment (tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and  postwar adversity. METHOD: A total of 127 war-exposed and predominantly ethnic Muslim secondary school students attending 10 schools in central Bosnia who reported severe symptoms of posttraumatic stress disorder (PTSD), depression, or  maladaptive grief and significant impairment in school or relationships were randomly assigned to one of two experimental conditions. These included either an active-treatment comparison condition (tier 1), consisting of a classroom-based psychoeducation and skills intervention alone (n = 61, 66% girls, mean age 16.0 years, SD 1.13) or a treatment condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2), trauma and grief component therapy for adolescents (n = 66, 63% girls, mean age 15.9 years, SD 1.11). Both interventions were implemented throughout the school year. Distressed students who were excluded from the study due to acute risk for  harm (n = 9) were referred for community-based mental health services (tier 3). RESULTS: Program effectiveness was measured via reductions in symptoms of PTSD, depression, and maladaptive grief assessed at pretreatment, posttreatment, and 4-month follow-up. Analysis of mean-level treatment effects showed significant pre- to posttreatment and posttreatment to 4-month follow-up reductions in PTSD and depression symptoms in both the treatment and comparison conditions. Significant pre- to posttreatment reductions in maladaptive grief reactions were  found only in the treatment condition. Analyzed at the individual case level, the percentages of students in the treatment condition who reported significant (p <.05) pre- to posttreatment reductions in PTSD symptoms (58% at posttreatment, 81% at 4-month follow-up) compare favorably to those reported in controlled treatment efficacy trials, whereas the percentages who reported significant reductions in depression symptoms (23% at posttreatment, 61% at follow-up) are comparable to, or higher than, those found in community treatment settings. Lower but substantial percentages of significant symptom reduction were found for PTSD  (33% at posttreatment, 48% at follow-up) and depression symptoms (13% at posttreatment; 47% at follow-up) in students in the comparison condition. The odds of significant symptom reduction were higher for PTSD symptoms at both posttreatment and 4-month follow-up and for maladaptive grief at posttreatment (no follow-up was conducted on maladaptive grief). Rates of significantly worsened cases were generally rare in both the treatment and comparison conditions. CONCLUSIONS: A three-tiered, integrative mental health program composed of schoolwide dissemination of psychoeducation and coping skills (tier 1), specialized trauma- and grief-focused intervention for severely traumatized and traumatically bereaved youths (tier 2), and referral of youths at acute risk  for community-based mental health services (tier 3) constitutes an effective and  efficient method for promoting adolescent recovery in postwar settings.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18664995 [PubMed - in process]

 

J Am Board Fam Med. 2008 Sep-Oct;21(5):398-407.

Mental health conditions are associated with increased health care utilization among urban family medicine patients.

Fogarty CT, Sharma S, Chetty VK, Culpepper L.

Department of Family Medicine, University of Rochester, Highland Family Medicine, 777 South Clinton Avenue, Rochester, NY 14620, USA. colleen_fogarty@urmc.rochester.edu

PURPOSE: To assess the relationship between the presence of a mental health condition and health care utilization among family medicine patients. METHODS: We used the Patient Health Questionnaire plus a posttraumatic stress disorder screen to measure 6 common mental health conditions. In a sample of 367 patients recruited from 3 urban family medicine practices affiliated with Boston University Medical Center, we measured self-reported health care utilization of primary care provider visits, emergency department visits, nonpsychiatric hospitalizations, and outpatient mental health visits. We determined the association between screening positive for the mental health conditions and health care utilization using both multivariable logistic regression and Poisson  regression methods while controlling for sex, age, race, income, insurance status, marital status, educational level, and the presence of chronic medical conditions. RESULTS: After controlling for potential confounders, generalized anxiety disorder, panic disorder, and posttraumatic stress disorder were statistically significantly associated with more PCP visits, ED visits, and nonpsychiatric hospitalizations. Neither major nor minor depression were associated with more PCP visits, ED visits, or nonpsychiatric hospitalizations, except that minor depression was associated with 103% increase in PCP visits (P < .001). Alcohol use disorder was associated with 16% fewer PCP visits (P = .01) but 238% more nonpsychiatric hospitalizations (P < .001). CONCLUSIONS: After controlling for confounders we found that mental health conditions among a sample of family medicine patients were associated with increased use of ED services, nonpsychiatric hospitalizations, and, to a lesser extent, PCP visits.

Publication Types:      Comparative Study     Multicenter Study     Research Support, Non-U.S. Gov't

PMID: 18772294 [PubMed - indexed for MEDLINE]

 

J Anal Psychol. 2008 Sep;53(4):525-41.

The impact of trauma on the psyche of the individual using the film Belleville Rendez-vous as an illustrative vehicle.

Waldron S.

Using the film Belleville Rendez-vous as a vehicle for discussion, this paper argues that whilst a traumatic complex may bring about dissociation of the psyche, this is not the only possibility, nor is dissociation necessarily to be seen solely as a difficulty to be overcome. If trauma is experienced within the context of support and validation, the experience of trauma may generate integration not only of the trauma but also of the growth potential that the trauma has previously inhibited.

Publication Types:      Case Reports

PMID: 18844736 [PubMed - indexed for MEDLINE]

 

J Behav Ther Exp Psychiatry. 2008 Sep;39(3):250-61. Epub 2007 Jul 25.

Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis.

Parsons TD, Rizzo AA.

Institute for Creative Technologies, University of Southern California, 13274 Fiji Way, Office 301, Marina del Rey, CA 90292-4019, USA. tparsons@ict.usc.edu

Virtual reality exposure therapy (VRET) is an increasingly common treatment for anxiety and specific phobias. Lacking is a quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after VRET. Searches of electronic databases yielded 52 studies, and of these, 21 studies (300 subjects) met inclusion criteria. Although meta-analysis revealed large declines in anxiety symptoms following VRET, moderator analyses were limited due to inconsistent reporting in the VRET literature. This highlights the need for future research studies that report uniform and detailed information regarding presence, immersion, anxiety and/or phobia duration, and demographics.

Publication Types:      Meta-Analysis

PMID: 17720136 [PubMed - indexed for MEDLINE]

 

J Clin Nurs. 2008 Sep;17(17):2335-42.

Medium-term post-Katrina health sequelae among New Orleans residents: predictors  of poor mental and physical health.

Kim SC, Plumb R, Gredig QN, Rankin L, Taylor B.

School of Nursing, Point Loma Nazarene University, San Diego, CA 92106, USA. sonkim@pointloma.edu

AIMS: To assess the medium-term post-Katrina mental and physical health of New Orleans residents and to determine demographic, social and environmental factors  that predict poor mental and physical health. BACKGROUND: Major disasters can have a negative impact on the health of survivors for prolonged periods. Although the initial and short-term impacts of Hurricane Katrina have been well described, the medium-term impacts have not been studied as thoroughly. DESIGN: Cross-sectional survey. METHODS: A convenience sample (n = 222) of residents in Gentilly area of New Orleans completed questionnaires between 16 and 18 December  2006. Multivariate logistic regression and multiple regression models were employed to determine predictors of poor mental and physical health. RESULTS: Poor mental health was reported by 52% of the respondents. Pre-Katrina depression [odds ratio (OR) = 19.1], post-Katrina depression (OR = 7.2), poor physical health (OR = 5.6), feeling unsafe from crime (OR = 4.3) and female gender (OR = 2.6) were significant predictor variables of poor mental health. Twenty-four percent of the variance in number of days of poor mental health was explained by  the independent variables (R(2) = 0.24; p < 0.001). Poor physical health was reported by 48% of the respondents. Poor mental health (OR = 3.9), lack of money  to buy food (OR = 2.7) and pre-Katrina arthritis (OR = 2.6) were significant predictor variables of poor physical health. Twenty-three percent of the variance in number of days of poor physical health was explained by the independent variables (R(2) = 0.23; p < 0.001). CONCLUSIONS: Approximately half of the New Orleans residents continue to experience poor mental and physical health 15 months after Katrina. The results support focusing post-Katrina efforts to protect residents from crime, improve mental health services to the depressed and improve food supply to the poor. RELEVANCE TO CLINICAL PRACTICE: Identifying predictors of poor mental and physical health may help clinicians and policy makers to focus their efforts in ameliorating the post-disaster health sequelae.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18705709 [PubMed - indexed for MEDLINE]

 

J Gen Intern Med. 2008 Sep;23(9):1386-92. Epub 2008 Jun 28.

PTSD in Latino patients: illness beliefs, treatment preferences, and implications for care.

Eisenman DP, Meredith LS, Rhodes H, Green BL, Kaltman S, Cassells A, Tobin JN.

RAND Corporation, Santa Monica, CA, USA. deisenman@mednet.ucla.edu

BACKGROUND: Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment. OBJECTIVE: To understand the illness beliefs and treatment preferences of Latino immigrants with PTSD. DESIGN: Semi-structured, face-to-face interviews. PARTICIPANTS: Sixty foreign-born, Latino adults recruited from five primary care  centers in New York and New Jersey and screened for PTSD. APPROACH: Content analytic methods identified common themes, their range, and most frequent or typical responses. RESULTS: Participants identified their primary feelings as sadness, anxiety, nervousness, and fear. The most common feeling was "sad" (triste). Other words frequently volunteered were "angry" (enojada), "nervous" (nerviosa), and "scared" (miedo). Participants viewed their PTSD as impairing health and functioning. They ascribed their somatic symptoms and their general medical problems to the "stress" from the trauma and its consequences on their lives. The most common reason participants volunteered for their work and school  functioning being impaired was their poor concentration, often due to intrusive thoughts. Most expressed their desire to receive mental health treatment, to receive it within their primary care center, and preferred psychotherapy over psychotropic medications. Among participants who did not report wanting treatment, most said it was because the trauma was "in the past." CONCLUSIONS: Clinicians may consider enquiring about PTSD in Latino patients who report feeling sad, anxious, nervous, or fearful. Our study suggests topics clinicians may include in the psychoeducation of patients with PTSD.

Publication Types:      Multicenter Study     Research Support, N.I.H., Extramural

PMID: 18587619 [PubMed - indexed for MEDLINE]

 

J Integr Neurosci. 2008 Sep;7(3):439-56.

Developing an integrated brain, behavior and biological response profile in posttraumatic stress disorder (PTSD).

Falconer EM, Felmingham KL, Allen A, Clark CR, McFarlane AC, Williams LM, Bryant  RA.

School of Psychology, University of New South Wales, Australia. efalconer@psy.unsw.edu.au

The present study sought to determine a profile of integrated behavioral, brain and autonomic alterations in PTSD. Previous findings suggest that PTSD is associated with changes across electrophysiological (EEG and ERP), autonomic and  cognitive/behavioral measures. In particular, PTSD has been associated with reduced cognitive performance, altered cortical arousal (measured by EEG), diminished late ERP component to oddball task targets (reduced P3 amplitude) and  increased autonomic arousal relative to healthy controls. The present study examined measures of cognitive function, auditory oddball ERP components, autonomic function (heart rate and skin conductance) and EEG during resting conditions in 44 individuals with PTSD and 44 non-trauma-exposed controls, and predicted that an integrated profile of changes across a number of these measures would show a high level of sensitivity and specificity in discriminating PTSD from controls. Nine variables showing strongly significant (p < 0.002) between-group differences were entered into a discriminant function analysis. Four of these measures successfully discriminated the PTSD and non-PTSD groups: change in tonic arousal, duration of attention switching, working memory reaction time and errors of commission during visuospatial maze learning. Tonic arousal change contributed the most variance in predicting group membership. These results extend previous findings and provide an integrated biomarker profile that characterizes both PTSD and non-PTSD groups with a high degree of sensitivity and specificity. This outcome provides a platform for future studies to test how this profile of disturbances in autonomic and information processing may be unique to  PTSD or may occur generically across clinical and/or other anxiety disorders.

PMID: 18988301 [PubMed - in process]

 

J Interpers Violence. 2008 Sep;23(9):1162-76. Epub 2008 Feb 21.

Reliability and validity of the SCL-90-R PTSD subscale.

Carlozzi NE, Long PJ.

Indiana University. ncarlozzi@kmrrec.org

Two studies examined the psychometric properties of the Posttraumatic Stress Disorder (PTSD) subscale of the SCL-90-R. Study 1 examined SCL-90-R responses from 2,361 college women to determine whether this subscale can appropriately assess the three dimensions of PTSD. Factor analysis and Cronbach's alpha suggest that this subscale is best conceptualized as a unidimensional index of PTSD symptomatology. Study 2 confirmed these results in a sample of 1,044 college men  and women. Findings in the second sample also supported the subscale's validity,  as it correlates well with the Posttraumatic Diagnostic Scale and with trauma frequency and can discriminate between individuals with and without PTSD diagnoses. Results suggest that the SCL-90-R PTSD subscale is a reliable, but unidimensional, measure for screening for distress associated with PTSD. Although there is some support for the usefulness of this scale, especially with women, it should only be considered a general indicator of distress with limited use for men.

Publication Types:      Validation Studies

PMID: 18292401 [PubMed - indexed for MEDLINE]

 

J Med Assoc Thai. 2008 Sep;91(9):1478-86.

Psychological wellbeing of survivors of the tsunami: empowerment and quality of life.

Chaiphibalsarisdi P.

Faculty of Nursing, Chulalongkorn University, Phyathai Rd, Pratumwan, Bangkok 10330, Thailand. Cpuangti@Chula.ac.th

OBJECTIVE: To compare the empowerment and the quality of life of individuals before and after receiving the psychological services and support interventions.  STUDY DESIGN: This quasi-experimental research had two hypotheses: 1) the survivors gained empowerment, and 2) the survivors experienced improvement in their quality of life, after receiving the interventions. SETTING: Krabi province of Thailand. STUDY POPULATION: 593 survivors of the Tsunami on 26 December 2004.  MATERIAL AND METHOD: The instrument to assess empowerment was modified from Miller, while the instrument to assess quality of life was WHO-BREF. RESULTS: After the intervention, the overall mean of empowerment was at the maximum level, and revealed an increased percentage of the quality of life at a good level in all four domains. The level of the psychological domain was the highest. CONCLUSION: The sample showed a significant increase in both empowerment and quality of life (p < 0.001). The findings support the hypotheses.

Publication Types:      Comparative Study     Research Support, Non-U.S. Gov't

PMID: 18843881 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Sep;196(9):687-93.

Limited literacy and psychiatric disorders among users of an urban safety-net hospital's mental health outpatient clinic.

Lincoln A, Espejo D, Johnson P, Paasche-Orlow M, Speckman JL, Webber TL, White RF.

Department of Health Science, Northeastern University, 316 Robinson Hall, 360 Huntington Avenue, Boston, MA 02115, USA. al.lincoln@neu.edu

Little is known about the relationship between mental illness and literacy despite both being prevalent problems. We examine whether literacy varies by psychiatric diagnoses. Interviews and chart reviews (N = 100) were conducted in a behavioral health outpatient clinic. The relationships among sociodemographics, rapid estimate of adult literacy in medicine, measures of verbal and visual intellectual abilities, and psychiatric diagnoses were examined. The mean rapid estimate of adult literacy in medicine score was 55.9 which is equivalent to below an eighth grade literacy level. Psychotic disorder (p = 0.03) was associated with limited literacy, and substance abuse (p = 0.003) and PTSD (p = 0.07) were associated with higher literacy in bivariate analyses. These diagnoses were further examined in multivariate models. Limitations include the small sample size and the over-representation of people with high levels of education.  Increasing our understanding of the relationships between health literacy and psychiatric disorders will help inform the development of appropriate psychiatric care and better outcomes.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18791430 [PubMed - indexed for MEDLINE]

 

J Oral Maxillofac Surg. 2008 Sep;66(9):1949-52.

Serotonin syndrome in the oral and maxillofacial surgery office: a review of the  literature and report of a case.

Szakaly B, Strauss R.

Resident, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.

Publication Types:      Case Reports     Review

PMID: 18718407 [PubMed - indexed for MEDLINE]

 

J Pers Soc Psychol. 2008 Sep;95(3):709-22.

Searching for and finding meaning in collective trauma: results from a national longitudinal study of the 9/11 terrorist attacks.

Updegraff JA, Silver RC, Holman EA.

Department of Psychology, Kent State University, Kent, OH 44242-0001, USA. jupdegr1@kent.edu

The ability to make sense of events in one's life has held a central role in theories of adaptation to adversity. However, there are few rigorous studies on the role of meaning in adjustment, and those that have been conducted have focused predominantly on direct personal trauma. The authors examined the predictors and long-term consequences of Americans' searching for and finding meaning in a widespread cultural upheaval--the terrorist attacks of September 11, 2001--among a national probability sample of U.S. adults (N=931). Searching for meaning at 2 months post-9/11 was predicted by demographics and high acute stress response. In contrast, finding meaning was predicted primarily by demographics and specific early coping strategies. Whereas searching for meaning predicted greater posttraumatic stress (PTS) symptoms across the following 2 years, finding meaning predicted lower PTS symptoms, even after controlling for pre-9/11 mental  health, exposure to 9/11, and acute stress response. Mediation analyses suggest that finding meaning supported adjustment by reducing fears of future terrorism.  Results highlight the role of meaning in adjustment following collective traumas  that shatter people's fundamental assumptions about security and invulnerability.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18729704 [PubMed - indexed for MEDLINE]

 

J Psychiatry Neurosci. 2008 Sep;33(5):413-22.

The neural networks of inhibitory control in posttraumatic stress disorder.

Falconer E, Bryant R, Felmingham KL, Kemp AH, Gordon E, Peduto A, Olivieri G, Williams LM.

Brain Dynamics Centre, Westmead Millenium Institute, Westmead Hospital, Westmead, NSW, Australia. efalconer@psy.unsw.edu.au

OBJECTIVE: Posttraumatic stress disorder (PTSD) involves deficits in information  processing that may reflect hypervigilence and deficient inhibitory control. To date, however, no PTSD neuroimaging study has directly examined PTSD-related changes in executive inhibition. Our objective was to investigate the hypothesis  that executive inhibitory control networks are compromised in PTSD. METHODS: Functional magnetic resonance imaging (fMRI) was used during a Go/No-Go inhibition task completed by a sample of patients with PTSD (n = 23), a matched sample of healthy (i.e. without trauma exposure) control participants (n = 23) and a sample of control participants with trauma exposure who did not meet criteria for PTSD (n = 17). RESULTS: Participants with PTSD showed more inhibition-related errors than did individuals without trauma exposure. During inhibition, control participants activated a right-lateralized cortical inhibitory network, whereas patients with PTSD activated only the left lateral frontal cortex. PTSD was associated with a reduction in right cortical activation and increased activation of striatal and somatosensory regions. CONCLUSION: The increased inhibitory error and reduced right frontal cortical activation are consistent with compromised inhibitory control in PTSD, while the increased activation of brain regions associated with sensory processing and a greater demand on inhibitory control may reflect enhanced stimulus processing in PTSD, which may undermine cortical control mechanisms.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18787658 [PubMed - in process]

 

J Psychoactive Drugs. 2008 Sep;40(3):225-36.

MDMA-assisted psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder.

Bouso JC, Doblin R, Farré M, Alcázar MA, Gómez-Jarabo G.

Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain. jbouso@santpau.cat

The purpose of this study was to investigate the safety of different doses of MDMA-assisted psychotherapy administered in a psychotherapeutic setting to women  with chronic PTSD secondary to a sexual assault, and also to obtain preliminary data regarding efficacy. Although this study was originally planned to include 29 subjects, political pressures led to the closing of the study before it could be  finished, at which time only six subjects had been treated. Preliminary results from those six subjects are presented here. We found that low doses of MDMA (between 50 and 75 mg) were both psychologically and physiologically safe for all the subjects. Future studies in larger samples and using larger doses are needed  in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 19004414 [PubMed - in process]

 

J Psychol. 2008 Sep;142(5):449-69.

Similarities and differences between traumatic and emotional memories: review and directions for future research.

Sotgiu I, Mormont C.

University of Turin, Department of Psychology, Via Verdi 10, Torino 10124, Italy. sotgiu@psych.unito.it

The authors review theory and empirical research on the characteristics of memories for traumatic versus emotional events, with the goal of bringing together the cognitive and clinical perspectives on this issue. They consider the most important approaches to the study of traumatic and emotional memory and summarize the results of recent studies that have compared autobiographical recollections of traumatic and nontraumatic emotional experiences (positive and negative), either in nonclinical or clinical samples. Overall, findings from the  current empirical literature are inconsistent. Although some researchers have found that traumatic memories are retrieved differently than are emotional memories, others have demonstrated that the phenomenological characteristics of these memory types are highly similar. The authors discuss methodological issues  that could help researchers to interpret the inconsistencies found in the empirical findings. Last, they suggest possible directions for future research that may advance researchers' knowledge of memory, trauma, and emotion.

Publication Types:      Comparative Study     Review

PMID: 18959220 [PubMed - indexed for MEDLINE]

 

J Urban Health. 2008 Sep;85(5):693-706. Epub 2008 Jun 25.

Experiences of traumatic events and associations with PTSD and depression development in urban health care-seeking women.

Gill JM, Page GG, Sharps P, Campbell JC.

National Institute of Nursing Research, National Institutes of Health, 10 Center  Drive, 10/CRC 2-1339, Bethesda, MD 20892-1506, USA. gillj@mail.nih.gov

Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines.  Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and  PTSD development. Survival analysis was used to determine if PTSD developed from  assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18581238 [PubMed - indexed for MEDLINE]

 

Neuropsychologia. 2008 Sep;46(11):2836-44. Epub 2008 May 28.

Altered reward processing in the nucleus accumbens and mesial prefrontal cortex of patients with posttraumatic stress disorder.

Sailer U, Robinson S, Fischmeister FP, König D, Oppenauer C, Lueger-Schuster B, Moser E, Kryspin-Exner I, Bauer H.

Faculty of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria. uta.sailer@univie.ac.at

Posttraumatic stress disorder (PTSD) is known to be associated with altered medial prefrontal activation in response to threatening stimuli and with behavioural deficits in prefrontal functions such as working memory and attention. Given the importance of these areas and processes for decision-making, this functional magnetic resonance imaging study investigated whether decision-making is altered in patients with PTSD. In particular, the neural response to gain and loss feedback was evaluated in a decision-making task in which subjects could maximise their number of points total by learning a particular response pattern. Behaviourally, controls learned the correct response pattern faster than patients. Functionally, patients and controls differed in their neural response to gains, but not in their response to losses. During the processing of gains in the late phase of learning, PTSD patients as compared to controls showed lower activation in the nucleus accumbens and the mesial PFC, critical structures in the reward pathway. This reduced activation was not due to different rates of learning, since it was similarly present in patients with unimpaired learning performance. These findings suggest that positive outcome information lost its salience for patients with PTSD. This may reflect decreasing motivation as the task progressed.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18597797 [PubMed - indexed for MEDLINE]

 

Neurosci Behav Physiol. 2008 Sep;38(7):721-6.

The possible use of hypoxic preconditioning for the prophylaxis of post-stress depressive episodes.

Rybnikova EA, Samoilov MO, Mironova VI, Tyul'kova EI, Pivina SG, Vataeva LA, Ordyan NE, Abritalin EY, Kolchev AI.

Laboratories for the Regulation of Brain Neuron Functions, Neuroendocrinology, and Nervous System Ontogenesis, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia.

The protective effects of hypoxic preconditioning on the development of depressive states in rat models were studied. Three episodes of intermittent preconditioning using hypobaric hypoxia (360 mmHg, 2 h) prevented the onset of depressive behavioral reactions, hyperfunction of the hypophyseal-adrenal system, and impairments in its suppression in the dexamethasone test in rats following unavoidable aversive stress in a model of endogenous depression. The anxiolytic and antidepressant actions of hypoxic preconditioning in experiments on rats were no less marked than those of the tetracyclic antidepressant ludiomil. The results obtained here provide evidence that preconditioning with intermittent hypobaric hypoxia increases resistance to psychoemotional stresses, has marked anxiolytic and antidepressant effects, and can be used for the prophylaxis of depressive episodes.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18709460 [PubMed - indexed for MEDLINE]

 

Postgrad Med. 2008 Sep;120(3):122-9.

Posttraumatic stress disorder and aging.

Khouzam HR.

Chemical Dependency Treatment Program, Veterans Affairs Central California Health Care System, Fresno, CA 93703, USA. hani.khouzam2@va.gov

The evidence base on effective treatments for posttraumatic stress disorder (PTSD) in the elderly population is scarce. The assessment and treatment of PTSD  could pose a challenge for primary care providers and residents in training involved in treating PTSD in older adults. This article will review the epidemiology, the morbidity, the mortality, the biological perspective, the prognosis, and the psychosocial and pharmacological treatment options, in addition to the spiritual dimensions of PTSD and aging.

Publication Types:      Review

PMID: 18824831 [PubMed - indexed for MEDLINE]

 

Psychiatr Danub. 2008 Sep;20(3):406-10.

Metabolic syndrome and depression in war veterans with post-traumatic stress disorder.

Jakovljević M, Babić D, Crncević Z, Martinac M, Maslov B, Topić R.

University Psychiatric Clinic Rebro, Clinical Hospital Centre Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia. predstojnik_psi@kbc-zagreb.hr

BACKGROUND: Post-traumatic stress disorder (PTSD), depression and metabolic syndromes are growing public health problems in post-war countries. Understanding the co-morbidity among PTSD, depression and metabolic syndrome has an important clinical and theoretical issue. OBJECTIVE: To examine the relationship between combat-related PTSD, co-morbid depression and metabolic syndrome as well as between severity of depression and metabolic syndrome. METHOD: Metabolic syndrome and co-morbid depression were investigated in 100 male war veterans with combat PTSD and in 79 males who needed medical attention in dispensary of family medicine. RESULTS: Metabolic syndrome according NCEP: ATP III was found in 25 % of war veterans with PTSD. Metabolic syndrome was identified more frequently in PTSD patients with co-morbid depression (47.8 %) compared to those without depression (9.1%). PTSD with moderate and severe co-morbid depression was associated with higher rates of metabolic syndrome (78.6% and 90.9% respectively) in comparison with mild depression (26.2%). CONCLUSIONS: PTSD is frequently comorbid with depression, and when the two disorders co-occur, the risk for metabolic syndrome is increased. Treatment of war veterans with PTSD should address co-morbid depression and metabolic syndrome as well as the clinical features of PTSD.

Publication Types:      Comparative Study

PMID: 18827772 [PubMed - indexed for MEDLINE]

 

Psychiatr Danub. 2008 Sep;20(3):384-9.

Metabolic syndrome and schizophrenia from integrative medicine perspective.

Maslov B, Jakovljević M, Crncević Z, Ostojić L, Marcinko D, Babić D, Korsić M.

School of Medicine, University of Mostar, Bosnia and Herzegovina. boris.maslov@tel.net.ba

BACKGROUND: There has been a growing interest in the effect that comorbid schizophrenia and metabolic syndrome may have on each other. OBJECTIVE: To examine metabolic syndrome from integrative medicine point of view including prevalence of metabolic syndrome in patients with schiziphrenia compared to their first-degree relatives, healthy volunteers without schizophrenia in close family, and patients with PTSD, as well as the percentage patients with schizophrenia without any component of metabolic syndrome. METHOD: Metabolic syndrome according to NCEP/ATP III criteria and number of its components were analysed in 205 patients with schizophrenia, 140 healthy volunteers and 105 patients with combat  PTSD. RESULTS: Metabolic syndrome was identified in 45.9% of the patients with schizophrenia, 38.1% of the war veterans with PTSD, 36.7% of the first-degree relatives of patients with schizophrenia and 16.2% of the healthy volunteers without schizophrenia in close family. Only 21.5% of the patients with schizophrenia were without any metabolic syndrome component. CONCLUSION: The comorbidity of schizophrenia and metabolic syndrome is very important for theory  and practice of integrative medicine. Almost 80% of the patients with schizophrenia have increased risk or developed cardiovascular disorders,.

Publication Types:      Comparative Study

PMID: 18827767 [PubMed - indexed for MEDLINE]

 

Psychiatr Danub. 2008 Sep;20(3):286-300.

Reliability and validity of DSM-IV Axis V scales in a clinical sample of veterans with posttraumatic stress disorder.

Jovanović AA, Gasić MJ, Ivković M, Milovanović S, Damjanović A.

Institute of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia.

OBJECTIVES: Psychometric properties of the DSM-IV Axis V scales in measuring adaptational functioning of psychotraumatised veterans have been chosen as the focus of this study. SUBJECTS AND METHODS: The reliability and validity of the Global Assessment of Functioning Scale (GAF), the Social and Occupational Assessment Scale (SOFAS), and the Global Assessment of Relational Functioning (GARF) were examined in a clinical sample of 129 veterans with posttraumatic stress disorder (PTSD). RESULTS: The interrater reliability of the GAF (ICC=0.82) and the SOFAS (ICC=0.83) was excellent, while the interrater reliability of the GARF (ICC=0.75) was good. Correlations with other clinician-rated scales of psychopathology and overall functioning showed that the GAF is primarily related  to a reduction in functioning due to psychiatric symptoms, while an assessment of functioning beyond psychopathology, considering the effects of the individual's general medical condition as well, was provided by the SOFAS and the GARF, which  is of importance for a comprehensive evaluation of the patients' health status. The factor analysis of the Axis V scales revealed a theoretically meaningful, single common factor (variance accounted for by the extracted factor = 76.91%), while observed differences, between the subjects with complete and partial PTSD,  in scores on the axis V scales support further use of the axis V scales as useful outcome variables. CONCLUSION: The issue of a valid and reliable measurement of functional impairment is of paramount importance not only in the domain of clinical psychiatry but in forensic practice as well. In this respect, our findings give strong support to extending the scope of the DSM axis V scales with the two experimental scales which provide both conceptual framework and useful tools for reliable and valid evaluation of adaptatinal functioning in persons suffering from PTSD.

Publication Types:      Comparative Study

PMID: 18827754 [PubMed - indexed for MEDLINE]

 

Psychiatr Danub. 2008 Sep;20(3):277-85.

Post traumatic stress disorder, depression and anxiety among family medicine residents after 1992-95 war in Bosnia and Herzegovina.

Hasanović M, Herenda S.

Department of Psychiatry, University Clinic Center Tuzla, Bosnia and Herzegovina. hameaz@bih.net.ba

BACKGROUND: The traumatic events experienced in Bosnia and Herzegovina during the 1992-1995 conflict may have a lasting effect on the mental health of the citizens, characterized by high rates of post-traumatic stress disorder (PTSD), depression, and anxiety. A diagnosis of PTSD, depression, and anxiety among family physician residents could affect their ability to diagnose and treat patients for depression, anxiety and PTSD. OBJECTIVES: To assess PTSD, depression and anxiety symptoms and prevalence amongst family medicine residents (FMR) who were general practitioners (GP) in different war engagements and compare them with FMR who were medical students, 9 years after the 1992-1995 war in Bosnia-Herzegovina (BH). SUBJECTS AND METHODS: We applied the Bosnia-Herzegovina  versions of both the Harvard Trauma Questionnaire (HTQ) for PTSD symptoms, and Hopkins Symptom Checklist - 25 (HSCL-25) for anxiety and depression symptoms to 78 residents (age 30-45 years, 84.6% females), who lived in BH during the conflict years. RESULTS: PTSD prevalence of 10.3% and depression and anxiety prevalence of 21.8%, was found. The anxiety symptoms score was significantly higher amongst FMR who were GPs (1.69+/-0.66) than medical students (1.40+/-0.41, t-test=2.219, P=0.029) during the war.

Publication Types:      Comparative Study

PMID: 18827753 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2008 Sep;59(9):1052-5.

Use of multiple psychotropic medications among adolescents aging out of foster care.

Raghavan R, McMillen JC.

George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, USA. raghavan@wustl.edu

OBJECTIVES: This study described the prevalence of and risk factors for using multiple concurrent psychotropics among adolescents leaving foster care. METHODS: In-person interviews were conducted with 406 adolescents who were aged 17 years and were leaving foster care in a Midwestern state. RESULTS: Of the 403 who had complete records, most (N=257, or 64%) did not report taking any psychotropic medications, while 46 (10%) were on three or more concurrent psychotropics. A history of physical or sexual abuse and a diagnosis of major depressive disorder  or manic episode were significantly associated with the use of three or more concurrent medications. Between 19% and 41% of adolescents with diagnoses for which psychotropics are indicated were not taking any medications. CONCLUSIONS: This local cohort of adolescents aging out of foster care seemed to display both  overuse and underuse of psychotropics. Research on larger and more representative cohorts of youths leaving foster care is necessary in order to understand the appropriateness of psychotropic prescribing among these adolescents.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18757601 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2008 Sep;59(9):1018-26.

Correlates of adverse childhood experiences among adults with severe mood disorders.

Lu W, Mueser KT, Rosenberg SD, Jankowski MK.

Department of Psychiatric Rehabilitation, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, 1776 Raritan Rd., Scotch Plains, NJ 07076, USA. luwe1@umdnj.edu

OBJECTIVES: Adverse childhood experiences have been found to be associated with poor physical and poor mental health, impaired functioning, and increased substance abuse in the general adult population. The purpose of this study was to examine the clinical correlates of these experiences among adults with severe mood disorders. METHODS: Adverse childhood experiences (including physical abuse, sexual abuse, parental mental illness, loss of parent, parental separation or divorce, witnessing domestic violence, and placement in foster or kinship care) were assessed retrospectively in a sample of 254 adults with major mood disorders. The relationships between cumulative exposure to these experiences and psychiatric problems, health, substance use disorders, community functioning, trauma exposure in adulthood, and high-risk behaviors were examined. RESULTS: Increased exposure to childhood adverse experiences was related to high-risk behaviors, diagnosis of a substance use disorder, exposure to trauma in adulthood, psychiatric problems (younger age at first hospitalization, number of  suicide attempts, and diagnosis of posttraumatic stress disorder), medical service utilization, and homelessness. CONCLUSIONS: The findings extend research  in the general population by suggesting that adverse childhood experiences contribute to worse mental and physical health and functional outcomes among adults with severe mood disorders.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18757595 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2008 Sep;59(9):996-1003.

Impact of the seeking safety program on clinical outcomes among homeless female veterans with psychiatric disorders.

Desai RA, Harpaz-Rotem I, Najavits LM, Rosenheck RA.

Northeast Program Evaluation Center, Department of Veterans Affairs Connecticut Healthcare System(182), 950 Campbell Ave., West Haven, CT 06516, USA. desai@yale.edu

OBJECTIVE: Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and  trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. METHODS: The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. RESULTS: There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic  stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. CONCLUSIONS: Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans. It is noteworthy that it could be delivered and implemented by case managers with little or no prior counseling experience.

PMID: 18757592 [PubMed - indexed for MEDLINE]

 

Psychiatr Serv. 2008 Sep;59(9):982-8.

Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders.

Ilgen MA, Hu KU, Moos RH, McKellar J.

Health Services Research and Development, Department of Veterans Affairs, 2215 Fuller Rd. (11H), Ann Arbor, MI 48105, USA. marki@umich.edu

OBJECTIVE: This observational study examined the association between continuing outpatient care for a psychiatric disorder, a substance use disorder, or both and decreased risk of readmission to psychiatric care after an index episode of inpatient psychiatric treatment. METHODS: Treatment records from all patients with co-occurring substance use and psychiatric disorders discharged from an inpatient psychiatric setting in the Department of Veterans Affairs (VA) between  July 1, 2004, and June 30, 2005 (N=26,826), were used to determine the impact of  psychiatric and substance use disorder continuing care on readmission to inpatient psychiatric treatment in the 90 days after discharge. RESULTS: Over 23% (6,280 of 26,826) of patients with both a psychiatric disorder and a substance use disorder who received inpatient psychiatric treatment in the VA were readmitted for additional psychiatric care within 90 days of discharge. Survival  analyses indicated that receiving continuing care for a substance use disorder (hazard ratio [HR]=.84, 95% confidence interval [CI]=.77-.92, p<.001) in the 30 days after discharge from the index episode was associated with a lower likelihood of rehospitalization. Psychiatric continuing care was not associated with risk of rehospitalization. A supplementary analysis indicated that substance use disorder continuing care was still associated with a reduced risk of rehospitalization over the 12 months after discharge, although the overall magnitude of the association was diminished (HR=.92, 95% CI=.86-.99, p=.02). CONCLUSIONS: Readmission to inpatient psychiatric treatment was common for patients with co-occurring disorders, and these observational findings indicate that continuing care for a substance use disorder was associated with lower risk  of early readmission.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18757590 [PubMed - indexed for MEDLINE]

 

Psychol Med. 2008 Sep;38(9):1351-60. Epub 2008 Feb 7.

DSM-IV pathological gambling in the National Comorbidity Survey Replication.

Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, Shaffer HJ.

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.  kessler@hcp.med.harvard.edu

BACKGROUND: Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG). METHOD: Data from the US National Comorbidity Survey  Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age of onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and  the subsequent risk of secondary disorders. RESULTS: Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age 16.7 v. 23.9 years, z=12.7, p<0.001), with gambling problems typically beginning  during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged US$4800. Onset and persistence of PG  were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder (PTSD) and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders. CONCLUSIONS: DSM-IV PG is a comparatively rare, seriously impairing, and undertreated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18257941 [PubMed - indexed for MEDLINE]

 

Psychol Psychother. 2008 Sep;81(Pt 3):297-307.

A cognitive model of peritraumatic dissociation.

Wing Lun LM.

Macquarie University, Sydney, New South Wales, Australia. lenora@unswalumni.com

PURPOSE: Interacting cognitive subsystems (ICS; Barnard & Teasdale, 1991) is presented as a framework for understanding the impact of perceptual problems in peritraumatic dissociation. METHODS: This paper analyses two peritraumatic dissociation symptoms, attention being drawn to stimuli and the experience of time slowing. ICS is described. Information processes in peritraumatic dissociation are analysed. RESULTS: Peritraumatic dissociative symptoms are conceptualized as problems with early processing of sensory information that result from problems of sensory feature binding. DISCUSSION: These problems are discussed in relation to experiences of fragmented memories in trauma within the  context of ICS. A role for mindful attention in psychological therapy is raised.

PMID: 18644214 [PubMed - indexed for MEDLINE]

 

Psychoneuroendocrinology. 2008 Sep;33(8):1041-50. Epub 2008 Jul 21.

Hostility is related to clusters of T-cell cytokines and chemokines in healthy men.

Mommersteeg PM, Vermetten E, Kavelaars A, Geuze E, Heijnen CJ.

Laboratory for Psychoneuroimmunology, University Medical Center Utrecht, KC03.068.0, Lundlaan 6, 3584EA Utrecht, The Netherlands.

Hostility is a risk factor for adverse health outcomes as diverse as cardiovascular disease and post-traumatic stress disorder (PTSD). Cytokines have  been suggested to mediate this relationship. We investigated whether in healthy men a relation existed between hostility and T-cell mitogen-induced cytokines and chemokines. Male Dutch military personnel (n=304) were included before deployment. Eleven cytokines and chemokines were measured in supernatants of T-cell mitogen-stimulated whole blood cultures by multiplex immunoassay. Factor analysis was used to identify clusters of cytokines and chemokines. In a regression analysis hostility was related to the cytokine/chemokine clusters, and the potential risk factors age, BMI, smoking, drinking, previous deployment, early life trauma and depression. Explorative factor analysis showed four functional clusters; a pro-inflammatory factor (IL-2, TNFalpha, IFNgamma), an anti-inflammatory factor (IL-4, IL-5, IL-10), IL-6/chemokine factor (IL-6, MCP-1, RANTES, IP-10), and MIF. Hostility was significantly related to decreased IL-6/chemokine secretion and increased pro- and anti-inflammatory cytokines. There was an inverse relation between age and hostility scores. Early life trauma and depression were positively and independently related to hostility as well. This study represents a novel way of investigating the relation between cytokines and psychological characteristics. Cytokines/chemokines clustered into functional factors, which were related to hostility in healthy males. Moreover this relation appeared to be independent of reported depression and early trauma.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18640786 [PubMed - indexed for MEDLINE]

 

Psychoneuroendocrinology. 2008 Sep;33(8):1155-9. Epub 2008 Jul 21.

Increased serum cortisol and growth hormone levels in earthquake survivors with PTSD or subclinical PTSD.

Song Y, Zhou D, Wang X.

Institute of Mental Health, Peking University, China. h0594004@hkusua.hku.hk

Alteration of neuroendocrine systems has been demonstrated to be involved in the  pathology of posttraumatic stress disorder (PTSD). Three months after an earthquake in Northern China, cortisol, growth hormone (GH) and prolactin (PRL) levels were assessed in 34 earthquake survivors with PTSD (according to DSM-IV criteria), 30 earthquake survivors with subclinical PTSD and 34 normal controls.  Only earthquake survivors diagnosed with PTSD had significantly higher serum GH levels. Also, we found that earthquake survivors (either with PTSD or subclinical PTSD) had significantly higher serum cortisol levels. We concluded that PTSD might be associated with an increased level of serum GH and traumatic survivors might be associated with a higher level of serum cortisol.

PMID: 18640782 [PubMed - indexed for MEDLINE]

 

Psychooncology. 2008 Sep;17(9):948-53.

The interaction of post-traumatic growth and post-traumatic stress symptoms in predicting depressive symptoms and quality of life.

Morrill EF, Brewer NT, O'Neill SC, Lillie SE, Dees EC, Carey LA, Rimer BK.

The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

OBJECTIVE: We sought to explore whether post-traumatic growth (PTG) (positive change or benefit finding resulting from trauma) moderates relationships between  post-traumatic stress symptoms (PTSS) and both depression and quality of life (QOL) among breast cancer survivors. METHODS: We interviewed 161 women previously treated for early stage breast cancer. We assessed PTG using the Post-traumatic Growth Inventory, PTSS using the PTSD Checklist, depressive symptoms using the CES-D and QOL using the FACT-B. RESULTS: Higher PTSS was associated with greater  depressive symptoms and lower QOL (p<0.01). The relationship between PTSS and depression was attenuated among women with higher levels of PTG (PTSS x PTG interaction, p<0.05). The same pattern of results was found for QOL (interaction  p<0.01). CONCLUSIONS: We report the novel finding that PTG moderated relationships between PTSS and both depression and QOL. We speculate that finding positive meaning in response to a distressing event, such as diagnosis of cancer, may be psychologically protective and could indirectly influence the long-term occurrence of depressive symptoms and impaired QOL. (c) 2008 John Wiley & Sons, Ltd.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18213677 [PubMed - indexed for MEDLINE]

 

Psychosom Med. 2008 Sep;70(7):764-72. Epub 2008 Aug 25.

Persistence of posttraumatic stress symptoms 12 and 36 months after acute coronary syndrome.

Wikman A, Bhattacharyya M, Perkins-Porras L, Steptoe A.

Department of Epidemiology and Public Health, University College London, London,  UK. a.wikman@ucl.ac.uk

OBJECTIVES: To assess the prevalence and predictors of posttraumatic stress symptoms in patients at 12 and 36 months post hospital admission for an acute coronary syndrome (ACS). There is increasing recognition that posttraumatic stress may develop in the aftermath of an acute cardiac event. However, there has been little research on the longer-term prevalence of posttraumatic stress disorder (PTSD). METHODS: Posttraumatic stress symptoms were assessed at 12 months in 213 patients with ACS and in 179 patients at 36 months. Predictor variables included clinical, demographic, and emotional factors measured during hospital admission. RESULTS: At 12 months post ACS, 26 (12.2%) patients qualified for a diagnosis of PTSD; 23 (12.8%) patients were identified with PTSD at 36 months. Posttraumatic symptoms at 12 months were associated with younger age, ethnic minority status, social deprivation, cardiac symptom recurrence, history of depression, depressed mood during admission, hostility, and Type D personality. In multiple regression, depressed mood during admission and recurrent cardiac symptoms were independent predictors of posttraumatic symptoms  (R(2) = 0.507, p < .001). At 36 months, posttraumatic stress symptoms were independently predicted by posttraumatic symptom levels at 12 months and depressed mood during admission (R(2) = 0.635, p < .001). CONCLUSION: Posttraumatic stress symptoms persist for at least 3 years after an acute cardiac event. Early emotional responses are important in predicting longer-term posttraumatic stress. It is important to identify patients at risk for posttraumatic stress as they are more likely to experience reduced quality of life.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18725431 [PubMed - in process]

 

Psychother Res. 2008 Sep;18(5):523-34.

Mental states as part of countertransference responses in psychotherapists facing reports of traumatic events of mourning and sexual violence.

Goldfeld P, Terra L, Abuchaim C, Sordi A, Wiethaeuper D, Bouchard MA, Mardini V,  Baumgardt R, Lauerman M, Ceitlin LH.

Federal University of the Rio Grande Do Sul, Porto Alegre, Brazil. rivoire@via-rs.net

The study aims to compare the mental states and countertransference responses of  92 psychodynamically oriented psychotherapists, male and female, experienced and  inexperienced, facing written reports of real patients who experienced traumatic  events. Two vignettes were presented: one of a sexual violence, the other the sudden death of a significant person. The Mental States Rating System (MSRS; Bouchard, Picard, Audet, Brisson, & Carrier, 1998), the MSRS Self-Report (Goldfeld & Bouchard, 2004), and the Inventory of Countertransference Behavior (ICB; Friedman & Gelso, 2000) were used. Results showed that the mourning vignette led to more reflective responses (MSRS) and the rape case was associated with more negative countertransference reactions (ICB). Female participants were  more reflective (MSRS); male therapists used less mentalized states (MSRS Self-Report) and expressed more negative reactions (ICB) for both scenarios. Experienced therapists showed more positive reactions on the ICB. The construct validity of the instruments is discussed in relation to the findings.

PMID: 18816003 [PubMed - indexed for MEDLINE]

 

Psychother Res. 2008 Sep;18(5):497-507.

Group interpersonal psychotherapy for low-income women with posttraumatic stress  disorder.

Krupnick JL, Green BL, Stockton P, Miranda J, Krause E, Mete M.

Department of Psychiatry, Georgetown University, Washington, DC 20007, USA. krupnicj@georgetown.edu

The aim of this study was to assess the efficacy of group interpersonal psychotherapy (IPT) for low-income women with chronic posttraumatic stress disorder (PTSD) subsequent to interpersonal trauma. Non-treatment-seeking predominantly minority women were recruited in family planning and gynecology clinics. Individuals with interpersonal trauma histories (e.g., assault, abuse, and molestation) who met criteria for current PTSD (N=48) were randomly assigned  to treatment or a wait list. Assessments were conducted at baseline, treatment termination, and 4-month follow-up; data analysis used a mixed-effects regression approach with an intent-to-treat sample. The results showed that IPT was significantly more effective than the wait list in reducing PTSD and depression symptom severity. IPT participants also had significantly lower scores than waitlist individuals on four interpersonal functioning subscales: Interpersonal Sensitivity, Need for Social Approval, Lack of Sociability, and Interpersonal Ambivalence.

Publication Types:      Randomized Controlled Trial     Research Support, N.I.H., Extramural

PMID: 18816001 [PubMed - indexed for MEDLINE]

 

Rehabil Nurs. 2008 Sep-Oct;33(5):192-7, 205.

Mechanisms of injury in wartime.

Lehman C.

University of Texas Health Science Center, San Antonio, TX, USA. lehmanc@uthscsa.edu

A significant number of wounded servicemembers are returning from the conflicts in Iraq and Afghanistan. As the U.S. government finds itself with more wounded servicemembers than its systems can handle, the wounded are beginning to use private rehabilitation facilities. Mechanisms of injury in war are unlike those of most injuries encountered in civilian life. Rehabilitation nurses in both military and private rehabilitation facilities can benefit from learning about the mechanisms of injury in war to better help their patients and anticipate potential and hidden complications. This article reviews the mechanisms of injury in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, the unique characteristics of military personnel, and the implications for rehabilitation nurses.

Publication Types:      Review

PMID: 18767400 [PubMed - indexed for MEDLINE]

 

Rehabil Nurs. 2008 Sep-Oct;33(5):187-91.

How do you intervene in posttraumatic stress disorder symptoms associated with traumatic injury?

Rumpler CH.

VA Medical Center, Cincinnati, OH, USA. carol.rumpler@va.gov

Publication Types:      Case Reports     Review

PMID: 18767399 [PubMed - indexed for MEDLINE]

 

Scand J Caring Sci. 2008 Sep;22(3):331-40. Epub 2008 Feb 21.

Trauma, PTSD and personality: the relationship between prolonged traumatization and personality impairments.

Daud A, af Klinteberg B, Rydelius PA.

Department of Women and Child Health, Child and Adolescent Psychiatric Unit, Astrid Lindgren's Children's Hospital, Karolinska Institutet, Stockholm, Sweden.  Atia.Daud@ki.se

OBJECTIVE: Chronic post-traumatic stress disorder (PTSD) has been associated with personality impairments involving externalized and internalized psychopathology.  This study has explored the association between PTSD symptoms as consequences of  prolonged torture experiences or early childhood trauma exposure and personality  traits. METHOD: One hundred and sixty-one men were included: 36 Iraqi men refugees (mean age = 43.9, SD = 8.7) who had longstanding torture experiences as  adults; 42 Swedish prisoners (mean age = 33.8, SD = 7), with early childhood trauma exposure; 31 Arab men refugees (mean age = 41.8, SD = 8.9) without self-reported torture or violence experiences; 52 non-traumatized Swedish males (mean age = 39.3, SD = 5.5). They were assessed for symptoms of PTSD or PTSD hypothetical clusters. Personality profile was assessed by the Karolinska Scales  of Personality (KSP). Factor analysis with varimax rotation was conducted and yielded three factors: externalized, internalized and avoidance domains. RESULTS: Individuals who suffered prolonged torture experiences or had early childhood trauma exposure showed impaired personality profiles in internalized and externalized domains. Individuals with or without PTSD showed significant differences p < 0.05 concerning: internalized, externalized and avoidance. ANOVA  and post-hoc analysis according to Scheffé showed that the prolonged torture group > early childhood trauma exposure > nontraumatized group. CONCLUSION: Prolonged torture experiences or early trauma exposure may impair personality formation by enhancing the effects of cognitive, affective and behavioural vulnerabilities.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18298618 [PubMed - indexed for MEDLINE]

 

Sex Abuse. 2008 Sep;20(3):305-22.

Moral repair with offenders: ethical issues arising from victimization experiences.

Ward T, Moreton G.

Victoria University of Wellington, New Zealand.

In this article, the authors examine the relevance of the concept of moral repair for sex offenders who have been victims of sexual or physical abuse. First, they  briefly review the literature on victimization rates and effects in sexual offenders. Second, the notion of moral repair and its constituent tasks is examined with particular emphasis given to Margaret Walker's recent analysis of the concept. Third, the concept of moral repair is applied to offenders and its implications and possible constraints discussed. Fourth, the authors outline a normative framework for addressing victimization issues with sexual offenders, drawing on the resources of human rights theory and strength-based treatment approaches. Finally, they conclude with a brief consideration of the ethical and  clinical implications of their normative model.

Publication Types:      Review

PMID: 18775841 [PubMed - indexed for MEDLINE]

 

Soc Psychiatry Psychiatr Epidemiol. 2008 Sep;43(9):736-42. Epub 2008 May 8.

Clinical epidemiology in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya.

Ndetei DM, Khasakhala L, Maru H, Pizzo M, Mutiso V, Ongecha-Owuor FA, Kokonya DA.

Africa Mental Health Foundation, Nairobi, Kenya. dmndetei@mentalhealthafrica.com

BACKGROUND: Knowledge of types and co-morbidities of disorders seen in any facility is useful for clinical practice and planning for services. AIM: To study the pattern of co-morbidities of and correlations between psychiatric disorders in in-patients of Mathari Hospital, the premier psychiatric hospital in Kenya. STUDY DESIGN: Cross-sectional. METHODS: All the patients who were admitted at Mathari Hospital in June 2004 and were well enough to participate in the study were approached for informed consent. Trained psychiatric charge nurses interviewed them using the Structured Clinical Interview for DSM-IV Axis I disorders Clinical Version (SCID-I). Information on their socio-demographic profiles and hospital diagnoses was extracted from their clinical notes using a structured format. RESULTS: Six hundred and ninety-one patients participated in the study. Sixty-three percent were male. More than three quarters (78%) of the patients were aged between 21 and 45 years. More than half (59.5%) of the males and slightly less than half (49.4%) of the females were single. All the patients  were predominantly of the Christian faith. Over 85% were dependents of another family member and the remainder were heads of households who supported their own  families. Schizophrenia, bipolar I disorder, psychosis, substance use disorder and schizo-affective disorder were the most common hospital and differential diagnoses. Of the anxiety disorders, only three patients were under treatment for post-traumatic stress disorder (PTSD). Nearly a quarter (24.6%) of the patients were currently admitted for a similar previous diagnosis. Schizophrenia was the most frequent DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-fourth edition) diagnosis (51%), followed by bipolar I disorder (42.3%), substance use disorder (34.4%) and major depressive illness (24.6%). Suicidal features were common in the depressive group, with 14.7% of this group reporting a suicidal attempt. All DSM-IV anxiety disorders, including obsessive-compulsive disorders, were highly prevalent although, with the exception of three cases of PTSD, none of these anxiety disorders were diagnosed  clinically. Traumatic events were reported in 33.3% of the patients. These were multiple and mainly violent events. Despite the multiplicity of these events, only 7.4% of the patients had a PTSD diagnosis in a previous admission while 4% were currently diagnosed with PTSD. The number of DSM-IV diagnoses was more than  the total number of patients, suggesting co-morbidity, which was confirmed by significant 2-tailed correlation tests. CONCLUSION: DSM-IV substance use disorders, major psychiatric disorders and anxiety disorders were prevalent and co-morbid. However, anxiety disorders were hardly diagnosed and therefore not managed. Suicidal symptoms were common. These results call for more inclusive clinical diagnostic practice. Standardized clinical practice using a diagnostic tool on routine basis will go a long way in ensuring that no DSM-IV diagnosis is  missed. This will improve clinical management of patients and documentation.

PMID: 18465102 [PubMed - indexed for MEDLINE]

 

Transcult Psychiatry. 2008 Sep;45(3):391-414.

Rethinking historical trauma: narratives of resilience.

Denham AR.

Depaertment of Anthropology, Northern Arizona University, Flagstaff, AZ 86011-5200, USA. aaron.denham@nau.edu

There is significant variation in how people experience, emplot and intergenerationally transmit trauma experiences. Despite this variation, the literature rarely illustrates alternative manifestations or resilient responses to the construct of historical trauma. Based upon person-centered ethnographic research, this article highlights how a four-generation American Indian family contextualizes historical trauma and, specifically, how they frame their traumatic past into an ethic that functions in the transmission of resilience strategies, family identity, and as a framework for narrative emplotment. In conclusion, the author clarifies the distinction between historical trauma--the precipitating conditions or experiences--and the historical trauma response--the  pattern of diverse responses that may result from exposure to historical trauma.

PMID: 18799640 [PubMed - indexed for MEDLINE]

 

Z Kinder Jugendpsychiatr Psychother. 2008 Sep;36(5):345-52.

[Psychotherapy for traumatized children and adolescents--cognitive-behavioral treatments]

[Article in German]

Simons M, Herpertz-Dahlmann B.

Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie RWTH Aachen, Neuenhofer Weg 21, Aachen. msimons@ukaachen.de

According to cognitive-behavioral models, both the avoidance of trauma-associated cues, as well as cognitive distortions of the trauma and the initial symptoms thereof lead to and subsequently maintain traumatic disorders. Trauma-focused cognitive behavioral therapy often starts with stabilizing interventions such as  relaxation training. The main intervention consists of exposure to external trauma-associated cues (exposure in vivo) and to mental trauma reminders (exposure in sensu). Cognitive interventions aim to modify feelings of exaggerated guilt and shame. Of the different cognitive-behavioral programmes validated, trauma-focused cognitive-behavioral therapy yields the best evidence,  particularly in the treatment of sexually abused children and adolescents.

Publication Types:      English Abstract     Review

PMID: 18791984 [PubMed - indexed for MEDLINE]

 

Pain. 2008 Aug 31;138(2):450-9. Epub 2008 Jun 27.

Quantitative testing of pain perception in subjects with PTSD--implications for the mechanism of the coexistence between PTSD and chronic pain.

Defrin R, Ginzburg K, Solomon Z, Polad E, Bloch M, Govezensky M, Schreiber S.

Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel. rutidef@post.tau.ac.il

Post-traumatic stress disorder (PTSD) often co-occurs with chronic pain. Neither  the underlying mechanism of this comorbidity nor the nature of pain perception among subjects with PTSD is well defined. This study is the first systematic and  quantitative evaluation of pain perception and chronic pain in subjects with PTSD. The study group consisted of 32 outpatients with combat- and terror-related PTSD, 29 outpatients with anxiety disorder and 20 healthy controls. Quantitative  somatosensory testing included the measurement of warm, cold, light touch and heat-pain thresholds and responses to acute suprathreshold heat and mechanical stimuli. Chronic pain was characterized, and levels of PTSD and anxiety symptomatology were assessed by self-report questionnaires. Subjects with PTSD exhibited higher rates of chronic pain, more intense chronic pain and more painful body regions compared with the other two groups. PTSD severity correlated with chronic pain severity. Thresholds of subjects with PTSD were significantly higher than those of subjects with anxiety and healthy controls, but they perceived suprathreshold stimuli as being much more intense than the other two groups. These results suggest that subjects with PTSD exhibit an intense and widespread chronic pain and a unique sensory profile of hyposensitivity to pain accompanied by hyper-reactivity to suprathreshold noxious stimuli. These features may be attributed to the manner with which PTSD subjects emotionally interpret and respond to painful stimuli. Alternatively, but not mutually exclusive, the findings may reflect altered sensory processing among these subjects.

Publication Types:      Comparative Study     Research Support, Non-U.S. Gov't

PMID: 18585862 [PubMed - in process]

 

Pain. 2008 Aug 31;138(2):301-9. Epub 2008 Feb 14.

An examination of the synergy of pain and PTSD on quality of life: additive or multiplicative effects?

Clapp JD, Beck JG, Palyo SA, Grant DM.

Department of Psychology, University at Buffalo-SUNY, Park Hall, Buffalo, NY 14260, USA. joshclapp@yahoo.com

Although models have been proposed to explain common factors that maintain comorbid pain and PTSD [Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001; 21: 857-77], the exact nature of the relationship between these two conditions and their impact on quality of life (QOL) is unknown. The aim of the present investigation was to examine the unique and interactive effects of PTSD and pain on role functioning and life satisfaction--two important domains of QOL. The study utilized a help-seeking sample of motor vehicle accident (MVA) survivors whose accidents resulted in symptoms of comorbid PTSD and pain (N=192). Hierarchical regression models were used to examine the relationship between four PTSD symptom clusters,  pain, and the interaction of each cluster and pain on role functioning and life satisfaction separately. Results of these analyses revealed a significant interaction of pain and emotional numbing on role functioning, suggesting a multiplicative effect on this domain of QOL. Decomposition of this interaction revealed a negative association between numbing and functioning at low levels of  pain but no relationship at higher levels. A marginal interaction of pain and hyperarousal also was noted for life satisfaction. Decomposition of the interaction effect revealed a marginal association between hyperarousal and decreased satisfaction only at high levels of pain. A main effect of emotional numbing on decreased life satisfaction also was observed in this model, suggesting a unique influence of numbing. The results of the current research indicate that the synergistic relationship of pain and PTSD may vary across domains of QOL.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural

PMID: 18280044 [PubMed - in process]

 

Lancet. 2008 Aug 30;372(9640):703-4.

Coming home.

MacReady N.

Publication Types:      News

PMID: 18767223 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 Aug 30;163(3):279-88. Epub 2008 Jul 25.

Volumetrics of the caudate nucleus: reliability and validity of a new manual tracing protocol.

Looi JC, Lindberg O, Liberg B, Tatham V, Kumar R, Maller J, Millard E, Sachdev P, Högberg G, Pagani M, Botes L, Engman EL, Zhang Y, Svensson L, Wahlund LO.

Research Centre for the Neurosciences of Ageing, Academic Unit of Psychological Medicine, Australian National University Medical School, The Canberra Hospital, Australian Capital Territory, Australia. Jeffrey.looi@act.gov.au

Our aim was to develop a reliable and valid manual segmentation protocol for tracing the caudate nucleus in MRI for volumetric and, potentially, shape analysis of the caudate. Using the protocol, two inter- and intra-rater reliability studies were conducted using five different raters on two different image analysis platforms (ANALYZE, Mayo Biomedical Imaging Resource, Rochester MN, USA, and HERMES, Nuclear Diagnostics AB, Stockholm, Sweden). Reference images for the detailed protocol are described. Two studies were performed. In study 1,  the intra-rater class correlation ICC(1,1) for an experienced rater (JCLL) using  this protocol for caudate nucleus volumes was evaluated by repeating right and left caudate measurements on 10 scans (20 comparisons) and was 0.972. The inter-rater class correlation ICC(1,k) with OL was 0.922 on 5 scans (10 comparisons) and with BL was 0.960 on 5 scans (10 comparisons). In study 2, VT obtained an intra-rater class correlation of 0.9 on 5 scans (involving 10 comparisons, e.g. right and left caudate). The inter-rater class correlation ICC(1,k) was 0.988 on 5 scans (again involving 10 comparisons) with EM. We therefore developed a novel, reliable and reference image-based, method of outlining the caudate nucleus on axial MRI scans, usable in two different image analysis laboratories, across two different sets number of tracers reliably, and  across software platforms. This method is therefore potentially usable for any image analysis package capable of displaying and measuring outlined voxels from MRI brain scans.

Publication Types:      Validation Studies

PMID: 18657402 [PubMed - indexed for MEDLINE]

 

Acta Psychiatr Scand. 2008 Aug 29. [Epub ahead of print]

Validity of 'post-traumatic stress disorder with secondary psychotic features': a review of the evidence.

Braakman MH, Kortmann FA, van den Brink W.

De Gelderse Roos, Institute of Mental Health Care, Wolfheze, the Netherlands.

Objective: To review the evidence from empirical studies regarding the validity of 'post-traumatic stress disorder with secondary psychotic features' (PTSD-SP) as a separate diagnostic entity. Method: The authors performed a review tracing publications between 1980 and January 2008. Results: Twenty-four comparative studies were included. These studies indicate that PTSD-SP is a syndrome that comprises PTSD-symptoms followed in time by the additional appearance of psychotic features. The psychotic features are not confined to episodes of re-experiencing, but remain present continuously. PTSD-SP seems to have some biological features differentiating it from schizophrenia and PTSD, e.g. there are differences in smooth pursuit eye movement patterns, concentrations of corticotropin-releasing factor and dopamine beta-hydroxylase activity. Conclusion: There is currently not yet full support for PTSD-SP as a nosological  entity. However, the delineation of PTSD-SP from other psychiatric syndromes is notable and biological studies seem to support the validity as a separate diagnostic entity.

PMID: 18764840 [PubMed - as supplied by publisher]

 

Acta Histochem Cytochem. 2008 Aug 28;41(4):89-95.

Expressions of Hippocampal Mineralocorticoid Receptor (MR) and Glucocorticoid Receptor (GR) in the Single-Prolonged Stress-Rats.

Zhe D, Fang H, Yuxiu S.

Department of Histology and Embryology, Basic Medical College, China Medical University, Shenyang, China.

Post-traumatic stress disorder (PTSD) is a stress-related mental disorder caused  by traumatic experience. Single-prolonged stress (SPS) is one of the animal models proposed for PTSD. Rats exposed to SPS showed enhanced inhibition of the hypothalamo-pituitary-adrenal (HPA) axis, which has been reliably reproduced in patients with PTSD. Mineralocorticoid receptor (MR) and glucocorticoid receptor (GR) in the hippocampus regulate HPA axis by glucocorticoid negative feedback. Abnormalities in negative feedback are found in PTSD, suggesting that GR and MR might be involved in the pathophysiology of these disorders.In the present study, we performed immunohistochemistry and western blotting to examine the changes in  hippocampal MR- and GR-expression after SPS. Immunohistochemistry revealed decreased MR- and GR-immunoreactivity (ir) in the CA1 of hippocampus in SPS animals. Change in GR sub-distribution was also observed, where GR-ir was shifted from nucleus to cytoplasm in SPS rats. Western blotting showed that SPS induced significantly decreased MR- and GR-protein in the whole hippocampus, although the degree of decreased expression of both receptors was different. Meanwhile, we also found the MR/GR ratio decreased in SPS rats. In general, SPS induced down-regulation of MR- and GR-expression. These findings suggest that MR and GR play critical roles in affecting hippocampal function. Changes in MR/GR ratio may be relevant for behavioral syndrome in PTSD.

PMID: 18787639 [PubMed - in process]

 

Psychol Med. 2008 Aug 28:1-10. [Epub ahead of print]

Negative bias in fast emotion discrimination in borderline personality disorder.

Dyck M, Habel U, Slodczyk J, Schlummer J, Backes V, Schneider F, Reske M.

Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.

BACKGROUND: The ability to decode emotional information from facial expressions is crucial for successful social interaction. Borderline personality disorder (BPD) is characterized by serious problems in interpersonal relationships and emotional functioning. Empirical research on facial emotion recognition in BPD has been sparsely published and results are inconsistent. To specify emotion recognition deficits in BPD more closely, the present study implemented two emotion recognition tasks differing in response format.MethodNineteen patients with BPD and 19 healthy subjects were asked to evaluate the emotional content of  visually presented stimuli (emotional and neutral faces). The first task, the Fear Anger Neutral (FAN) Test, required a rapid discrimination between negative or neutral facial expressions whereas in the second task, the Emotion Recognition (ER) Test, a precise decision regarding default emotions (sadness, happiness, anger, fear and neutral) had to be achieved without a time limit. RESULTS: In comparison to healthy subjects, BPD patients showed a deficit in emotion recognition only in the fast discrimination of negative and neutral facial expressions (FAN Test). Consistent with earlier findings, patients demonstrated a negative bias in the evaluation of neutral facial expressions. When processing time was unlimited (ER Test), BPD patients performed as well as healthy subjects  in the recognition of specific emotions. In addition, an association between performance in the fast discrimination task (FAN Test) and post-traumatic stress  disorder (PTSD) co-morbidity was indicated. CONCLUSIONS: Our data suggest a selective deficit of BPD patients in rapid and direct discrimination of negative  and neutral emotional expressions that may underlie difficulties in social interactions.

PMID: 18752730 [PubMed - as supplied by publisher]

 

J Behav Ther Exp Psychiatry. 2008 Aug 23. [Epub ahead of print]

Cognitive Behavioral Intervention for Trauma in Schools (CBITS): School-based treatment on a rural American Indian reservation.

Morsette A, Swaney G, Stolle D, Schuldberg D, van den Pol R, Young M.

National Native Children's Trauma Center, Division of Educational Research and Service and Department of Psychology, The University of Montana - Missoula, 32 Campus Drive, MT 59812, USA.

This study examines a pilot school-based treatment program for American Indian adolescents residing on a reservation who presented with symptoms of Posttraumatic Stress Disorder (PTSD) and symptoms of depression. This is the first study directed at treating American Indian children with trauma; seven case studies demonstrate our findings that a manualized cognitive behavior therapy intervention delivered in group format for 10 weeks has potential for helping some children who experience PTSD symptoms and depression. The findings generally replicate previous research conducted with groups of non-Indian adolescents in urban settings. PTSD and depressive symptoms decreased for three of the four students who completed treatment. Directions for future research include the need to understand and control attrition and to address cultural influences, including making adaptations in the cognitive behavioral formulations and techniques regarding feelings as operant behaviors. Results contribute to knowledge of feasibility and acceptability of cultural adaptations of CBT for trauma in an under-served population.

PMID: 18835478 [PubMed - as supplied by publisher]

 

Neurosci Lett. 2008 Aug 22;441(2):237-41. Epub 2008 Jun 18.

A modified single-prolonged stress model for post-traumatic stress disorder.

Wang W, Liu Y, Zheng H, Wang HN, Jin X, Chen YC, Zheng LN, Luo XX, Tan QR.

Department of Psychosomatics, Xi'jing Hospital, Fourth Military Medical University, No. 17, West Chang'le Road, Xi'an 710032, China.

In the rat, single-prolonged stress (SPS) model produces a core symptom of post-traumatic stress disorder (PTSD), the enhanced fear response to the traumatic cue (conditioned fear response). This investigative tool is typically used for PTSD studies. However, whether SPS can produce another core symptom of PTSD, hyperarousal (the sensitized fear response in animal models), has not been  evaluated. It is also not clear whether SPS can enhance both conditioned and sensitized fear responses after different incubation times. In this study, a single inescapable electric foot shock was given to rats immediately after SPS procedures (SPS&S). After different incubation times (1, 7 or 14 days), the conditioned or sensitized fear response was measured by re-exposing the stressed  rats to the shock context or a neutral tone in a novel environment. Additionally, paroxetine, a selective serotonin reuptake inhibitor (SSRI) was administered after SPS&S for 14 days to test its potential preventive effect on PTSD-like symptoms. We observed that conditioned fear persisted and sensitized fear increased with ongoing incubation times after SPS&S. Early rapid intervention with paroxetine after SPS&S ameliorated PTSD-like symptoms in both fear responses and anxiety behaviors. Our data suggests that this modified SPS&S model may be both novel and predictably mimic the clinical characteristics of PTSD better than other investigative paradigms.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18577419 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2008 Aug 21. [Epub ahead of print]

Prospective Prediction of Posttraumatic Stress Disorder Symptoms Using Fear Potentiated Auditory Startle Responses.

Pole N, Neylan TC, Otte C, Henn-Hasse C, Metzler TJ, Marmar CR.

Department of Psychology, Smith College, Northampton, Massachusetts.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been most consistently associated with exaggerated physiologic reactivity to startling sounds when such  sounds occur in threatening contexts. There is conflicting evidence about whether startle hyperreactivity is a preexisting vulnerability factor for PTSD or an acquired result of posttrauma neural sensitization. Until now, there have been no prospective studies of physiologic reactivity to startling sounds in threatening  contexts as predictors of PTSD symptoms. METHODS: One hundred and thirty-eight police academy cadets without current psychopathology were exposed to repeated 106-dB startling sounds under increasing (low, medium, or high) threat of mild electric shock while their eye-blink electromyogram, skin conductance, heart rate, and subjective fear responses were recorded. Measures of response habituation were also calculated. Following 1 year of exposure to police-related  trauma, these participants were assessed for PTSD symptom severity. RESULTS: After accounting for other baseline variables that were predictive of PTSD symptom severity (age and general psychiatric distress), more severe PTSD symptoms were prospectively and independently predicted by the following startle  measures: greater subjective fear under low threat, greater skin conductance under high threat, and slower skin conductance habituation. CONCLUSIONS: These results imply that hypersensitivity to contextual threat (indexed by greater fear under low threat), elevated sympathetic nervous system reactivity to explicit threat (indexed by larger responses under high threat), and failure to adapt to repeated aversive stimuli (evidenced by slower habituation) are all unique preexisting vulnerability factors for greater PTSD symptom severity following traumatic stress exposure. These measures may eventually prove useful for preventing PTSD.

PMID: 18722593 [PubMed - as supplied by publisher]

 

JAMA. 2008 Aug 20;300(7):779.

PTSD prevalence still high for persons living near World Trade Center attacks.

Mitka M.

Publication Types:      News

PMID: 18714052 [PubMed - indexed for MEDLINE]

 

Neuropsychopharmacology. 2008 Aug 20. [Epub ahead of print]

A History of Corticosterone Exposure Regulates Fear Extinction and Cortical NR2B, GluR2/3, and BDNF.

Gourley SL, Kedves AT, Olausson P, Taylor JR.

[1] 1Interdepartmental Neuroscience Program, Yale University, New Haven, CT, USA  [2] 2Division of Molecular Psychiatry, Department of Psychiatry, Connecticut Mental Health Center,Yale University, New Haven, CT, USA.

A history of exposure to stressors may be a predisposing factor for developing posttraumatic stress disorder (PTSD) after trauma. Extinction of conditioned fear appears to be impaired in PTSD, but the consequences of prior stress or excess glucocorticoid exposure for extinction learning are not known. We report that prior chronic exposure to the stress hormone, corticosterone (CORT), decreases endogenous CORT secretion upon context reexposure and impairs extinction after contextual fear conditioning in rats, while leaving fear memory acquisition and expression intact. Posttraining administration of the glucocorticoid receptor (GR) antagonist, RU38486, partially mimicked prior CORT exposure effects on freezing during fear extinction training. Extinction of conditioned fear is an active learning process thought to involve glutamatergic targets-including specific NMDA and AMPA receptor subunits-in the ventromedial prefrontal cortex (vmPFC), which includes the prelimbic, infralimbic, and medial orbitofrontal cortices. After CORT exposure, decreases in the NMDA receptor NR2B subunit and AMPA receptor subunits, GluR2/3, as well as brain-derived neurotrophic factor, were detected in cortical regions, but not dorsal hippocampus (CA1). Receptor subunit expression levels in the vmPFC correlated with freezing during training.  In addition, prior CORT selectively decreased sucrose preference, consistent with established models of anhedonia and with blunted affect in PTSD. Together, these  data suggest a cellular mechanism by which chronically elevated glucocorticoid exposure-as may be experienced during repeated exposure to stressors-interferes with the neural systems that modulate behavioral flexibility and may thereby contribute to psychopathological fear states.Neuropsychopharmacology advance online publication, 20 August 2008; doi:10.1038/npp.2008.123.

PMID: 18719621 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Aug 16. [Epub ahead of print]

Preclinical Assessment for Selectively Disrupting a Traumatic Memory via Postretrieval Inhibition of Glucocorticoid Receptors.

Taubenfeld SM, Riceberg JS, New AS, Alberini CM.

Departments of Neuroscience, Mount Sinai School of Medicine, New York, New York.

BACKGROUND: Traumatic experiences may lead to debilitating psychiatric disorders  including acute stress disorder and posttraumatic stress disorder. Current treatments for these conditions are largely ineffective, and novel therapies are  needed. A cardinal symptom of these pathologies is the reexperiencing of the trauma through intrusive memories and nightmares. Studies in animal models indicate that memories can be weakened by interfering with the postretrieval restabilization process known as memory reconsolidation. We previously reported that, in rats, intraamygdala injection of the glucocorticoid receptor antagonist  RU38486 disrupts the reconsolidation of a traumatic memory. Here we tested parameters important for designing novel clinical protocols targeting the reconsolidation of a traumatic memory with RU38486. METHODS: Using rat inhibitory avoidance, we tested the efficacy of postretrieval systemic administration of RU38486 on subsequent memory retention and evaluated several key preclinical parameters. RESULTS: Systemic administration of RU38486 before or after retrieval persistently weakens inhibitory avoidance memory retention in a dose-dependent manner, and memory does not reemerge following a footshock reminder. The efficacy of treatment is a function of the intensity of the initial trauma, and intense traumatic memories can be disrupted by changing the time and number of interventions. Furthermore, one or two treatments are sufficient to disrupt the memory maximally. The treatment selectively targets the reactivated memory without interfering with the retention of another nonreactivated memory. CONCLUSIONS: RU38486 is a potential novel treatment for psychiatric disorders linked to traumatic memories. Our data provide the parameters for designing promising clinical trials for the treatment of flashback-type symptoms of PTSD.

PMID: 18708183 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Aug 15;64(4):327-35.

Neurophysiological responses to traumatic reminders in the acute aftermath of serious motor vehicle collisions using [15O]-H2O positron emission tomography.

Osuch EA, Willis MW, Bluhm R; CSTS Neuroimaging Study Group, Ursano RJ, Drevets WC.

Collaborators: Fullerton C, Crowley B, Epstein R, Gerber M, Grover M, Russotto J, Tiongson J.

Department of Psychiatry, University of Western Ontario, London, Ontario, Canada. elizabeth.osuch@lhsc.on.ca

BACKGROUND: Neuroimaging studies report that individuals with posttraumatic stress disorder show abnormal responses in the amygdala and medial prefrontal cortex (mPFC)/anterior cingulate cortex (ACC) during exposure to traumatic reminders. However, neural responses arising in the early aftermath of a traumatic event have not been studied. METHODS: Twenty-two motor vehicle collision survivors and 12 nontraumatized control subjects participated. Regional cerebral blood flow (rCBF) was measured using [(15)O]-H(2)O positron emission tomography (PET) at rest and as subjects listened to scripts of traumatic and neutral events. Self-report measures rated emotional responses to the scripts; standardized assessments (Impact of Events--Revised) evaluated acute stress symptoms at scanning and at 3-month follow-up. Most subjects improved symptomatically. RESULTS: At rest, trauma subjects showed hyperperfusion in right mPFC/ACC and hypoperfusion in right amygdala compared with control subjects. In trauma subjects, listening to trauma scripts versus neutral scripts resulted in decreased flow in the right amygdala and left amygdala/perirhinal cortex, and symptom scores correlated negatively with right hippocampal flow changes. Symptom improvement at 3 months correlated negatively with rCBF changes in right perirhinal cortex and hippocampus during the trauma versus neutral script contrast. Subjective disturbance during the trauma versus neutral contrast correlated positively with rCBF changes in right amygdala and left mPFC. Functional connectivity analyses of rCBF changes during trauma versus neutral scripts demonstrated left amygdala coupling with right ACC and bilateral anterior insula, as well as coupling between the amygdala and contralateral hippocampus. CONCLUSIONS: In recently traumatized subjects functional interactions between the amygdala, perirhinal cortex and ACC/mPFC that occur during exposure to traumatic  reminders may underlie adaptive/recuperative processes.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, N.I.H., Intramural

PMID: 18423575 [PubMed - indexed for MEDLINE]

 

Biol Psychiatry. 2008 Aug 15;64(4):281-5. Epub 2008 Apr 11.

Low plasma brain-derived neurotrophic factor and childhood physical neglect are associated with verbal memory impairment in major depression--a preliminary report.

Grassi-Oliveira R, Stein LM, Lopes RP, Teixeira AL, Bauer ME.

Faculty of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.

BACKGROUND: Early life stress has been suggested to mediate vulnerability to affective disorders. Animal models of repeated maternal separation have shown reduced brain-derived neurotrophic factor (BDNF) levels in specific brain regions implicated with hypothalamic-pituitary-adrenal axis and memory formation. In addition, BDNF levels are also reduced in major depressive disorder (MDD) and bipolar disorder. The aim of this study was to investigate whether childhood physical neglect (CPN) and plasma BDNF levels would impact on memory performance  in adult female subjects with recurrent major depression. METHODS: Recurrent female MDD outpatients with CPN (MDD + CPN, n = 17) and without CPN (MDD, n = 17) and healthy control subjects (n = 15) were assessed for plasma BDNF content and verbal memory performance. Memory was assessed through the logical memory component of the Weschler Memory Scale-Revised for immediate and delayed recall.  Brain-derived neurotrophic factor was assessed with enzyme-linked immunosorbent assays (ELISAs). RESULTS: Major depressive disorder patients showed lower plasma  BDNF concentrations than healthy control subjects (p < .001). Major depressive disorder + CPN had even lower BDNF levels compared with control subjects and MDD  (p < .05). Brain-derived neurotrophic factor levels were negatively related to psychological morbidity and positively correlated to memory performance. Regression models showed that severity of self-reported CPN and low plasma BDNF predicted impairment on immediate verbal recall. Delayed recall impairment was predicted by severity of CPN and depression and memory retention by posttraumatic stress disorder (PTSD) severity symptoms. CONCLUSIONS: Our data suggest that CPN  and plasma BDNF are important factors associated with depression and verbal memory performance, particularly with encoding processes.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18406398 [PubMed - indexed for MEDLINE]

 

Int J Neuropsychopharmacol. 2008 Aug 13:1-13. [Epub ahead of print]

Exposure to extreme stress impairs contextual odour discrimination in an animal model of PTSD.

Cohen H, Liberzon I, Richter-Levin G.

Ministry of Health Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Post-traumatic stress disorder (PTSD) patients respond to trauma-related danger cues even in objectively safe environments as if they were in the original event, seemingly unable to adequately modulate their responses based on the contextual cues present. In order to model this inability to utilize contextualized memory,  in an animal model of PTSD, a novel experimental paradigm of contextual cue processing was developed - the differential contextual odour conditioning (DCOC)  paradigm - and tested in trauma-exposed animals and controls. In the DCOC paradigm, animals encountered cinnamon odour in both an aversive environment and  a rewarding (safe) environment. Response (freezing) to cinnamon odour was tested  in a third, neutral environment to examine the ability of animals to modulate their responses based on the contextual cues. The effect of exposure to traumatic stressors, e.g. predator scent stress (PSS) and underwater trauma (UWT), on contextual cue discrimination was assessed. Rats trained in the DCOC paradigm acquired the ability to modulate their behavioural responses to odour cue based on contextual cues signalling safe vs. dangerous environment. The PSS and UWT stressors abolished the ability to modulate their responses based on contextual cues, both when exposure preceded DCOC training, and when it followed successfully completed training. The DCOC paradigm offers a promising model for studying the neurobiological basis of contextual modulation of response to potential threat in animals, a process that is disrupted by exposure to severe stress/trauma, and thus might be particularly salient for the study of PTSD.

PMID: 18700055 [PubMed - as supplied by publisher]

 

JAMA. 2008 Aug 13;300(6):720-1.

Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder.

Corrigan JD, Cole TB.

Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, USA.

PMID: 18698070 [PubMed - indexed for MEDLINE]

 

JAMA. 2008 Aug 13;300(6):711-9.

Prevalence of chronic pain after traumatic brain injury: a systematic review.

Nampiaparampil DE.

Department of Internal Medicine, Veterans Affairs Central California Healthcare System, Fresno, CA 93703, USA. devichechi@gmail.com

CONTEXT: The Centers for Disease Control and Prevention estimates that approximately 1.4 million US individuals sustain traumatic brain injuries (TBIs)  per year. Previous reports suggest an association between TBI and chronic pain syndromes (eg, headache) thought to be more common in patients with mild TBI and  in those who have sustained brain injury from violent rather than unintentional trauma. Comorbid psychiatric disorders such as posttraumatic stress disorder (PTSD) may also mediate chronic pain symptoms. OBJECTIVES: To determine the prevalence of chronic pain as an underdiagnosed consequence of TBI and to review  the interaction between chronic pain and severity of TBI as well as the characteristics of pain after TBI among civilians and combatants. EVIDENCE ACQUISITION: The Ovid/MEDLINE database was searched for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat (combat disorders, war, military medicine, wounds and injuries, military personnel, veterans). The PubMed and MD Consult databases were searched in a similar fashion. The Cochrane Collaboration, National Institutes of Health Clinical Trials Database, Meta-Register of Current  Controlled Trials, and CRISP databases were searched using the keyword brain injury. All articles in peer-reviewed journals reporting original data on pain syndromes in adult patients with TBI with regard to pain prevalence, pain category, risk factors, pathogenesis, and clinical course were selected, and manual searches were performed of their reference lists. The data were pooled and prevalence rates calculated. EVIDENCE SYNTHESIS: Twenty-three studies (15 cross-sectional, 5 prospective, and 3 retrospective) including 4206 patients were identified. Twelve studies assessed headache pain in 1670 patients. Of these, 966 complained of chronic headache, yielding a prevalence of 57.8% (95% confidence interval [CI], 55.5%-60.2%). Among civilians, the prevalence of chronic pain was  greater in patients with mild TBI (75.3% [95% CI, 72.7%-77.9%]) compared with moderate or severe TBI (32.1% [95% CI, 29.3%-34.9%]). Twenty studies including 3289 civilian patients with TBI yielded a chronic pain prevalence of 51.5% (95% CI, 49.8%-53.2%). Three studies assessed TBI among 917 veterans and yielded a pain prevalence of 43.1% (95% CI, 39.9%-46.3%). PTSD may mediate chronic pain, but brain injury appears to have an independent correlation with chronic pain. CONCLUSIONS: Chronic pain is a common complication of TBI. It is independent of psychologic disorders such as PTSD and depression and is common even among patients with apparently minor injuries to the brain.

Publication Types:      Review

PMID: 18698069 [PubMed - indexed for MEDLINE]

 

JAMA. 2008 Aug 13;300(6):691-702.

Comment in:     JAMA. 2008 Dec 17;300(23):2729; author reply 2729-30.

Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal.

Kohrt BA, Jordans MJ, Tol WA, Speckman RA, Maharjan SM, Worthman CM, Komproe IH.

Department of Anthropology, Emory University, 1557 Dickey Dr, Atlanta, GA 30322,  USA. brandonkohrt@gmail.com

CONTEXT: Former child soldiers are considered in need of special mental health interventions. However, there is a lack of studies investigating the mental health of child soldiers compared with civilian children in armed conflicts. OBJECTIVE: To compare the mental health status of former child soldiers with that of children who have never been conscripts of armed groups. DESIGN, SETTING, AND  PARTICIPANTS: Cross-sectional cohort study conducted in March and April 2007 in Nepal comparing the mental health of 141 former child soldiers and 141 never-conscripted children matched on age, sex, education, and ethnicity. MAIN OUTCOME MEASURES: Depression symptoms were assessed via the Depression Self Rating Scale, anxiety symptoms via the Screen for Child Anxiety Related Emotional Disorders, symptoms of posttraumatic stress disorder (PTSD) via the Child PTSD Symptom Scale, general psychological difficulties via the Strength and Difficulties Questionnaire, daily functioning via the Function Impairment tool, and exposure to traumatic events via the PTSD Traumatic Event Checklist of the Kiddie Schedule of Affective Disorders and Schizophrenia. RESULTS: Participants were a mean of 15.75 years old at the time of this study, and former child soldiers ranged in age from 5 to 16 years at the time of conscription. All participants experienced at least 1 type of trauma. The numbers of former child soldiers meeting symptom cutoff scores were 75 (53.2%) for depression, 65 (46.1%) for anxiety, 78 (55.3%) for PTSD, 55 (39.0%) for psychological difficulties, and  88 (62.4%) for function impairment. After adjusting for traumatic exposures and other covariates, former soldier status was significantly associated with depression (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.31-4.44) and PTSD among girls (OR, 6.80; 95% CI, 2.16-21.58), and PTSD among boys (OR, 3.81; 95% CI, 1.06-13.73) but was not associated with general psychological difficulties (OR, 2.08; 95% CI, 0.86-5.02), anxiety (OR, 1.63; 95% CI, 0.77-3.45), or function impairment (OR, 1.34; 95% CI, 0.84-2.14). CONCLUSION: In  Nepal, former child soldiers display greater severity of mental health problems compared with children never conscripted by armed groups, and this difference remains for depression and PTSD (the latter especially among girls) even after controlling for trauma exposure.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18698067 [PubMed - indexed for MEDLINE]

 

JAMA. 2008 Aug 13;300(6):676-90.

Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia.

Johnson K, Asher J, Rosborough S, Raja A, Panjabi R, Beadling C, Lawry L.

Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA.

CONTEXT: Liberia's wars since 1989 have cost tens of thousands of lives and left  many people mentally and physically traumatized. OBJECTIVES: To assess the prevalence and impact of war-related psychosocial trauma, including information on participation in the Liberian civil wars, exposure to sexual violence, social  functioning, and mental health. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, population-based, multistage random cluster survey of 1666 adults aged 18 years or older using structured interviews and questionnaires, conducted during a 3-week period in May 2008 in Liberia. MAIN OUTCOME MEASURES: Symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), social functioning, exposure to sexual violence, and health and mental health needs among Liberian adults who witnessed or participated in the conflicts during the last 2 decades. RESULTS: In the Liberian adult household-based population, 40% (95% confidence interval [CI], 36%-45%; n = 672/1659) met symptom criteria for MDD, 44% (95% CI, 38%-49%; n = 718/1661) met symptom criteria for PTSD, and 8% (95% CI, 5%-10%; n = 133/1666) met criteria for social dysfunction.  Thirty-three percent of respondents (549/1666) reported having served time with fighting forces, and 33.2% of former combatant respondents (182/549) were female. Former combatants experienced higher rates of exposure to sexual violence than noncombatants: among females, 42.3% (95% CI, 35.4%-49.1%) vs 9.2% (95% CI, 6.7%-11.7%), respectively; among males, 32.6% (95% CI, 27.6%-37.6%) vs 7.4% (95%  CI, 4.5%-10.4%). The rates of symptoms of PTSD, MDD, and suicidal ideation were higher among former combatants than noncombatants and among those who experienced sexual violence vs those who did not. The prevalence of PTSD symptoms among female former combatants who experienced sexual violence (74%; 95% CI, 63%-84%) was higher than among those who did not experience sexual violence (44%; 95% CI,  33%-53%). The prevalence of PTSD symptoms among male former combatants who experienced sexual violence was higher (81%; 95% CI, 74%-87%) than among male former combatants who did not experience sexual violence (46%; 95% CI, 39%-52%).  Male former combatants who experienced sexual violence also reported higher rates of symptoms of depression and suicidal ideation. Both former combatants and noncombatants experienced inadequate access to health care (33.0% [95% CI, 22.6%-43.4%] and 30.1% [95% CI, 18.7%-41.6%], respectively). CONCLUSIONS: Former  combatants in Liberia were not exclusively male. Both female and male former combatants who experienced sexual violence had worse mental health outcomes than  noncombatants and other former combatants who did not experience exposure to sexual violence.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18698066 [PubMed - indexed for MEDLINE]

 

JAMA. 2008 Aug 13;300(6):655-62.

School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial.

Tol WA, Komproe IH, Susanty D, Jordans MJ, Macy RD, De Jong JT.

HealthNet TPO, Department of Public Health and Research, Tolstraat 127, 1074 VJ,  Amsterdam, The Netherlands. wtol@healthnettpo.org

CONTEXT: Little is known about the efficacy of mental health interventions for children exposed to armed conflicts in low- and middle-income settings. Childhood mental health problems are difficult to address in situations of ongoing poverty  and political instability. OBJECTIVE: To assess the efficacy of a school-based intervention designed for conflict-exposed children, implemented in a low-income  setting. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial involving  495 children (81.4% inclusion rate) who were a mean (SD) age of 9.9 (1.3) years,  were attending randomly selected schools in political violence-affected communities in Poso, Indonesia, and were screened for exposure (> or = 1 events), posttraumatic stress disorder, and anxiety symptoms compared with a wait-listed control group. Nonblinded assessment took place before, 1 week after, and 6 months after treatment between March and December 2006. INTERVENTION: Fifteen sessions, over 5 weeks, of a manualized, school-based group intervention, including trauma-processing activities, cooperative play, and creative-expressive elements, implemented by locally trained paraprofessionals. MAIN OUTCOME MEASURES: We assessed psychiatric symptoms using the Child Posttraumatic Stress Scale, Depression Self-Rating Scale, the Self-Report for Anxiety Related Disorders 5-item version, and the Children's Hope Scale, and assessed function impairment as treatment outcomes using standardized symptom checklists and locally developed rating scales. RESULTS: Correcting for clustering of participants within schools, we found significantly more improvement in posttraumatic stress disorder symptoms (mean change difference, 2.78; 95% confidence interval [CI], 1.02 to 4.53) and maintained hope (mean change difference, -2.21; 95% CI, -3.52 to -0.91) in the treatment group than in the wait-listed group. Changes in traumatic idioms (stress-related physical symptoms) (mean change difference, 0.50; 95% CI, -0.12 to 1.11), depressive symptoms (mean  change difference, 0.70; 95% CI, -0.08 to 1.49), anxiety (mean change difference, 0.12; 95% CI, -0.31 to 0.56), and functioning (mean change difference, 0.52; 95%  CI, -0.43 to 1.46) were not different between the treatment and wait-listed groups. CONCLUSIONS: In this study of children in violence-affected communities,  a school-based intervention reduced posttraumatic stress symptoms and helped maintain hope, but did not reduce traumatic-stress related symptoms, depressive symptoms, anxiety symptoms, or functional impairment. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN25172408.

Publication Types:      Randomized Controlled Trial     Research Support, Non-U.S. Gov't

PMID: 18698064 [PubMed - indexed for MEDLINE]

 

BMC Psychiatry. 2008 Aug 12;8:68.

The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice.

Braga LL, Fiks JP, Mari JJ, Mello MF.

Graduate Program in Psychiatry - Department of Psychiatry, Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil. lorensblu@gmail.com

BACKGROUND: Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are  often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an  obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder. DISCUSSION: A critical review of scientific literature showed that stress can be  divided in stages to facilitate specific terminological adjustments to the event  itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10. SUMMARY: The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to  resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities. METHODS: To develop this debate article, a current specialized literature review was achieved by searching and retrieving the key terms from two major databases: PubMed and PsycINFO. The key terms included "disaster", "catastrophe", "barbarism", "terrorism", "trauma", "psychic trauma" and "violence", also in combination with the terms "PTSD", "concept" and "conceptual aspects". The data were captured specially from review articles. The  included studies were those mostly identified by the authors as relevant by the presence of a conceptual approach in any part of the paper. Researches that relied solely on empirical indicators, like psychopathological, neurobiological or pharmacological aspects, were excluded. The focus here was in conceptual aspects, even when some few empirical studies were included. As it was noted a paucity of medical references related to conceptual aspects of these terms, a wider literature needed to be included, including chapters, books and articles proceeded from the Humanities areas. "Interdisciplinary research is needed in this area to include perspectives from a range of different disciplines" once that "to promote public health (...) new dimensions of such interactions and the  implications thereof should be pursued in collaboration with researchers from broader areas" 1.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18694520 [PubMed - in process]

 

J Anxiety Disord. 2008 Aug 12. [Epub ahead of print]

A factor analytic comparison of five models of PTSD symptoms.

Lancaster SL, Melka SE, Rodriguez BF.

Southern Illinois University, United States.

This study examined the factor structure of PTSD symptoms in a sample of college  students (n=344) reporting exposure to a range of traumatic events. The sample was randomly split and an exploratory factor analysis was conducted with half of  the sample. The factor structure obtained in the exploratory analysis was evaluated against three other models using confirmatory factor analysis utilizing the second half of the sample. This series of factor analyses identified and confirmed a three-factor symptom structure consisting of intrusion/avoidance, dysphoria, and hyperarousal clusters. These results add to the body of literature which has found that PTSD includes a cluster of symptoms shared with other diagnoses (dysphoria) and a more specific factor related directly to the effects  of encountering traumatic experiences.

PMID: 18829253 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Aug 12. [Epub ahead of print]

Stressful events and support during birth: The effect on anxiety, mood and perceived control.

Ford E, Ayers S.

Psychology Department, University of Sussex, Brighton, BN1 9QH, UK.

Following childbirth, 16% of women may have anxiety disorders and 2% develop PTSD. It is important to identify factors that influence women's emotional reactions to birth. This study investigated how stressful events and support from hospital staff during birth each affects women's anxiety and perceived control. METHODS: A between-subjects experimental design used birth stories to manipulate  levels of stressful events (high/low) and support (high/low) during birth. Participants (n=137) imagined undergoing one of the birth experiences and rated their perceived control, mood, and anxiety. RESULTS: Manipulation checks indicated the birth stories reliably elicited mood responses. Anxiety, mood, and  perceived control were more strongly influenced by support than by stressful events. There was a significant interaction between stressful events and support  for perceived control. CONCLUSIONS: Level of support from hospital staff during birth has a greater effect on women's emotional reactions than stressful events.  Supportive care during birth increases perceived control and reduces anxiety and  negative mood.

PMID: 18789646 [PubMed - as supplied by publisher]

 

Biol Psychiatry. 2008 Aug 8. [Epub ahead of print]

Ambulatory Cardiovascular Activity and Hostility Ratings in Women with Chronic Posttraumatic Stress Disorder.

Beckham JC, Flood AM, Dennis MF, Calhoun PS.

Mental Health Service Line, Durham Veterans Affairs Medical Center, Durham, North Carolina; Veterans Affairs Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham, North Carolina; Department of Psychiatry, Duke  University Medical Center, Durham, North Carolina.

BACKGROUND: The objective of the current study is to evaluate the relationship between hostility and ambulatory cardiovascular activity in women with and without posttraumatic stress disorder (PTSD). METHODS: One hundred and one women  completed 24 hours of ambulatory monitoring and standardized diagnostic and hostility measures. Generalized estimating equations analysis was used to examine the effects of group and hostility factor scores (hostile beliefs, overt hostility, and covert hostility) on ambulatory heart rate (AHR) and ambulatory systolic (ASBP) and diastolic (ADBP) blood pressure. RESULTS: After controlling for covariates, there was an interaction between PTSD and both hostile beliefs and overt hostility for AHR. Increases in hostility were associated with greater  increases in heart rate among women with PTSD relative to those without PTSD. There was a similar interaction between hostile beliefs and group for ADBP. CONCLUSIONS: Increased AHR and blood pressure have been linked to poor cardiovascular outcomes in nonpsychiatric populations. Individuals with PTSD display increased hostility, a construct that has also been linked to poorer cardiovascular outcomes. Increases in hostile beliefs were associated with a greater increase in ADBP among women with PTSD as compared with control subjects. These data suggest that PTSD might in part moderate the relationship between hostility and cardiovascular outcomes.

PMID: 18692171 [PubMed - as supplied by publisher]

 

J Anxiety Disord. 2008 Aug 6. [Epub ahead of print]

The validity and diagnostic efficiency of the Davidson Trauma Scale in military veterans who have served since September 11th, 2001.

McDonald SD, Beckham JC, Morey RA, Calhoun PS.

VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, United States.

The present study examined the psychometric properties and diagnostic efficiency  of the Davidson Trauma Scale (DTS), a self-report measure of posttraumatic stress disorder (PTSD) symptoms. Participants included 158 U.S. military veterans who have served since September 11, 2001 (post-9/11). Results support the DTS as a valid self-report measure of PTSD symptoms. The DTS demonstrated good internal consistency, concurrent validity, and convergent and divergent validity. Diagnostic efficiency was excellent when discriminating between veterans with PTSD and veterans with no Axis I diagnosis. However, although satisfactory by conventional standards, efficiency was substantially attenuated when discriminating between PTSD and other Axis I diagnoses. Thus, results illustrate  that potency of the DTS as a diagnostic aid was highly dependent on the comparison group used for analyses. Results are discussed in terms of applications to clinical practice and research.

PMID: 18783913 [PubMed - as supplied by publisher]

 

Int J Biol Sci. 2008 Aug 5;4(4):223-35.

Dysregulated mitochondrial genes and networks with drug targets in postmortem brain of patients with posttraumatic stress disorder (PTSD) revealed by human mitochondria-focused cDNA microarrays.

Su YA, Wu J, Zhang L, Zhang Q, Su DM, He P, Wang BD, Li H, Webster MJ; Traumatic  Stress Brain Study Group, Rennert OM, Ursano RJ.

Department of Biochemistry, Molecular Biology, the Catherine Birch McCormick Genomics Center, The George Washington University School of Medicine, Health Sciences, Washington, DC 20037, USA. bcmyas@gwumc.edu

Posttraumatic stress disorder (PTSD) is associated with decreased activity in the dorsolateral prefrontal cortex (DLPFC), the brain region that regulates working memory and preparation and selection of fear responses. We investigated gene expression profiles in DLPFC Brodmann area (BA) 46 of postmortem patients with (n=6) and without PTSD (n=6) using human mitochondria-focused cDNA microarrays. Our study revealed PTSD-specific expression fingerprints of 800 informative mitochondria-focused genes across all of these 12 BA46 samples, and 119 (+/->1.25, p<0.05) and 42 (+/->1.60, p<0.05) dysregulated genes between the PTSD  and control samples. Quantitative RT-PCR validated the microarray results. These  fingerprints can essentially distinguish the PTSD DLPFC BA46 brains from controls. Of the 119 dysregulated genes (+/-> or =125%, p<0.05), the highest percentages were associated with mitochondrial dysfunction (4.8%, p=6.61 x 10(-6)), oxidative phosphorylation (3.8%, p=9.04 x 10(-4)), cell survival-apoptosis (25.2%, p<0.05) and neurological diseases (23.5%, p<0.05). Fifty (50) dysregulated genes were present in the molecular networks that are known to be involved in neuronal function-survival and contain 7 targets for neuropsychiatric drugs. Thirty (30) of the dysregulated genes are associated with a number of neuropsychiatric disorders. Our results indicate mitochondrial dysfunction in the PTSD DLPFC BA46 and provide the expression fingerprints that may ultimately serve as biomarkers for PTSD diagnosis and the drugs and molecular targets that may prove useful for development of remedies for prevention and treatment of PTSD.

PMID: 18690294 [PubMed - in process]

 

AAOHN J. 2008 Aug;56(8):364.

The returning veteran--a lesson in reintegration.

Maher HK.

ExxonMobil Medicine and Occupational Health, Houston, TX, USA.

Families, coworkers, employers, and health care providers play a role in the reintegration of returning veterans.

PMID: 18717303 [PubMed - indexed for MEDLINE]

 

AAOHN J. 2008 Aug;56(8):357-63.

Mindfulness meditation for veterans---implications for occupational health providers.

Cuellar NG.

School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.

Mindfulness meditation (MfM) is a mind-body therapy identified by the National Center for Complementary and Alternative Medicine. Initially taught in a formal classroom setting, MfM is a sustainable intervention with minimal costs that can  be used over time. For veterans, after mastery, this technique shows promise in improving health outcomes and quality of life. This article describes MfM, discusses the conceptual framework and evidence-based research for MfM, and identifies the implications of MfM use by health care providers who are caring for war veterans.

Publication Types:      Review

PMID: 18717302 [PubMed - indexed for MEDLINE]

 

AAOHN J. 2008 Aug;56(8):343-6.

Transition from the Afghanistan and Iraqi battlefields to home: an overview of selected war wounds and the federal agencies assisting soldiers regain their health.

Brown ND.

Occupational health nurses are encountering veterans in the workplace who have served one or more tours of duty in Afghanistan or Iraq. Soldiers making the transition from combat to civilian life may have physical and mental injuries from war. Occupational health nurses who recognize the unique nature of these injuries and are knowledgeable about resources for meeting veterans' needs will be instrumental in facilitating their return to civilian life.

PMID: 18717300 [PubMed - indexed for MEDLINE]

 

AAOHN J. 2008 Aug;56(8):337-41.

Reflections on the culture of veterans.

Hobbs K.

Sharp Memorial Hospital, San Diego, CA, USA.

Veterans, as a cultural group, present unique challenges to health care providers. Veteran culture includes health inequalities and health disparities related to posttraumatic stress disorder, depression, and substance abuse that must be understood in context to provide the best care possible to this population. Veterans are not, however, frequently viewed in terms of culturally competent nursing care. Changes in the approach to this population are necessary  to provide effective, comprehensive, and compassionate care.

Publication Types:      Review

PMID: 18717299 [PubMed - indexed for MEDLINE]

 

AAOHN J. 2008 Aug;56(8):335-6.

Caring for our wounded warriors.

McCauley LA.

Publication Types:      Editorial     Introductory Journal Article

PMID: 18717298 [PubMed - indexed for MEDLINE]

 

Addict Behav. 2008 Aug;33(8):1039-47. Epub 2008 Apr 14.

Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD.

Rash CJ, Coffey SF, Baschnagel JS, Drobes DJ, Saladin ME.

The University of Mississippi Medical Center, Department of Psychiatry and Human  Behavior, Jackson, MS 39216, USA. carlarash@gmail.com

Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance  abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale-Revised (IES-R) in a sample  of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18501524 [PubMed - in process]

 

Am J Med Sci. 2008 Aug;336(2):111-5.

Exposure to Hurricane Katrina, post-traumatic stress disorder and birth outcomes.

Xiong X, Harville EW, Mattison DR, Elkind-Hirsch K, Pridjian G, Buekens P.

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112-2715, USA. xxiong@tulane.edu

BACKGROUND: Little is known about the effects of natural disasters on pregnancy outcomes. We studied mental health and birth outcomes among women exposed to Hurricane Katrina. METHODS: We collected data prospectively from a cohort of 301  women from New Orleans and Baton Rouge. Pregnant women were interviewed during pregnancy about their experiences during the hurricane, and whether they had experienced symptoms of post-traumatic stress disorder (PTSD) and/or depression.  High hurricane exposure was defined as having 3 or more of the 8 severe hurricane experiences, such as feeling that one's life was in danger, walking through floodwaters, or having a loved one die. RESULTS: The frequency of low birth weight was higher in women with high hurricane exposure (14.0%) than women without high hurricane exposure (4.7%), with an adjusted odds ratio (aOR): 3.3; 95% confidence interval (CI): 1.13-9.89; P < 0.01. The frequency of preterm birth was higher in women with high hurricane exposure (14.0%) than women without high  hurricane exposure (6.3%), with aOR: 2.3; 95% CI: 0.82-6.38; P > 0.05. There were no significant differences in the frequency of low birth weight or preterm birth  between women with PTSD or depression and women without PTSD or depression (P > 0.05). CONCLUSIONS: Women who had high hurricane exposure were at an increased risk of having low birth weight infants. Rather than a general exposure to disaster, exposure to specific severe disaster events and the intensity of the disaster experience may be better predictors of poor pregnancy outcomes. To prevent poor pregnancy outcomes during and after disasters, future disaster preparedness may need to include the planning of earlier evacuation of pregnant women to minimize their exposure to severe disaster events.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18703903 [PubMed - indexed for MEDLINE]

 

Am J Nurs. 2008 Aug;108(8):13.

Nursing in a time of war.

Long R.

Publication Types:      Letter

PMID: 18664740 [PubMed - indexed for MEDLINE]

 

An Pediatr (Barc). 2008 Aug;69(2):134-40.

[Post-traumatic stress disorder in premature newborns]

[Article in Spanish]

Reyes-Alvarado S, Romero Sánchez J, Rivas-Ruiz F, Perea-Milla E, Medina López R,  León Ruiz AM, Alvarez Aldeán J.

Unidad de Investigación. Hospital Costa del Sol. Marbella. Málaga. España. sirenia16@gmail.com.

INTRODUCTION: Preterm newborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). PATIENTS AND METHODS: Prospective follow-up  study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. RESULTS: The number of responses considered to be pathological observed among neonates, in the mothers'  arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR = 3.3). CONCLUSIONS: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU.

Publication Types:      English Abstract

PMID: 18755118 [PubMed - indexed for MEDLINE]

 

Arch Psychiatr Nurs. 2008 Aug;22(4):217-25.

Evolution of posttraumatic stress disorder and future directions.

Ray SL.

The University of Western Ontario, London, Ontario, Canada. slray@uwo.ca

The knowledge that trauma can cause long-term physiological and psychological problems has been recognized for centuries. Today, such suffering would be classified as the characteristic symptoms of posttraumatic stress disorder (PTSD). Nurses in all practice settings are increasingly caring for individuals suffering from military trauma, natural disasters, and interpersonal violence such as childhood sexual, physical, and emotional abuse, intimate partner violence, and collective violence. This article discusses how the diagnosis of PTSD evolved over the course of history, limitations of the PTSD diagnostic category, and additional diagnostic categories for trauma. Implications for nursing practice and future directions for research are explored.

Publication Types:      Review

PMID: 18640541 [PubMed - indexed for MEDLINE]

 

Aust N Z J Psychiatry. 2008 Aug;42(8):693-701.

Reducing symptoms of trauma among carers of people with psychosis: pilot study examining the impact of writing about caregiving experiences.

Barton K, Jackson C.

Department of Psychology, Birmingham and Solihull Mental Health Trust, Great Barr, Birmingham, UK. karen.barton@bsmht.nhs.uk

OBJECTIVES: To establish whether writing about experiences of the first episode of psychosis may alleviate trauma-like symptoms among carers of people with psychosis. METHOD: A total of 37 people caring for someone with early psychosis were randomized to two conditions: either writing about the first psychotic episode, or writing about time management. Data were collected before and after intervention, and 8 weeks later. RESULTS: Those in the writing group were significantly less likely to avoid reminders and feelings associated with their relative's episode at follow up. Furthermore, carers in this group who exhibited  trauma-like symptoms had significantly greater reductions in trauma severity. CONCLUSIONS: Written emotional disclosure can help carers who are experiencing trauma symptoms following a relative's first episode of psychosis. If writing about emotional events is beneficial through mechanisms of exposure then screening participants for trauma symptoms may eliminate previous research inconsistencies. These results, however, need to be replicated in a larger study.

Publication Types:      Randomized Controlled Trial

PMID: 18622777 [PubMed - indexed for MEDLINE]

 

Australas Psychiatry. 2008 Aug;16(4):297.

DSM-IV cure for post-traumatic stress disorder.

Cantor C.

Publication Types:      Letter

PMID: 18683298 [PubMed - indexed for MEDLINE]

 

Australas Psychiatry. 2008 Aug;16(4):295-6.

Acute trauma response at a conference abroad.

McCarthy L, Alderman C.

Publication Types:      Letter

PMID: 18683296 [PubMed - indexed for MEDLINE]

 

Australas Psychiatry. 2008 Aug;16(4):268-72.

Hallucinations in adolescent inpatients with post-traumatic stress disorder and schizophrenia: similarities and differences.

Jessop M, Scott J, Nurcombe B.

Child and Youth Mental Health Service, Royal Children's Hospital and Health District Service, Brisbane, QLD, Australia. Mary_Jessop@health.qld.gov.au

OBJECTIVE: This study compares the phenomenology of hallucinations in a series of hospitalized adolescents diagnosed with post-traumatic stress disorder (PTSD) and schizophrenia. METHODS: Subjects admitted to a tertiary adolescent inpatient unit were screened for hallucinations. Those reporting hallucinations were asked standardized questions relating to these experiences. Hallucinations in subjects  with a primary diagnosis of schizophrenia or PTSD were compared. RESULTS: Hallucinations in both schizophrenia and PTSD have similar form and content. Frequent, vivid, realistic, external hallucinations occurred in both disorders. Hallucinations in PTSD were usually derogatory and related to self-harm, but not  direct reflections of traumatic events. Patients with PTSD reported greater emotional distress, self-harm and suicidal ideation than those with schizophrenia. CONCLUSIONS: This case series suggests that the phenomenology of hallucinations in adolescents with schizophrenia and PTSD is similar.

PMID: 18608156 [PubMed - indexed for MEDLINE]

 

Br J Psychiatry. 2008 Aug;193(2):165-6.

Differences in psychological effects in hospital doctors with and without post-traumatic stress disorder.

Einav S, Shalev AY, Ofek H, Freedman S, Matot I, Weiniger CF.

Department of Anesthesia, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Post-traumatic stress disorder (PTSD) can reduce performance. The association between PTSD and other psychopathologies among hospital doctors was examined using self-report questionnaires during a wave of suicide bombing in Jerusalem. Thirty-three doctors with PTSD symptoms and 155 without were compared on coping,  burnout and acceptance of treatment. Doctors with PTSD symptoms demonstrated significantly more anxiety, depression, negative coping strategies and burnout. Hospital doctors who develop PTSD symptoms suffer greater burnout and manifest negative coping strategies but are reluctant to receive treatment.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18670006 [PubMed - indexed for MEDLINE]

 

Brain Behav Immun. 2008 Aug;22(6):994-1003. Epub 2008 Apr 18.

Symptom severity predicts degree of T cell activation in adult women following childhood maltreatment.

Lemieux A, Coe CL, Carnes M.

Department of Psychology, The College of St. Scholastica, 1200 Kenwood Avenue, Tower 3646, Duluth, MN 55811, USA. Alemieu2@css.edu

Although depression is often associated with a reduction in cellular immune responses, other types of emotional disturbance and psychopathology can activate  certain aspects of immunity. Activation markers on T cells, in particular, have been found to be elevated in post-traumatic stress states. However, little is known about the relationship between the severity of PTSD symptoms and the degree of change in T cell phenotypes, or about the potential role of neuroendocrine factors in mediating the association. Twenty-four women with a history of sexual  trauma during childhood, including 11 who met diagnostic criteria for PTSD, were  compared to 12 age-matched, healthy women without a history of maltreatment. The  women provided fasted blood samples for enumeration of cell subsets by immunofluorescence and 24-h urine samples for analysis of catecholamine and cortisol levels. The percent of T cells expressing CD45RA, an early activation marker, was higher in the PTSD diagnosed women, and the levels correlated positively with intrusive symptoms and negatively with avoidant symptoms. These alterations in cell surface markers did not appear to be mediated by norepinephrine (NE) or cortisol, making them a distinctive and independent biomarker of arousal and disturbance in PTSD.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't

PMID: 18396007 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Aug;32(8):785-96. Epub 2008 Aug 28.

Childhood victimization and lifetime revictimization.

Widom CS, Czaja SJ, Dutton MA.

Psychology Department, John Jay College of Criminal Justice (CUNY), New York, NY  10019, USA.

OBJECTIVE: To examine the fundamental hypothesis that childhood victimization leads to increased vulnerability for subsequent (re)victimization in adolescence  and adulthood and, if so, whether there are differences in rates of experiencing  traumas and victimizations by gender, race/ethnicity, and type of childhood abuse and/or neglect. METHODS: Using a prospective cohort design, participants are individuals with documented cases of childhood physical and sexual abuse and neglect from the years 1967 through 1971 and a matched control group. Both groups were interviewed in-person (mean age 39.5 years) in 2000-2002 using a new instrument to assess lifetime trauma and victimization history. RESULTS: Abused and neglected individuals reported a higher number of traumas and victimization experiences than controls and all types of childhood victimization (physical abuse, sexual abuse, and neglect) were associated with increased risk for lifetime revictimization. Significant group (abuse/neglect vs. control) by gender and group by race/ethnicity interactions were found. Childhood victimization increased risk for physical and sexual assault/abuse, kidnapping/stalking, and having a family friend murdered or commit suicide, but not for general traumas, witnessing trauma, or crime victimization. CONCLUSIONS: These findings provide strong support for the need for early intervention with abused and neglected children and their families to prevent subsequent exposure to traumas and victimization experiences.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18760474 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Aug;32(8):797-810. Epub 2008 Aug 26.

The impact of exposure to domestic violence on children and young people: a review of the literature.

Holt S, Buckley H, Whelan S.

Children's Research Centre, University of Dublin, Trinity College, Dublin, Ireland.

OBJECTIVE: This article reviews the literature concerning the impact of exposure  to domestic violence on the health and developmental well-being of children and young people. Impact is explored across four separate yet inter-related domains (domestic violence exposure and child abuse; impact on parental capacity; impact  on child and adolescent development; and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted. METHOD: A comprehensive search of identified databases was conducted within an 11-year framework (1995-2006). This yielded a vast literature which was selectively organized and analyzed according to the four domains identified above. RESULTS: This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioral problems and of increased exposure to the presence of other adversities in their  lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring  adult, usually the mother. CONCLUSION: Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and  that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. PRACTICE IMPLICATIONS: This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding  that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child-centered approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience, and responsive to their individual needs.

Publication Types:      Comparative Study     Research Support, Non-U.S. Gov't

PMID: 18752848 [PubMed - indexed for MEDLINE]

 

Chin J Traumatol. 2008 Aug;11(4):203-8.

Posttraumatic stress and immune dissonance.

Jiang JX.

State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital/ Institute of Surgery Research, Third Military Medical University, Chongqing 400042, China. jiangjx@cta.cq.cn

Stress or neuroendocrine response usually occurs soon after trauma, which is central to the maintenance of post-traumatic homeostasis. Immune inflammatory response has been recognized to be a key element both in the pathogenesis of post-traumatic complications and in tissue repair. Despite the existence of multiple and intricate interconnected neuroendocrine pathways, the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system have been considered to be the most important in trauma. Although the short-term and appropriate activation of these stress responses is vital to the host's adaptation, prolonged duration and exaggerative magnitude of their activity leads to deleterious effects on immune function in trauma, causing immune dissonance. The overall appropriate and controlled activation and termination of the neuroendocrine responses that mediate the necessary physiological functions involved in maintaining and restoring homeostasis in the event of trauma are of critical importance. This review will describe the effects of some important neuroendocrine responses on immune system. Present evidences indicate that the neuroendocrine and immune systems form a cohesive and integrated early host response to trauma, and identify areas for further research to fully elucidate the regulatory role of neuroendocrine system in trauma.

Publication Types:      Research Support, Non-U.S. Gov't     Review

PMID: 18667117 [PubMed - indexed for MEDLINE]

 

Clinics. 2008 Aug;63(4):473-8.

Evaluation of physical activity habits in patients with posttraumatic stress disorder.

de Assis MA, de Mello MF, Scorza FA, Cadrobbi MP, Schooedl AF, da Silva SG, de Albuquerque M, da Silva AC, Arida RM.

Laboratório de Neurociências, Núcleo de Pesquisas Tecnológicas, Universidade de Mogi das Cruzes, São Paulo, SP, Brasil.

OBJECTIVE: In this study, we present data from a survey that aimed to assess the  physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder. METHOD: Fifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37+/-12 years, and the mean time between diagnosis and follow-up was 3.6+/-4.2 years. RESULTS: Substantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation. DISCUSSION: Several studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits. CONCLUSION: Our findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18719757 [PubMed - in process]

 

Croat Med J. 2008 Aug;49(4):506-14.

Changes in plasma lipid concentrations and risk of coronary artery disease in army veterans suffering from chronic posttraumatic stress disorder.

Dzubur Kulenović A, Kucukalić A, Malec D.

Department of Psychiatry, University Clinical Center Sarajevo, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina. almadz@epn.ba

AIM: To test the differences in serum lipid concentrations between veterans with  chronic posttraumatic stress disorder (PTSD) and veterans without PTSD. METHODS:  We determined plasma lipid parameters and calculated risk factors for 50 veterans in the PTSD group and 50 veterans in the non-PTSD group. Trauma exposure, coping  strategies, and quality of life were assessed with Life Stressor List, Manchester Short Assessment of Quality of Life Scale, and Folkman-Lazarus Coping Strategies  Questionnaire. RESULTS: There was no difference between the groups in the exposure to combat trauma. PTSD group had significantly lover education than non-PTSD group (10.6+/-1.8 vs 12.4+/-2.6 years, P=0.007) and lower monthly income per family member (euro67.8+/-51.3 vs euro281.9+/-208.2, P<0.001). PTSD group had significantly higher levels of all plasma lipid parameters (cholesterol: 6.54+/-1.24 vs 5.40+/-1.09 mmol/L, P<0.001; triglycerides: 2.55+/-0.68 vs 1.73+/-0.77 mmol/L, P<0.001; very low density lipoprotein-cholesterol: 1.14+/-0.32 vs 0.78+/-0.35 mmol/L, P<0.001; low density lipoprotein-cholesterol:  4.49+/-1.06 vs 3.46+/-0.93 mmol/L, P<0.001). High-density lipoprotein cholesterol concentration was significantly lower in PTSD group (0.96+/-0.18 vs 1.15+/-0.24 mmol/L, P<0.001). Established risk factor for arteriosclerosis (6.96+/-1.19 vs 4.71+/-0.88, P<0.001) and Adult Treatment Panel III ten years risk for coronary disease (19.44+/-7.27% vs 9.74+/-4.10%, P<0.001) were significantly higher in the PTSD group. Secondary traumatization was significantly more frequent in the PTSD  group (3.8+/-5.7 vs 1.3+/-4.7 events; P<0.001). CONCLUSIONS: Chronic PTSD is associated with dyslipidemia, leading to an increased risk of coronary artery disease. Environmental factors and coping strategies should be considered as important factors for the occurrence and persistence of PTSD.

PMID: 18716998 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2008 Aug;49(4):499-505.

Sexual functioning in war veterans with posttraumatic stress disorder.

Anticević V, Britvić D.

Split University Hospital, Soltanska 1, 21000 Split, Croatia. vanticevic@yahoo.com

AIM: To assess the sexual dysfunction among Croatian war veterans with combat-related posttraumatic stress disorder (PTSD). METHOD: The study included two groups--101 war veterans with PTSD and 55 healthy control volunteers receiving outpatient general health care in several outpatient clinics in Split.  tructured interviews on different aspects of sexual functioning were conducted from April to October 2007 by trained interviewers. RESULTS: Respondents with PTSD reported significantly less sexual activity during the previous month than controls (sexual fantasies 2.5+/-1.6 vs 3.7+/-1.7, P<0.001; foreplay 2.4+/-1.6 vs 3.5+/-1.6, P<0.001; oral sex 1.6+/-1.2 vs 2.6+/-1.5, P<0.001; and sexual intercourse 2.4+/-1.6 vs 3.8+/-1.5, P<0.001) on a 7-point Likert type scale (from 1--not a single time to 7--more times a day). As reasons for reduced sexual activities, respondents with PTSD more frequently than controls reported their own health problems (3.2+/-1.2 vs 1.5+/-0.8; P<0.001) or health problems of their partner (2.4+/-1.1 vs 1.9+/-1.1; P=0.004), whereas controls more frequently reported overwork than respondents with PTSD (2.6+/-1.1 vs 2.1+/-1.0; P=0.007) on a 5-point Likert type scale (from 1--not a single time to 5--always). Respondents with PTSD reported antidepressant (n=52, 51%) or anxyolitics use (n=73, 72.3%). In a subgroup analysis, respondents with PTSD who were taking antidepressants masturbated less frequently than those who were not taking them (1.9+/-1.3 vs 2.5+/-1.6; P=0.039), whereas premature ejaculation was more often experienced by  respondents with PTSD who were not taking antidepressants than by those who were  taking them (3.5+/-1.8 vs 2.7+/-1.5; P<0.049) both on a 7-point Likert type scale (from 1--not a single time to 7--more times a day). Conclusion. War veterans with PTSD had less sexual activity, hypoactive sexual desire, and erectile difficulties. Antidepressant therapy in veterans with PTSD may be associated with hypoactive sexual desire.

PMID: 18716997 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2008 Aug;49(4):491-8.

Psychological problems in children of war veterans with posttraumatic stress disorder in Bosnia and Herzegovina: cross-sectional study.

Klarić M, Francisković T, Klarić B, Kvesić A, Kastelan A, Graovac M, Lisica ID.

Psychiatric Department of Clinical hospital Mostar, Kardinala Stepinca bb, 88000  Mostar, Bosnia and Herzegovina. klaricmiro@net.hr

AIM: To assess psychological problems in children as reported by their veteran fathers with war-related posttraumatic stress disorder (PTSD). METHOD: The study  group consisted of 154 veterans with war-related PTSD who were treated at the Mostar University Hospital. The control group consisted of 77 veterans without war-related PTSD who were selected from veteran associations by the snowball method. General Demographic Questionnaire, the first and fourth module of the Harvard Trauma Questionnaire-Bosnia and Herzegovina version, and the Questionnaire on Developmental, Emotional, and Behavioral Problems in Children, created specifically for the needs of this study, were used to collect data on veterans' perception of psychological problems in their children. RESULTS: In comparison with veterans without PTSD, veterans with PTSD reported significantly  more developmental (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.51-3.73), behavioral (OR, 3.92; 95% CI, 1.53-10.03), and emotional problems (OR, 17.74; 95% CI, 2.40-131.10) in their children. CONCLUSION: Veterans with war-related PTSD more often reported developmental problems in their children. Father's PTSD may have long-term and long-lasting consequences on the child's personality.

Publication Types:      Comparative Study

PMID: 18716996 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2008 Aug;49(4):483-90.

Health care and community-based interventions for war-traumatized people in Croatia: community-based study of service use and mental health.

Francisković T, Tovilović Z, Suković Z, Stevanović A, Ajduković D, Kraljević R, Bogić M, Priebe S.

Center for Psychotrauma, University of Rijeka School of Medicine, 15 Cambieri Street, 51000 Rijeka, Croatia.

AIM: To explore the use of health care and community-based services in war-affected regions of Croatia and its relation to mental health. METHODS: A sample of 719 adults exposed to at least one war-related traumatic event were selected by random-walk technique from three Croatian counties and interviewed for socio-demographic data, mental health status (Mini International Neuropsychiatric Interview), and service use (Matrix for the Assessment of Community and Healthcare Services) in the period from 1991 to 2006. Descriptive analysis of service use was performed. Relations between service use, current mental health, and recovery from posttraumatic stress disorder (PTSD) were analyzed using logistic regression models. RESULTS: The traumatized population used a wide range of health care and community-based services. Health care was the most frequently used service category, especially primary health care (92.5%), followed by accommodation support (57.9%), financial support (57.7%), and employment support (32.5%). Compared with participants without mental disorders, participants with current PTSD were more likely to use only legal support (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.15-3.99), while participants with other mental disorders were more likely to use social support and contacts (OR, 1.72; 95% CI, 1.08-2.75). Receiving accommodation support (OR,  2.05; 95% CI, 1.03-4.06) was the only significant predictor of recovery from PTSD, while seeking legal support (OR, 0.28; 95% CI, 0.08-0.92) was related to slower recovery. CONCLUSION: Although a wide range of services were organized to  help the traumatized population in Croatia, only the solution of housing issue significantly predicted recovery. The organization of help services should take into consideration the existing infrastructure and local specificities, and respect the needs of people in war-affected areas.

PMID: 18716995 [PubMed - indexed for MEDLINE]

 

Croat Med J. 2008 Aug;49(4):459-75.

Psychopharmacotherapy of posttraumatic stress disorder.

Kozaric-Kovacic D.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops after a psychological trauma usually caused by a situation perceived as deeply threatening to a person's life or integrity. Complex neurobiological changes triggered by such a traumatic and stressful experience may explain a wide range of PTSD symptoms and provide the rationale for psychopharmacological treatment. Selective serotonin-reuptake inhibitors make the first-line treatment of PTSD. Clinical experience has shown that they are more effective than noradrenalin-reuptake inhibitors or tricyclic antidepressants. Antipsychotic drugs, especially atypical ones, have been shown effective in PTSD patients with  psychotic characteristics or refractoriness to other treatments. Mood stabilizers seem to reduce mostly autonomous overreactions to stress, whereas the evidence for effectiveness of monoamine oxidase inhibitors is largely inconclusive. Other  groups of medications, such as serotonin agonists and antagonists, new antidepressants, dual inhibitors of serotonin- and noradrenalin-reuptake, anticonvulsants, and opiate antagonists are also sometimes used in PTSD treatment. However, as shown in the present review, most clinical studies performed to date to investigate the effectiveness of different psychopharmacological agents in the therapy of PTSD have serious limitations in terms of small sample size, lack of blinding and randomization, and small effect  size. More rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder.

Publication Types:      Editorial

PMID: 18716993 [PubMed - indexed for MEDLINE]

 

Curr Psychiatry Rep. 2008 Aug;10(4):331-5.

Anxiety disorders in pregnancy.

Vythilingum B.

Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, J  Block, Anzio Road, Observatory, Cape Town 7935, South Africa. bavanisha.vythilingum@uct.ac.za

There is now growing realization that many women suffer from new onset or worsening of anxiety disorders during pregnancy. Studies of anxiety symptoms in pregnancy show that a significant portion of women are affected. Anxiety symptoms in pregnancy have been associated with adverse fetal and infant outcomes. Furthermore, having an anxiety disorder during pregnancy is one of the strongest  risk factors for postnatal depression. Although the literature on treating anxiety disorders in pregnancy per se is sparse, response to standard treatment is good. The risk of teratogenicity with pharmacotherapy must be considered, but  it can be minimized by judicious tapering and cessation of medication during high-risk periods.

Publication Types:      Review

PMID: 18627672 [PubMed - indexed for MEDLINE]

 

Curr Psychiatry Rep. 2008 Aug;10(4):318-22.

Comorbidity of pain and anxiety disorders.

Gureje O.

Department of Psychiatry, University of Ibadan, University College Hospital, PMB  5116, Ibadan, Nigeria. ogureje@comui.edu.ng

The comorbidity of anxiety disorders with pain has received little research attention even though recent studies show that these disorders are as likely to co-occur with chronic pain conditions as depressive disorder. Comorbid anxiety has implications for the impact and outcome of pain conditions. Even though it may be intuitively plausible to suppose that the anxiety occurs in the context of a preexisting pain condition, there is evidence for a reverse causal link and shared risk factors, including distal events occurring in childhood.

Publication Types:      Review

PMID: 18627670 [PubMed - indexed for MEDLINE]

 

Eur J Public Health. 2008 Aug;18(4):422-7. Epub 2008 May 8.

Do medical services personnel who deployed to the Iraq war have worse mental health than other deployed personnel?

Jones M, Fear NT, Greenberg N, Jones N, Hull L, Hotopf M, Wessely S, Rona RJ.

King's Centre for Military Health Research, Institute of Psychiatry, King's College London, London, UK. margaret.jones@kcl.ac.uk

AIM: There is evidence of increased health care utilization by medical personnel  (medics) compared to other trades in the UK Armed Forces. The aim of this study was to compare the burden of mental ill health in deployed medics with all other  trades during the Iraq war. METHODS: Participants' main duty during deployment was identified from responses to a questionnaire and verified from Service databases. Psychological health outcomes included psychological distress, post-traumatic stress disorder, multiple physical symptoms, fatigue and heavy drinking. RESULTS: A total of 479 out of 5824 participants had a medical role. Medics were more likely to report psychological distress (OR 1.30, 95% CI 1.00-1.70), multiple physical symptoms (OR 1.65, 95% CI 1.20-2.27) and, if men, fatigue (1.38, 95% CI 1.05-1.81) than other personnel. Female medics were less likely to report fatigue (0.57 95% CI 0.35-0.92). Neither post-traumatic stress disorder nor heavy drinking symptoms were associated with a medical role. Traumatic medical experiences, lower group cohesion and preparedness, and post-deployment experiences explained the positive associations with psychological ill health. Medics made greater use of medical facilities than other trades. CONCLUSIONS: There is a small excess of psychological ill health in medics, which can be explained by poorer group cohesion, traumatic medical and post-deployment experiences. The association of mental ill health with a medical  role was not the consequence of a larger proportion of reservists in this group.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18467359 [PubMed - indexed for MEDLINE]

 

Expert Rev Neurother. 2008 Aug;8(8):1233-46.

From efficacy to effectiveness: the trajectory of the treatment literature for children with PTSD.

Nikulina V, Hergenrother JM, Brown EJ, Doyle ME, Filton BJ, Carson GS.

Department of Psychology, Marillac Hall, Rm 409, 8000 Utopia Parkway, Jamaica, NY 11439, USA. vnikulina@hotmail.com

This review summarizes efficacious treatments for preschoolers, children and adolescents with post-traumatic stress disorder, with a focus on the advances made within the last 5 years. There is considerable support for the use of trauma-specific cognitive-behavioral interventions, in both individual and group  formats. The research on psychopharmacological treatments lags behind that of psychotherapy and is currently inconclusive. Limitations of the studies are discussed and treatments that warrant further consideration are reviewed. The authors also review current advances in effectiveness and suggest future directions that are important in generalizing the interventions to underserved and hard to reach populations. The article concludes with the authors' projections for the evolution of the field within the upcoming 5 years.

Publication Types:      Review

PMID: 18671667 [PubMed - indexed for MEDLINE]

 

Fa Yi Xue Za Zhi. 2008 Aug;24(4):288-92.

[Detection of malingering post-traumatic stress disorder]

[Article in Chinese]

Huang LP, Xie B.

Shanghai Mental Health Center, Shanghai JiaoTong University, Shanghai 200030, China. simone_72000@yahoo.com.cn

Assessment of post-traumatic stress disorder is a frequently encountered problem  in forensic practices. Detection of malingering has become a focus in these assessments. While it is a difficult task due to kinds of traumatic events, complex clinical symptoms, subjective medical information, and presence of diverse psychotic disorders. The clinical traits, detecting methods and testing instruments of PTSD malingering were reviewed so as to help practical management  and assessment.

Publication Types:      English Abstract

PMID: 18817042 [PubMed - in process]

 

Fertil Steril. 2008 Aug;90(2):340-5. Epub 2007 Oct 24.

Civil war and male infertility in Lebanon.

Kobeissi L, Inhorn MC, Hannoun AB, Hammoud N, Awwad J, Abu-Musa AA.

University of Michigan School of Public Health, Ann Arbor, Michigan, USA.

OBJECTIVE: To investigate the long-term impacts of the 15-year Lebanese civil war on male infertility. DESIGN: Clinic-based, case-control study, using reproductive history and risk factor interview data and laboratory-based semen analysis. SETTING: Two IVF clinics in Beirut, Lebanon, during an 8-month period (January-August 2003). PATIENT(S): One hundred twenty infertile male cases and 100 fertile male controls, distinguished by semen analysis and reproductive history. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Standard clinical semen  analysis. RESULT(S): Infertile male cases were more likely than fertile controls  to have lived through the Lebanese civil war and to have experienced war-related  trauma (residence in bombing areas, participation in combat, injuries, kidnapping, and displacement from home). Cases had a 57% increase in their odds of exposure to civil war-related trauma. CONCLUSION(S): This case-control study demonstrates an association between the Lebanese civil war and male infertility.  Wartime and postwar exposure to a number of potential reproductive risk factors-including toxins, injuries, and stress-is believed to be the main factor  leading to this finding.

Publication Types:      Multicenter Study     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17919611 [PubMed - indexed for MEDLINE]

 

Int J Law Psychiatry. 2008 Aug-Sep;31(4):319-30. Epub 2008 Jul 21.

Unaccompanied refugee children and adolescents: the glaring contrast between a legal and a psychological perspective.

Derluyn I, Broekaert E.

Department of Orthopedagogics, Ghent University, H. Dunantlaan 2, 9000 Gent, Belgium. Ilse.Derluyn@UGent.be

Unaccompanied refugee children and adolescents are a vulnerable group: they live  not only in a relatively difficult situation as minor refugees staying in another country, but also face other risks due to the absence of their parents, such as traumatic experiences, exploitation or abuse. The difficult living situation of these unaccompanied refugee children and adolescents might therefore threaten their emotional well-being, resulting in important emotional and behavioural problems. This 'psychological' perspective shows the necessity of a strongly elaborated reception and care system for these children and adolescents in order  to meet their specific situation and needs. Nevertheless, the case study of unaccompanied refugee minors living in Belgium, as explored in this paper, shows  that the legal perspective on these youths - considering them as 'refugees' and 'migrants', not as 'children' - is predominantly the starting point to build the  care system on. Moreover, this legal perspective contrasts sharply with the psychological perspective, as such that these children and adolescents do not receive appropriate support and care as they need.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18644626 [PubMed - indexed for MEDLINE]

 

J Abnorm Child Psychol. 2008 Aug;36(6):915-25. Epub 2008 Mar 11.

Post-traumatic reactions in adolescents: how well do the DSM-IV PTSD criteria fit the real life experience of trauma exposed youth?

Saul AL, Grant KE, Carter JS.

Department of Psychology, DePaul University, 2219 N. Kenmore Ave., Chicago, IL 60614, USA. asaul@depaul.edu

This study examined the structure and symptom specific patterns of post traumatic distress in a sample of 1,581 adolescents who reported exposure to at least one traumatic event. Symptom reporting patterns are consistent with past literature in that females reported more symptoms than males and older youth reported more symptoms than did their younger peers. Young people reporting exposure to exclusively violent type traumas were also found to be more likely to endorse symptoms than peers exposed exclusively to non violent type traumas. Confirmatory factor analysis provided stronger support for a four-factor model of PTSD than either the DSM-IV model or an alternate model. Further examination of the four factor model revealed gender differences in factor loadings with small to moderate effect sizes for recurrent, distressing memories, flashbacks, restricted affect, difficulty remember details, detachment, limited future orientation, hypervigilance and startle symptoms. Differences in factor loadings with the four factor model were also noted between younger and older adolescents, with medium to large effect sizes on the arousal items. In contract, comparison of the factor loadings revealed only small differences between youth exposed exclusively to violent traumatic stressors and those exposed exclusively to non violent traumatic stressors, suggesting relative similarity between these two groups.

PMID: 18330689 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2008 Aug;117(3):662-72.

The structure of distress following trauma: posttraumatic stress disorder, major  depressive disorder, and generalized anxiety disorder.

Grant DM, Beck JG, Marques L, Palyo SA, Clapp JD.

Department of Psychology, University at Buffalo-SUNY, Buffalo, NY 14260, USA. dmgrant2@buffalo.edu

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD).  Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical  implications of these results are discussed. Copyright (c) 2008 APA, all rights reserved.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18729617 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2008 Aug;117(3):637-46.

Family-of-origin maltreatment, posttraumatic stress disorder symptoms, social information processing deficits, and relationship abuse perpetration.

Taft CT, Schumm JA, Marshall AD, Panuzio J, Holtzworth-Munroe A.

National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, MA 02130, USA. casey.taft@va.gov

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior. Copyright (c) 2008 APA, all rights reserved.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18729615 [PubMed - indexed for MEDLINE]

 

J Abnorm Psychol. 2008 Aug;117(3):502-19.

Psychological trauma and schizotypal personality disorder.

Berenbaum H, Thompson RJ, Milanek ME, Boden MT, Bredemeier K.

Department of Psychology, University of Illinois at Urbana-Champaign, Champaign,  IL 61820, USA. hberenba@uiuc.edu

Two studies examined the relation between psychological trauma and schizotypal symptoms. In Study 1, in which 1,510 adults completed telephone interviews, both  childhood maltreatment and the experience of an injury or life-threatening event  were significantly associated with schizotypal symptoms. In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use). Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A  among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance. Copyright (c) 2008 APA, all rights reserved.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18729605 [PubMed - indexed for MEDLINE]

 

J Am Acad Child Adolesc Psychiatry. 2008 Aug;47(8):858-62.

Providing evidence-based practice to ethnically diverse youths: examples from the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program.

Ngo V, Langley A, Kataoka SH, Nadeem E, Escudero P, Stein BD.

UCLA Semel Institute, Division of Child and Adolescent Psychiatry, Los Angeles, CA 90024-6505, USA. vno@mednet.ucla.edu

Publication Types:      Case Reports     Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, P.H.S.

PMID: 18645419 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Aug;22(6):1021-8. Epub 2007 Nov 13.

Media exposure and dimensions of anxiety sensitivity: differential associations with PTSD symptom clusters.

Collimore KC, McCabe RE, Carleton RN, Asmundson GJ.

Anxiety and Illness Behaviour Laboratory and Department of Psychology, University of Regina, Regina, SK, Canada.

The present investigation examined the impact of anxiety sensitivity (AS) and media exposure on posttraumatic stress disorder (PTSD) symptoms. Reactions from 143 undergraduate students in Hamilton, Ontario were assessed in the Fall of 2003 to gather information on anxiety, media coverage, and PTSD symptoms related to exposure to a remote traumatic event (September 11th). Regression analyses revealed that the Anxiety Sensitivity Index (ASI; [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual, 2nd ed. Worthington, Ohio: International Diagnostic Systems]) and State-Trait Anxiety Inventory trait form (STAI-T; [Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). State-trait anxiety inventory. Palo Alto, California: Consulting Psychologists Press]) total scores were significant predictors of PTSD symptoms in general. The ASI total score was also a significant predictor of hyperarousal and avoidance symptoms. Subsequent analyses further demonstrated differential relationships based on subscales and symptom clusters. Specifically, media exposure and trait anxiety predicted hyperarousal and re-experiencing symptoms, whereas the ASI fear of somatic sensations subscale significantly predicted avoidance and overall PTSD symptoms. Implications and directions for future research are discussed.

Publication Types:      Comparative Study     Research Support, Non-U.S. Gov't

PMID: 18093798 [PubMed - indexed for MEDLINE]

 

J Behav Med. 2008 Aug;31(4):341-9. Epub 2008 Jun 14.

Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R).

Sledjeski EM, Speisman B, Dierker LC.

Department of Psychology, Wesleyan University, Middletown, CT 06459, USA. ldierker@wesleyan.edu

The present study sought to extend prior research by using data from the National Comorbidity Survey-Replication (NCS-R) to examine the relationship between number of lifetime traumas, posttraumatic stress disorder (PTSD) and 15 self-reported chronic medical conditions. The goal was to determine whether the commonly found  relationship between PTSD symptomatology and physical health were better explained by the number of lifetime traumas experienced. The NCS-R is a representative US household survey that assessed lifetime experience of a variety of traumas, lifetime diagnosis of PTSD and 15 chronic medical conditions (e.g. pain conditions, cardiovascular disorders, etc.). Two major findings emerged: (1) there was a graded relationship between trauma exposure, PTSD, and the majority of chronic medical conditions where individuals with PTSD had the highest likelihood of chronic medical condition and non-traumatized individuals had the lowest risk and; (2) with the exception of headaches, the relationship between PTSD and chronic medical conditions was explained by the number of lifetime traumas experienced when analyses were subset to traumatized individuals. The present study supports prior research suggesting that multiple traumas have a cumulative effect on physical health. The impact of trauma on health may be independent of PTSD symptomatology.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, P.H.S.

PMID: 18553129 [PubMed - indexed for MEDLINE]

 

J Child Adolesc Psychiatr Nurs. 2008 Aug;21(3):186-90.

Culture bound anxiety disorder in adolescence: a case study.

Hamilton JM.

Collins Clinic at Montevista Hospital, USA. dr.hamilton@cox.net

TOPIC: There are a number of culture-bound syndromes in the literature that may directly impact on clients' systems of meaning and, thus, the clinician's ability to effectively intervene. This applies to Hispanic/Latino children, particularly  those who present with anxiety and somatic symptoms. PURPOSE: This case study deals with a 14-year-old Hispanic girl who presented at a behavioral health clinic with anxiety behaviors. SOURCES: Review of the literature and case example from practice. CONCLUSION: Since culture can have a profound influence on a child's thoughts, emotions, and behaviors, nurses' cultural understanding is critical in psychiatric diagnostic evaluation and treatment.

Publication Types:      Case Reports

PMID: 18667051 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Aug;64(8):921-7.

Psychological services for returning veterans and their families: evolving conceptualizations of the sequelae of war-zone experiences.

Sammons MT, Batten SV.

California School of Professional Psychology, San Francisco, CA 94133-1221, USA.  msammons@alliant.edu

The provision of effective and timely behavioral health care for veterans returning from the conflicts in Iraq and Afghanistan has become the focus of national attention. In this special issue, attempts to provide psychological care for service members and their families are examined in light of three key constructs. First, it is contended that at no other time in history has more attention been paid to the psychological consequences of engaging in combat. Second, for the first time in recorded warfare, psychological morbidity is likely to far outstrip physical injury associated with combat. Finally, although posttraumatic stress disorder and traumatic brain injury are serious concerns, most service members return without significant physical or psychological injury  and will be able to return to functioning without notable problems. Accurate diagnosis, a focus on resilience, and the expectation of readjustment are essential precepts that should guide clinical efforts and resource allocation. (c) 2008 Wiley Periodicals, Inc.

PMID: 18615709 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Aug;64(8):972-83.

Couple therapy with combat veterans and their partners.

Erbes CR, Polusny MA, Macdermid S, Compton JS.

Minneapolis VA Medical Center, Minneapolis, MN 55417, USA. Christopher.erbes@va.gov

Service members returning from Iraq and Afghanistan face psychological challenges that can exert profound effects on families and couples, but can also be treated  within a systemic context. Couple therapy offers a means of increasing social support, decreasing interpersonal conflict, and addressing the experiential avoidance that maintains posttraumatic symptoms. For combat veterans and their partners, we present an adaptation of integrative behavioral couple therapy (IBCT) that reduces conflict and encourages intimacy through acceptance and skills strategies. By doing so, IBCT exposes service members in couple therapy to emotions, interpersonal situations, and activities that facilitate recovery from  combat-related distress. We illustrate common presenting problems in this population and the utilization of IBCT with a case example. (c) 2008 Wiley Periodicals, Inc.

Publication Types:      Case Reports

PMID: 18615593 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Aug;64(8):958-71.

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: application to operation enduring and Iraqi Freedom veterans.

Monson CM, Fredman SJ, Adair KC.

National Center for PTSD, Women's Health Sciences Division VA Boston Healthcare System, Boston, MA 02130, USA. Candice.Monson@va.gov

As the newest generation of veterans returns home from their duties abroad, many  face the individual and interpersonal aftereffects of duty-related traumatic experiences. Despite the established association between posttraumatic stress disorder (PTSD) and relationship problems, there is a lack of evidence-based conjoint treatments that target both PTSD and relationship distress. Cognitive-behavioral conjoint therapy (CBCT) for PTSD was developed to address this need. The authors summarize knowledge on the association between PTSD and relationship functioning, as well as recent research on veterans and their partners. Following an overview of CBCT for PTSD, the authors present a case study to illustrate the application of CBCT to an Operation Enduring and Iraqi Freedom couple. (c) 2008 Wiley Periodicals, Inc.

Publication Types:      Case Reports     Research Support, N.I.H., Extramural

PMID: 18613094 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Aug;64(8):947-57.

Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans.

Silver SM, Rogers S, Russell M.

V.A. Medical Center, Coatesville, PA 19320, USA.

Recent practice guidelines and meta-analyses have designated eye movement desensitization and reprocessing (EMDR) as a first-line treatment for trauma. Eye movement desensitization and reprocessing is an eight-phase therapeutic approach  guided by an information-processing model that addresses the combat veteran's critical incidents, current triggers, and behaviors likely to prove useful in his or her future. Two case examples of combat veterans illustrate the ability of EMDR to achieve symptom reduction in a variety of clinical domains (e.g., anxiety, depression, anger, physical pain) simultaneously without requiring the patient to carry out homework assignments or discuss the details of the event. The treatment of phantom limb pain and other somatic presentations is also reviewed. The ability of EMDR to achieve positive effects without homework indicates that it can be effectively employed on consecutive days, making it especially useful during combat situations. (c) 2008 Wiley Periodicals, Inc.

Publication Types:      Case Reports

PMID: 18612994 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Aug;64(8):940-6.

Virtual reality exposure therapy for active duty soldiers.

Reger GM, Gahm GA.

Madigan Army Medical Center, Department of Psychology, Tacoma, WA 98431, USA. greg.reger@us.army.mil

Virtual reality exposure (VRE) therapy is a promising treatment for a variety of  anxiety disorders and has recently been extended to the treatment of posttraumatic stress disorder (PTSD). In this article, the authors briefly review the rationale for VRE and its key processes. They illustrate the treatment with an active-duty Army soldier diagnosed with combat-related PTSD. Six sessions of VRE were provided using an immersive simulation of a military convoy in Iraq. Self-reported PTSD symptoms and psychological distress were reduced at posttreatment relative to pretreatment reports, as assessed by the PTSD Checklist-Military Version and the Behavior and Symptom Identification Scale-24.  The case outcomes parallel those reported in the research with other disorders and suggest the applicability of VRE in treating active duty soldiers with combat-related PTSD. (c) 2008 Wiley Periodicals, Inc.

Publication Types:      Review

PMID: 18612993 [PubMed - indexed for MEDLINE]

 

J Clin Psychol. 2008 Aug;64(8):1004-13.

Assessing and treating veterans with traumatic brain injury.

French LM, Parkinson GW.

Walter Reed Army Medical Center, Department of Orthopaedics and Rehabilitation, Washington DC 20307, USA. louis.french@amedd.army.mil

Conflicts in Iraq and Afghanistan have resulted in greater proportions of service members with traumatic brain injury than in prior conflicts. These brain injuries range from the mild (concussion) to severe, and have enormous implications for clinical practice with these soldiers. The highly stressful and dangerous context in which these injuries are sustained set them apart in significant ways from brain injuries seen in civilian settings. The associated emotional toll of the environment and comorbid injuries, often resulting from blast exposure, complicates the clinical picture. In this article, the authors describe the complex presentations in this population of traumatically brain injured combat veterans and illustrate with case vignettes. (c) 2008 Wiley Periodicals, Inc.

PMID: 18561183 [PubMed - indexed for MEDLINE]

 

J Consult Clin Psychol. 2008 Aug;76(4):704-10.

Treating comorbid panic disorder in veterans with posttraumatic stress disorder.

Teng EJ, Bailey SD, Chaison AD, Petersen NJ, Hamilton JD, Dunn NJ.

Michael E. DeBakey Veterans Affairs Medical Center and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas 77030, USA. Ellen.Teng@va.gov

This study compares the effectiveness of panic control treatment (PCT) with that  of a psychoeducational supportive treatment (PE-SUP) in treating panic disorder among a veteran sample with a primary diagnosis of chronic posttraumatic stress disorder (PTSD). Thirty-five patients randomized to receive 10 individual sessions of either PCT or PE-SUP underwent assessments at pretreatment, at 1-week posttreatment, and at a 3-month follow-up. Intent-to-treat analyses of covariance showed that PCT participants significantly improved on panic severity at posttreatment and panic fear at the 3-month follow-up. The PCT group also showed  significant reductions in anxiety sensitivity at posttreatment and follow-up compared with that of the PE-SUP group. A significantly higher proportion of persons (63%) in the PCT group was panic free by the follow-up period compared with that of the PE-SUP group (19%). Patient self-report and clinician ratings showed no changes in general anxiety, depression, and PTSD symptoms in either group. These findings indicated that PCT was superior to an active control therapy in reducing the frequency, severity, and distress associated with panic disorder and suggested that brief cognitive-behavioral therapy for panic is effective for persons with chronic PTSD. Copyright 2008 APA, all rights reserved.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18665698 [PubMed - in process]

 

J Consult Clin Psychol. 2008 Aug;76(4):695-703.

A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder.

Bryant RA, Moulds ML, Guthrie RM, Dang ST, Mastrodomenico J, Nixon RD, Felmingham KL, Hopwood S, Creamer M.

School of Psychology, University of New South Wales, Sydney, New South Wales, Australia. r.bryant@unsw.edu.au

Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure  (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up  assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of  the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients. Copyright 2008 APA, all rights reserved.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18665697 [PubMed - in process]

 

J Consult Clin Psychol. 2008 Aug;76(4):686-94.

Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial.

Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T.

Department of Clinical Psychology, University of Konstanz, Konstanz, Germany. frank.neuner@uni-konstanz.de

Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether  trained lay counselors can carry out effective treatment of posttraumatic stress  disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by  lay counselors. Strictly manualized narrative exposure therapy (NET) was compared with more flexible trauma counseling (TC) and a no-treatment monitoring group (MG). Fewer participants (4%) dropped out of NET treatment than TC (21%). Both active treatment groups were statistically and clinically superior to MG on PTSD  symptoms and physical health but did not differ from each other. At follow-up, a  PTSD diagnosis could not be established anymore in 70% of NET and 65% TC participants, whereas only 37% in MG did not meet PTSD criteria anymore. Short-term psychotherapy carried out by lay counselors with limited training can  be effective to treat war-related PTSD in a refugee settlement. Copyright 2008 APA, all rights reserved.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18665696 [PubMed - in process]

 

J Consult Clin Psychol. 2008 Aug;76(4):648-56.

An examination of family adjustment among Operation Desert Storm veterans.

Taft CT, Schumm JA, Panuzio J, Proctor SP.

National Center for PTSD, Veterans Affairs Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA 02130, USA. casey.taft@va.gov

This study examined interrelationships among combat exposure, symptoms of posttraumatic stress disorder (PTSD), and family adjustment in a sample of male and female Operation Desert Storm veterans (N = 1,512). In structural equation models for both male and female veterans, higher combat exposure was associated with higher PTSD symptoms, which in turn were associated with poorer family adjustment, although these indirect effects did not reach statistical significance. The model for female veterans evidenced a significant direct negative association between combat exposure and family adjustment when it statistically accounted for PTSD symptoms. When the relative impacts of separate  PTSD symptom groupings were examined, those reflecting withdrawal/numbing symptoms and arousal/lack of control symptoms significantly and indirectly accounted for the negative effects of combat exposure on family adjustment. Study findings indicate a number of possible pathways through which war-zone deployments negatively impact military families and suggest several avenues for future research. Copyright 2008 APA, all rights reserved.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18665692 [PubMed - in process]

 

J Consult Clin Psychol. 2008 Aug;76(4):633-47.

A longitudinal investigation of interpersonal violence in relation to mental health and substance use.

Hedtke KA, Ruggiero KJ, Fitzgerald MM, Zinzow HM, Saunders BE, Resnick HS, Kilpatrick DG.

Department of Psychiatry and Behavioral Sciences, Medical Universityof South Carolina, Charleston, SC 29425, USA. ruggierk@musc.edu

The authors examined longitudinally the mental health status of women as a function of different types and combinations of exposure to interpersonal violence. A structured telephone interview was administered to a household probability sample of 4,008 women (18-89 years of age), who were then recontacted for 1- and 2-year follow-up interviews. Interviews assessed lifetime violence history (i.e., sexual assault, physical assault, witnessed serious injury or violent death), past-year mental health functioning (i.e., posttraumatic stress disorder [PTSD], depression, and substance use problems), and new instances of violence occurring after the baseline interview. Results indicate that (a) lifetime violence exposure was associated with increased risk of PTSD, depression, and substance use problems; (b) odds of PTSD, depression, and substance use problems increased incrementally with the number of different types of violence experienced; (c) relations were fairly stable over a 2-year period; and (d) new incidents of violence between the baseline and follow-up interviews were associated with heightened risk of PTSD and substance use problems. Greater  understanding of the cumulative impact of violence exposure will inform service provision for individuals at high risk. Copyright 2008 APA, all rights reserved.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18665691 [PubMed - in process]

 

J Emerg Med. 2008 Aug;35(2):139-47. Epub 2007 Aug 7.

The mental health consequences of terrorism: implications for emergency medicine  practitioners.

Dimaggio C, Madrid PA, Loo GT, Galea S.

Department of Epidemiology, Columbia University Mailman School of Public Health,  New York, New York 10032, USA.

Emergency physicians are likely to be first-line responders in any local or regional terrorist event. In addition to preparing for the potential physical conditions and injuries that are associated with terrorism, they should be aware  of the behavioral and mental health implications as well. It is helpful to be familiar with the characteristics that predict who may be at increased risk for mental illness after such events and how they may be identified in an Emergency Department setting. Although most people in the general population with behavioral conditions stemming from a terrorist event can be expected to recover  spontaneously within several months, other individuals are at increased risk of developing more debilitating mental health conditions that have been associated with post-terrorist and disaster environments. Screening tools are available to help emergency practitioners identify them and refer patients for more formal psychiatric evaluation and potential interventions to facilitate and speed the recovery process.

Publication Types:      Research Support, U.S. Gov't, P.H.S.

PMID: 17976792 [PubMed - indexed for MEDLINE]

 

J Fam Psychol. 2008 Aug;22(4):586-94.

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms.

Renshaw KD, Rodrigues CS, Jones DH.

Department of Psychology, University of Utah, Salt Lake City, UT 84112, USA. keith.renshaw@psych.utah.edu

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined  spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low  levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When  spouses perceived high levels of such activity, soldiers' self-reported symptoms  had no relationship with spouses' marital satisfaction. These findings highlight  the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18729672 [PubMed - indexed for MEDLINE]

 

J Immigr Minor Health. 2008 Aug;10(4):291-304.

Relations between trauma experiences and psychological, physical and neuroendocrine functioning among Somali refugees: mediating role of coping with acculturation stressors.

Matheson K, Jorden S, Anisman H.

Department of Psychology, Carleton University, Ottawa, ON, Canada. Kim_Matheson@carleton.ca

Refugees may be prone to stress-related psychological and physical health disorders, coupled with disturbances of hypothalamic-pituitary-adrenal functioning reflected by cortisol levels. It was suggested that traumatic encounters would directly influence stress-related outcomes, as well as indirectly influence them by undermining refugees' ability to cope with acculturation challenges. Somali refugees to Canada (N = 90) consistently reported encountering trauma, which was related to poorer self-reported outcomes  (trauma symptoms, depressive affect, physical health), and these relations were mediated by increased use of emotion-focused (especially avoidant) coping strategies. Trauma symptoms and multiple traumatic experiences were associated with an exaggerated morning cortisol rise, but with a blunted response to stressor reminder cues. This blunted cortisol reactivity among participants encountering prior trauma was mediated by their increased propensity to cope by means of passive resignation. Evidently, refugees were at risk for stress-related dysfunction long after migrating, and the diminished capacity to cope with acculturation challenges was particularly important in this regard.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 17939054 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Aug;23(8):1108-19. Epub 2008 Feb 21.

Posttraumatic stress disorder following ethnoreligious conflict in Jos, Nigeria.

Obilom RE, Thacher TD.

Jos University Teaching Hospital, Jos, Nigeria.

In September 2001, ethnoreligious rioting occurred in Jos, Nigeria. Using a multistage cluster sampling technique, 290 respondents were recruited in Jos 7 to 9 months after the riot. Data were collected regarding demographics, exposure to  traumatic events, and psychological symptoms. Resting pulse and blood pressure were recorded. A total of 145 (52.5%) witnessed or were victims of personal attacks, 165 (59.6%) lost their possessions, 56 (20.7%) had their homes burned, 44 (16.2%) witnessed relatives' deaths, and 8 (2.9%) were robbed. A total of 252  (89.7%) of the respondents met reexperiencing criteria, 138 (49.1%) met avoidance criteria, and 236 (84.0%) met arousal criteria for posttraumatic stress disorder  (PTSD). A total of 116 (41%, 95% confidence interval [CI] = 36% to 47%) met all three categories for PTSD. Only personal attacks (adjusted odds ratio = 2.8, 95%  CI = 1.7 to 4.7) and a heart rate of 90 beats/min or more (adjusted odds ratio =  2.8, 95% CI = 1.4 to 5.8) were significantly related to PTSD in a multivariate model.

PMID: 18292399 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Aug;23(8):1027-40. Epub 2008 Feb 21.

Treating low-income and minority women with posttraumatic stress disorder: a pilot study comparing prolonged exposure and treatment as usual conducted by community therapists.

Feske U.

School of Pharmacy, University of Pittsburgh, PA, USA. ulf1@pitt.edu

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD  or treatment as usual (TAU; n = 12). Participants are predominantly low income and African American with complex trauma and psychiatric histories. Treatment is  delivered by community therapists with no prior training in behavior therapy for  anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in  a front-line services clinic.

Publication Types:      Randomized Controlled Trial

PMID: 18292398 [PubMed - indexed for MEDLINE]

 

J Interpers Violence. 2008 Aug;23(8):1041-55. Epub 2008 Feb 13.

Differences in female and male victims and perpetrators of partner violence with  respect to WEB scores.

Houry D, Rhodes KV, Kemball RS, Click L, Cerulli C, McNutt LA, Kaslow NJ.

Emory University, USA.

Measurements of intimate partner violence (IPV) based on acts of violence have repeatedly found substantial bilateral violence between intimates. However, the context of this violence is not well defined by acts alone. The objective of this research was to compare differences in women and men within each IPV status category (victim, perpetrator, and both) with respect to levels of battering as defined by their scores on the Women's Experience With Battering Scale (WEB), which asks gender-neutral questions about the abuse of power and control and fear in an intimate relationship. In our study, women disclosed higher levels of battering on the WEB, despite IPV status (victimization or both victimization and perpetration). In addition, female IPV victims were 5 times more likely than their male counterparts to disclose high rates of battering on the WEB. Depressive symptoms, symptoms of posttraumatic stress disorder, African American  race, and IPV victimization were independently associated with higher WEB scores.

Publication Types:      Comparative Study     Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, P.H.S.

PMID: 18272721 [PubMed - indexed for MEDLINE]

 

J Med Assoc Thai. 2008 Aug;91(8):1263-8.

Stress and Adjustment Disorder Section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN)--Thai version: validity and reliability study.

Piyavhatkul N, Krisanaprakornkit T, Paholpak S.

Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. nawanant@kku.ac.th

OBJECTIVES: To determine the validity and reliability of the Thai version of the  Stress and Adjustment Disorder section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview version 2.1 Stress and Adjustment Disorder section was translated into Thai and its content validity tested by back translation. The linguistic clarity of the psychiatric schedules for Thais from the country's four regions was tested by psychiatrists competent in the use of the schedules and aware of their underlying objectives. The reliability of SCAN: Stress and Adjustment Disorder section was tested between June and November 2006 on 30 participants, including 18 patients with stress-related disorders (adjustment disorder post-traumatic stress disorder, acute stress reaction) and 12 normal volunteers. RESULTS: Based on reactions from the sample and consultations from competent psychiatrists, content validity was established The duration of interviews for the Stress and Adjustment Disorder section averaged 17.92 min (25.59 for patients with stress-related disorders and 6.41 for normal subjects). The respective mean inter- and intra-rater reliability kappa was 0.90 (SD = 0.12) and 0.94 (SD = 0.09). A respective 77.05% and 85.26% of the items reached a substantial to almost perfect level of inter- and intra-rater agreement. CONCLUSION: The Stress and Adjustment  Disorder section of the WHO Schedules for Clinical Assessment in Neuropsychiatry  (SCAN Thai Version) is demonstrably an effective tool for diagnosing stress-related disorders among Thais.

Publication Types:      Research Support, Non-U.S. Gov't     Validation Studies

PMID: 18788701 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Aug;196(8):605-11.

Development and initial validation of a statistical prediction instrument for assessing combat-related posttraumatic stress disorder.

Marx BP, Humphreys KL, Weathers FW, Martin EK, Sloan DM, Grove WM, Kaloupek DG, Keane TM.

Department of Psychiatry, National Center for PTSD, VA Boston Healthcare System,  Boston, Massachusetts 02130, USA. brian.marx@va.gov

Statistical analyses were used to derive and validate a statistical prediction instrument to determine combat-related posttraumatic stress disorder (PTSD) status. Participants were 1081 Vietnam veterans with and without combat-related PTSD. The statistical prediction instrument, which consisted of 12 well-known risk and resilience variables associated with PTSD, proved to be an accurate and  efficient means of detecting PTSD among participants and compared well against other existing self-report measures of PTSD. The instrument's practical applications and its use in clinical appraisals of PTSD are discussed.

PMID: 18974672 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Aug;196(8):597-604.

Psychiatric distress among Asian and European American survivors of the 1994 Northridge earthquake.

Kulkarni M, Pole N.

Department of Psychology, Smith College, Northampton, Massachusetts 01060, USA.

Relatively few studies focus on the psychological effects of trauma exposure on Asian Americans. This article presents secondary analyses of a random survey of 118 Asian American and 762 European American survivors of the 1994 Northridge, California earthquake. Asian American participants reported more psychiatric distress and were more than twice as likely to meet caseness criteria on the Brief Symptom Inventory. Ethnic differences remained after accounting for group differences in age, immigrant status, and exposure to the earthquake. Moreover, moderator analyses showed that Asian Americans were not more sensitive to these risk factors but that ethnic differences were explained by the interaction of ethnicity and having a foreign born parent. Though more work needs to be done to  understand the basis of these differences, these findings challenge model minority myths about Asian American people and draw attention to their potential  need for greater mental health resources following a natural disaster.

Publication Types:      Comparative Study

PMID: 18974671 [PubMed - indexed for MEDLINE]

 

J Nerv Ment Dis. 2008 Aug;196(8):585-96.

Comment in:     J Nerv Ment Dis. 2008 Oct;196(10):725-6.

Diagnosis and distress in Navajo healing.

Csordas TJ, Storck MJ, Strauss M.

Department of Anthropology, University of California, San Diego, La Jolla, California 92093-0532, USA. tcsordas@ucsd.edu

In contemporary Navajo society, traditional Navajo ceremonies, Native American Church prayer meetings, and Navajo Christian faith healing are all highly sought-after resources in the everyday pursuit of health and well-being. What is  the nature of affliction among patients who turn to such forms of religious healing? Are these patients typically afflicted with psychiatric disorder? In this article we discuss 84 Navajo patients who participated in the Navajo Healing Project during a period in which they consulted one of these forms of healing. We present diagnostic results obtained from the Structured Clinical Interview for DSMIV (SCID) administered to these patients. We then present an ethnographically  augmented analysis comparing the research diagnosis obtained via the SCID with a  clinical diagnosis, with the diagnosis given by religious healers, and with the understanding of their own distress on the part of patients. These analyses demonstrate how a cultural approach contributes to the basic science and clinical understandings of affliction as well as to discussion of the advantages and limitations of DSM categories as descriptors of distress and disorder.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18974670 [PubMed - indexed for MEDLINE]

 

J Pediatr Surg. 2008 Aug;43(8):1480-6.

Posttraumatic stress disorder in mothers of children who have undergone surgery for congenital disease at a pediatric surgery department.

Nagata S, Funakosi S, Amae S, Yoshida S, Ambo H, Kudo A, Yokota A, Ueno T, Matsuoka H, Hayashi Y.

Department of Psychiatry, Graduate School of Medicine, Tohoku University, Miyagi-ken 980-8575, Japan. nagata.tohoku@gmail.com

PURPOSE: The aim of the study was to investigate posttraumatic stress disorder (PTSD) in mothers of children who have undergone surgery for congenital disease at a pediatric surgery department. METHODS: A questionnaire survey was carried out in 145 mothers of children who had undergone surgery and were still alive. For comparison, the mothers were categorized into 3 groups according to the severity of their child's disease. RESULTS: Of the 145 mothers, 29 (20%) were likely to be diagnosed as having developed PTSD at the time of the survey. Posttraumatic stress disorder symptoms correlated with factors such as anxiety and condition of the child. In terms of the disease severity of the child, factors such as anxiety tended to be observed more frequently in the higher disease severity group, whereas the proportion of mothers likely to be diagnosed  as having developed PTSD was smallest in the moderate-severity group. CONCLUSIONS: Twenty percent of the mothers of children had probably developed PTSD. In the moderate-severity group, there seemed to be a factor that alleviated PTSD symptoms. Because mothers provided effective care for the symptoms of children in the moderate-severity group, this observation suggests that participation of the mother in their child's treatment might prevent them from developing PTSD symptoms.

PMID: 18675639 [PubMed - indexed for MEDLINE]

 

J Psychiatr Res. 2008 Aug;42(10):802-7. Epub 2008 Feb 20.

Probing reward function in posttraumatic stress disorder: expectancy and satisfaction with monetary gains and losses.

Hopper JW, Pitman RK, Su Z, Heyman GM, Lasko NB, Macklin ML, Orr SP, Lukas SE, Elman I.

Behavioral Psychopharmacology Research Laboratory, Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA.

BACKGROUND: Posttraumatic stress disorder (PTSD) may be associated with dysfunctional reward processing. The present study assessed for such dysfunction  in both the expectancy and outcome phases of reward processing. METHODS: Male Vietnam veterans with (n=15) and without (n=11) combat-related PTSD were administered a wheel of fortune-type gambling task. Self-reported ratings of expectancy and satisfaction were collected respectively before and after each experience of monetary gain or loss. RESULTS: PTSD participants reported both lower expectancy of reward and lower satisfaction with reward when it was received. The latter result was manifest in a failure of PTSD participants to show the greater satisfaction that normally accompanies rewards received under conditions of low expectancy. CONCLUSION: These results suggest reward function impairment in PTSD related to expectancy, satisfaction, and the expectancy-satisfaction relationship.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18068725 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):357-68.

Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first two years after Hurricane Katrina.

Galea S, Tracy M, Norris F, Coffey SF.

Department of Epidemiology, School of Public Health, University of Michigan, Ann  Arbor, MI 48109-2029, USA. sgalea@umich.edu

Hurricane Katrina was the most devastating natural disaster to hit the United States in the past 75 years. The authors conducted interviews of 810 persons who  were representative of adult residents living in the 23 southernmost counties of  Mississippi before Hurricane Katrina. The prevalence of posttraumatic stress disorder (PTSD) since Hurricane Katrina was 22.5%. The determinants of PTSD were  female gender, experience of hurricane-related financial loss, postdisaster stressors, low social support, and postdisaster traumatic events. Kaplan-Meier survival curves suggest that exposure to both hurricane-related traumatic events  and to financial and social stressors influenced the duration of PTSD symptoms. Postdisaster interventions that aim to improve manipulable stressors after these  events may influence the onset and course of PTSD.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18720399 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):421-4.

Corroborating evidence of posttraumatic growth.

Shakespeare-Finch J, Enders T.

School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia. j.shakespeare-finch@qut.edu.au

Over the last decade, a healthy shift in the trauma literature has meant that published theory and research in the posttraumatic growth (PTG) domain has burgeoned, but the validity of the self-report questionnaires used to measure PTG has recently been criticized. Corroboration of these subjective reports by an observer would provide convergent validity. Therefore, this study's aim was to validate the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996). Sixty-one trauma survivors and 61 paired significant others completed the PTGI. A significant correlation was reported between the total PTGI scores of the trauma  survivors and the corroborating significant others, supporting the use of the PTGI as an appropriate measure of positive posttrauma changes.

Publication Types:      Validation Studies

PMID: 18720398 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):410-6.

A prospective study of trait anger and PTSD symptoms in police.

Meffert SM, Metzler TJ, Henn-Haase C, McCaslin S, Inslicht S, Chemtob C, Neylan T, Marmar CR.

Department of Psychiatry, University of California, San Francisco, CA 94143, USA. smeffert@lppi.ucsf.edu

It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder ( PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.

PMID: 18720397 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):402-9.

Tonic immobility mediates the influence of peritraumatic fear and perceived inescapability on posttraumatic stress symptom severity among sexual assault survivors.

Bovin MJ, Jager-Hyman S, Gold SD, Marx BP, Sloan DM.

Department of Psychology, Temple University, Philadelphia, PA, USA.

This study evaluated whether tonic immobility mediates the relations between perceived inescapability, peritraumatic fear, and posttraumatic stress disorder (PTSD) symptom severity among sexual assault survivors. Female undergraduates (N  = 176) completed questionnaires assessing assault history, perceived inescapability, peritraumatic fear, tonic immobility, and PTSD symptoms. Results  indicated that tonic immobility fully mediated relations between perceived inescapability and overall PTSD symptom severity, as well as reexperiencing and avoidance/numbing symptom clusters. Tonic immobility also fully mediated the relation between fear and reexperiencing symptoms, and partially mediated relations between fear and overall PTSD symptom severity, and avoidance/numbing symptoms. Results suggest that tonic immobility could be one path through which trauma survivors develop PTSD symptoms. Further study of tonic immobility may inform our ability to treat trauma victims.

PMID: 18720396 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):385-93.

Does prior psychological health influence recall of military experiences? a prospective study.

Wilson J, Jones M, Hull L, Hotopf M, Wessely S, Rona RJ.

Department of Psychological Medicine, King's Centre for Military Health Research, King's College, London, UK.

In a prospective study, we evaluated pre- and postdeployment psychological health on recall of risk factors to assess recall bias. Measures of the General Health Questionnaire (GHQ), PTSD Checklist (PCL), and symptom clusters from the PCL were obtained from 681 UK military personnel along with information on traumatic and protective risk factors. Postdeployment psychological health was more important in explaining recall of traumatic experiences than predeployment psychological health. Predeployment intrusive cluster scores were highly associated with traumatic exposures. Postdeployment, but not predeployment GHQ showed small effects for most risk factors. With the exception of intrusive thoughts, there is insufficient evidence to suggest predeployment psychological status would be useful in correcting for recall bias in subsequent cross-sectional studies.

PMID: 18720395 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):369-76.

Spanish and English versions of the PTSD Checklist-Civilian version (PCL-C): testing for differential item functioning.

Miles JN, Marshall GN, Schell TL.

RAND Corporation, Santa Monica, CA 90407-2138, USA. jmiles@rand.org

Interpretation of ethnic differences in PTSD is predicated on demonstration that  differences are not due to measurement bias. This is difficult when multiple languages are used in the assessment. This study used confirmatory factor analysis to examine possible differential item functioning (DIF) across English and Spanish versions of the PTSD Checklist-Civilian Version (PCL-C). Data were derived from two assessments of Hispanics (Ns = 304, 213), who were hospitalized  with physical injuries. After correction for multiple testing, univariate tests revealed no statistically significant DIF effects; multivariate tests revealed some indication of DIF at the initial assessment only. This bias was inconsistent across waves and unlikely to be substantively consequential, indicating that the  two versions of the PCL-C were generally equivalent.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18720394 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):425-9.

Association of objective measures of trauma exposure from motor vehicle accidents and posttraumatic stress symptoms.

Fujita G, Nishida Y.

Department of Criminology and Behavioral Sciences, National Research Institute of Police Science, Kashiwa-shi, Japan. fujita@nrips.go.jp

Associations of objective measures of trauma exposure with psychological sequelae following motor vehicle accidents (MVA) were examined in a Japanese population. Impact and injury severity of 93 MVA victims was assessed using on-the-scene in-depth investigations measured by the Injury Severity Score (ISS), barrier equivalent speed (BES), and change in velocity during the impact (Delta-v). Results showed that ISS, BES, and Delta-v were not related to posttraumatic stress symptoms (PTSS) or psychiatric symptoms at 5 and 14 months after the MVA.  Subjective measures (e.g., perceived life risk, persistent medical problems) were significantly related to psychological sequelae. These findings suggest that the  objective measures of trauma exposure are not associated directly with PTSS or psychiatric symptoms after an MVA.

PMID: 18720393 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):417-20.

Nonnightmare distressed awakenings in veterans with posttraumatic stress disorder: response to prazosin.

Thompson CE, Taylor FB, McFall ME, Barnes RF, Raskind MA.

VA Northwest Network, Mental Illness Research, Education and Clinical Center, Seattle, WA 98108, USA.

Twenty-two veterans with posttraumatic stress disorder (PTSD) were assessed for trauma-related nightmares and nonnightmare distressed awakenings (NNDA) before and after treatment with the alpha-1 adrenoreceptor antagonist prazosin at an average bedtime dose of 9.6 mg/day. Ratings combining frequency and intensity dimensions of trauma-related nightmares decreased from 3.6 to 2.2, NNDA from 5.2  to 2.1, and sleep difficulty from 7.2 to 4.1 per week. These results suggest that increased brain adrenergic activity may contribute to the pathophysiology of both trauma-related nightmares and NNDA in PTSD.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18720392 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):394-401.

Relationships among PTSD symptoms, social support, and support source in veterans with chronic PTSD.

Laffaye C, Cavella S, Drescher K, Rosen C.

VA HSR&D Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. Charlene.Laffaye@va.gov

The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD. Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers. Veteran peers provided  relatively high perceived support and little interpersonal stress. Spouses were seen as both interpersonal resources and sources of interpersonal stress. More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives. Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms.

PMID: 18720391 [PubMed - indexed for MEDLINE]

 

J Trauma Stress. 2008 Aug;21(4):377-84.

Trauma history characteristics and subsequent PTSD symptoms in motor vehicle accident victims.

Irish L, Ostrowski SA, Fallon W, Spoonster E, Dulmen M, Sledjeski EM, Delahanty DL.

Department of Psychology, Kent State University, Kent, OH 44242, USA.

The present study examined the relationship between trauma history characteristics (number and type of traumas, age at first trauma, and subjective  responses to prior traumas) and the development of posttraumatic stress disorder  (PTSD) symptoms following a motor vehicle accident (MVA). One hundred eighty-eight adult MVA victims provided information about prior traumatization and were evaluated for PTSD symptoms 6 weeks and one year following the MVA. Results indicated that after controlling for demographics and depression, prior trauma history characteristics accounted for a small, but significant amount of the variance in PTSD symptoms. Distress from prior trauma and number of types of  prior traumas were the most meaningful trauma history predictors. Results encourage further evaluation of trauma history as a multifaceted construct.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18720390 [PubMed - indexed for MEDLINE]

 

Med Care. 2008 Aug;46(8):813-20.

The prevalence and predictors of mental health treatment services in a national sample of depressed veterans.

Chermack ST, Zivin K, Valenstein M, Ilgen M, Austin KL, Wryobeck J, Blow FC.

Department of Veterans Affairs, Ann Arbor Center of Excellence (COE), Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Ann Arbor, Michigan 48108, USA. Chermack@umich.edu

BACKGROUND: Few studies of acute depression care have examined the provision of psychotherapy or combined treatment in addition to medication management. This study examined acute phase depression treatment in the VA healthcare system, including measures of medication treatment (MT), psychotherapy (PT), and combined treatment (CT = MT plus PT). Both low level care (receipt of any MT, PT, or CT, but all below guideline levels) as well as guideline concordant care (GC MT, PT,  and CT) were examined. METHODS: The sample included 41,412 patients with new depression diagnoses. Analyses examined the relationship between demographics and psychiatric comorbidities (eg, substance use disorders, post-traumatic stress disorder, depression with both substance use disorders and post-traumatic stress  disorder) and receipt of each type of care (low level and guideline concordant MT, PT, and CT). RESULTS: The majority (75%) received at least some treatment, with 35% of the sample receiving guideline concordant care (particularly GC MT).  Those with psychiatric comorbidities generally were more likely to receive GC care, older veterans were less likely to receive each type of care, and African Americans were less likely to receive GC MT but more likely to receive GC PT and  GC CT than whites. CONCLUSIONS: Although it is difficult to benchmark, the VA overall seems similar or better than the private sector in providing guideline concordant acute phase treatment for its depressed patients. The majority of veterans received some acute phase depression treatment, but only a minority seem to receive guideline concordant care (particularly PT and CT).

Publication Types:      Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18665061 [PubMed - indexed for MEDLINE]

 

Mil Med. 2008 Aug;173(8):721-8.

Suicide among discharged psychiatric inpatients in the Department of Veterans Affairs.

Desai RA, Dausey D, Rosenheck RA.

Northeast Program Evaluation Center, VA Connecticut Healthcare System, Department of Psychiatry and Epidemiology and Public Health, School of Medicine, Yale University, New Haven, CT 06510, USA.

OBJECTIVE: The objective of this study was to explore correlates of the use of firearms to commit suicide. METHODS: A national sample of psychiatric patients discharged from Department of Veterans Affairs medical centers was followed from  the time of discharge until December 1999. The study explores state-level measures as correlates of overall suicide and suicide by firearm, controlling for individual sociodemographic characteristics and psychiatric diagnosis. The outcomes of interest were completed suicide and suicide by firearm. RESULTS: Patients who were male, Caucasian, and who had a diagnosis of substance abuse or  post-traumatic stress disorder were significantly more likely to use a firearm than another means to commit suicide. Multivariable models indicated that veterans living in states with lower rates of gun ownership, more restrictive gun laws, and higher social capital were less likely to commit suicide with a firearm. CONCLUSIONS: Gun ownership rates, legislation, and levels of community cohesiveness are significantly associated with the likelihood of psychiatric patients committing suicide with a gun.

Publication Types:      Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18751586 [PubMed - indexed for MEDLINE]

 

Neuropsychopharmacology. 2008 Aug;33(9):2108-16. Epub 2007 Oct 24.

Effects of single prolonged stress and D-cycloserine on contextual fear extinction and hippocampal NMDA receptor expression in a rat model of PTSD.

Yamamoto S, Morinobu S, Fuchikami M, Kurata A, Kozuru T, Yamawaki S.

Department of psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan.

Although the impaired extinction of traumatic memory is one of the hallmark symptoms of posttraumatic stress disorder (PTSD), the underlying mechanisms of impaired extinction are unclear and effective pharmacological interventions have  not yet been developed. Single prolonged stress (SPS) has been proposed as an animal model of PTSD, since rats subjected to SPS (SPS rats) show enhanced negative feedback of the HPA axis and increased contextual fear, which are characteristics similar to those observed in patients with PTSD. In this study, using SPS rats, we examined (a) the ability of SPS to impair fear extinction, (b) whether D-cycloserine (DCS) can alleviate impaired fear extinction in SPS rats, and (c) the effect of SPS and/or DCS on the levels of N-methyl-D-aspartate (NMDA) receptor subunit mRNAs in the rat hippocampus during extinction training. SPS rats exhibited impaired fear extinction in the contextual fear test, which was alleviated by the repeated administration of DCS. The effect of enhanced extinction, induced by the administration of DCS to SPS rats, was maintained for  one week following extinction training. SPS induced significant upregulation of the levels of NMDA receptor subunit mRNAs before and during the period of extinction training, while repeated administration of DCS eliminated the enhanced mRNA levels of NMDARs. Behavioral analyses indicated that SPS is an appropriate animal model of PTSD and that DCS may be effective in the treatment of PTSD. These findings suggest that DCS, irrespective of its mechanistic involvement in the enhancement of fear extinction, may help to reverse hippocampal plasticity, and thus reverse the NMDA compensatory alterations.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 17957211 [PubMed - indexed for MEDLINE]

 

Neurosci Biobehav Rev. 2008 Aug;32(6):1121-35. Epub 2008 Apr 23.

Long-term neuroendocrine and behavioural effects of a single exposure to stress in adult animals.

Armario A, Escorihuela RM, Nadal R.

Institut de Neurociències, Universitat Autonòma de Barcelona, 08193 Bellaterra, Barcelona, Spain. Antonio.armario@uab.cat

There is now considerable evidence for long-lasting sequels of stress. A single exposure to high intensity predominantly emotional stressors such as immobilisation in wooden-boards (IMO) induces long-term (days to weeks) desensitization of the hypothalamic-pituitary-adrenal (HPA) response to the same  (homotypic) stressor, whereas the response to novel (heterotypic) stressors was enhanced. In addition, long-lasting changes in behaviour have been described after a single exposure to brief or more prolonged sessions of shocks, predator,  predator odour, underwater stress or a combination of three stressors on 1 day. The most consistent changes are reduced entries into the open arms of the elevated plus-maze and enhanced acoustic startle response, both reflecting enhanced anxiety. However, it is unclear whether there is any relationship between the intensity of the stressors, as evaluated by the main physiological indexes of stress (e.g. HPA axis), the putative traumatic experience they represent and their long-term behavioural consequences. This is particularly critical when trying to model post-traumatic stress disorders (PTSD), which demands a great effort to validate such putative models.

Publication Types:      Research Support, Non-U.S. Gov't     Review

PMID: 18514314 [PubMed - indexed for MEDLINE]

 

Nicotine Tob Res. 2008 Aug;10(8):1415-27.

Impact of Posttraumatic Stress Disorder on early smoking lapse and relapse during a self-guided quit attempt among community-recruited daily smokers.

Zvolensky MJ, Gibson LE, Vujanovic AA, Gregor K, Bernstein A, Kahler C, Legues CW, Brown RA, Feldner MT.

Department of Psychology, University of Vermont, 2 Colchester Avenue, Burlington, VT 05405, USA. Michael.Zvolensky@uvm.edu

The present investigation examined whether daily smokers with posttraumatic stress disorder (PTSD), as compared to daily smokers with either anxiety psychopathology or no current Axis I psychopathology, have decreased success in the early phases of a self-guided smoking quit attempt. Participants were 140 daily smokers (81 women; M (age) = 29.5; SD = 11.9; range = 18-65 years); approximately one-third of the sample met criteria for current PTSD (n = 47), one-third met criteria for other current anxiety disorders (without PTSD; n = 33), and one-third did not meet criteria for any current Axis I disorder (n = 60). Consistent with prediction, membership in the PTSD group, compared to membership in the other anxiety disorders group and the group with no current Axis I psychopathology, was associated with increased risk of lapse during the first week following quit day. Additionally, daily smokers with PTSD and other anxiety disorders were at significantly increased risk of relapse during the first week post-cessation compared to persons without Axis I psychopathology. However, the PTSD group and the other anxiety disorders group did not differ from one another in terms of relapse. Results suggest that PTSD is associated with increased risk of smoking lapse and relapse compared to smokers with no current Axis I psychiatric problems, and increased risk of early smoking lapse but not relapse, as compared to those with other anxiety disorders. Findings provide novel evidence that PTSD, and perhaps anxiety disorders more generally, may be important factors in reducing the odds of successful unaided quit attempts in the early phases of cessation.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18686190 [PubMed - in process]

 

Soc Psychiatry Psychiatr Epidemiol. 2008 Aug;43(8):602-11. Epub 2008 Jun 13.

Psychotic experiences in people who have been sexually assaulted.

Kilcommons AM, Morrison AP, Knight A, Lobban F.

Dept. of Clinical Psychology, University of Liverpool, Liverpool, UK. akilcommons@aol.com

OBJECTIVE: In recent years, there has been a call for greater awareness of the relationship between trauma and psychosis, and several studies involving patients with psychotic disorders have found a link between traumatic life experience and  the development of psychosis. However, little research has examined psychotic experiences in a traumatised population. METHOD: This study investigated psychotic experiences in a sample of 40 survivors of sexual assault (SA) compared to a control group without a history of sexual assault (measured using a self-report questionnaire) and examined the psychological factors that may contribute to the development of psychotic experiences in sexually traumatised individuals. In particular, the role of dissociation and cognitive factors such as post-traumatic cognitions were explored. RESULTS: Of the 26 sexually assaulted participants that were interviewed, 46% reported auditory hallucinations and 46%  reported visual hallucinations. A significantly higher rate of psychotic phenomena (delusional ideation and predisposition to hallucinations) was found in the sexually assaulted group compared to the control group. Severity of SA trauma was significantly associated with severity of PTSD and psychotic symptomatology.  Dissociation was strongly associated with all measures of psychotic phenomena and negative cognitions about the self and the world were associated with predisposition to hallucinations and delusional ideation. Regression analyses revealed that after controlling for the severity of SA trauma, dissociation and negative beliefs about the self significantly predicted delusional distress, and  dissociation significantly predicted predisposition to visual hallucinations. CONCLUSIONS: These exploratory findings support the idea that psychotic phenomena may be caused by traumatic life experiences and highlight the need for further research. The implications of these results for research and clinical practice are discussed.

PMID: 18560786 [PubMed - in process]

 

Violence Against Women. 2008 Aug;14(8):944-60.

Violence against women with HIV risk and recent criminal justice system involvement: prevalence, correlates, and recommendations for intervention.

Weir BW, Bard RS, O'Brien K, Casciato CJ, Stark MJ.

Multnomah County Health Department, Portland, USA.

This research note examines the prevalence and correlates of intimate partner violence (IPV) and other violence (OV) among women (N = 529) at risk for HIV and  with histories of criminal justice system involvement. The 3-month prevalences of IPV and OV were 31.2% and 18.7%, respectively. IPV was associated with having a current main partner, substance use, sexual risk behavior, trading sex, anxiety,  depression, and lower self-esteem. OV was associated with no current employment or schooling, unstable housing, drug use, trading sex, anxiety, depression, and lower self-esteem. The high prevalence of violence demonstrates the need for intervention in this population; the correlates show that effective interventions must address the complex issues in these women's lives.

Publication Types:      Research Support, N.I.H., Extramural

PMID: 18667407 [PubMed - indexed for MEDLINE]

 

Violence Against Women. 2008 Aug;14(8):905-16.

Sex trafficking in Nepal: survivor characteristics and long-term outcomes.

Crawford M, Kaufman MR.

University of Connecticut, USA.

There has been little systematic research on therapy, rehabilitation, and social  reintegration of women formerly trafficked into prostitution. This study examines characteristics and outcomes of Nepali sex trafficking survivors. Twenty case files of survivors rehabilitated in the shelter of an antitrafficking NGO were randomly selected. All individuals in the sample suffered somatic and behavioral  sequelae. Three quarters of the survivors eventually returned to their villages to live. These results suggest that current rehabilitation and reintegration programs are producing positive results. However, there is need for more systematic diagnosis, record keeping, and outcome studies as well as education to reduce stigma and promote safe migration practices.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18667405 [PubMed - indexed for MEDLINE]

 

World J Pediatr. 2008 Aug;4(3):165-72.

Psychological effects of earthquakes in children: prospects for brief behavioral  treatment.

Salcioğlu E, Başoğlu M.

Section of Trauma Studies, Institute of Psychiatry, King's College London, UK. Ebru.Salcioglu@iop.kcl.ac.uk

BACKGROUND: Treatment of child earthquake survivors is a relatively less investigated issue in disaster research. A review of the evidence on the mental health effects of earthquakes, risk factors, and findings from treatment studies  may provide useful insights into effective treatment of traumatized children. DATA SOURCES: Studies of child and adolescent earthquake survivors included the PILOTS database (electronic index for literature on psychological trauma) and relevant evidence from various studies of adult earthquake survivors. RESULTS: Evidence points to elevated rates of posttraumatic stress disorder (PTSD), depression, and earthquake-related fears in children and adolescents. Traumatic stress appears to be mediated by loss of control over fear induced by exposure to unpredictable and uncontrollable earthquakes. This implies that interventions enhancing sense of control over fear are likely to be most effective. Recent studies indeed show that a control focused behavioral treatment (CFBT) involving  mainly encouragement for self-exposure to feared situations is highly effective in facilitating recovery from earthquake trauma. Evidence also suggests that CFBT can be delivered through booklets and similar media. CONCLUSIONS: Pilot studies suggest that CFBT has promise in effective treatment of PTSD in children. Further research is needed to confirm these preliminary findings and to develop self-help tools for children.

Publication Types:      Research Support, Non-U.S. Gov't     Review

PMID: 18822924 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Jul 31. [Epub ahead of print]

Socially related fears following exposure to trauma: Environmental and genetic influences.

Collimore KC, Asmundson GJ, Taylor S, Jang KL.

Anxiety and Illness Behaviour Laboratory, University of Regina, Regina, SK, Canada S4S 0A2.

Few studies have examined why socially related fears and posttraumatic stress commonly, but not invariably, co-occur. It may be that only traumata of human agency (e.g., sexual assault), for which there is an interpersonal component, give rise to co-occurring socially related fears. These symptoms might also co-occur because of shared genetic factors. We investigated these issues using a  sample of 882 monozygotic and dizygotic twins. No significant differences in socially related fear (i.e., fear of negative evaluation, fear of socially observable arousal symptoms) were found between participants reporting assaultive or nonassaultive trauma. However, significant differences in socially related fear were found when participants were grouped into probable PTSD and no PTSD groups. Participants with probable PTSD exhibited greater socially related fear (i.e., fear of negative evaluation) than those without PTSD. Using biometric structural equation modeling, trauma exposure was best explained by shared and nonshared environmental influences. The fear of socially observable arousal symptoms was influenced by genetic and nonshared environmental influences. Implications and directions for future research are discussed.

PMID: 18774260 [PubMed - as supplied by publisher]

 

J Interpers Violence. 2008 Jul 28. [Epub ahead of print]

Gender Differences in PTSD in Israeli Youth Exposed to Terror Attacks.

Laufer A, Solomon Z.

Netanya Academic College.

Differences between boys' and girls' exposure to terror and posttraumatic symptoms were examined in a sample of 2,999 Israeli adolescents. Gender differences were also assessed regarding perceived social support, religious beliefs, and ideological commitment. Results indicate that girls reported more posttraumatic symptoms than boys, although boys reported twice the rate of very severe symptoms. Differences were also found between boys and girls in levels of  fear, religiosity, ideological commitment, and social support, but not regarding  exposure. Path analysis revealed that gender is not a direct predictor of posttraumatic stress disorder (PTSD); however, it does have an indirect effect, especially through fear, which was the best predictor of PTSD. Social extrinsic religiosity and ideological intolerance were positive predictors of PTSD. The study concludes that gender differences in PTSD are largely the result of differences in levels of fear and are not due to differences in political ideology, religiosity, or social support.

PMID: 18663245 [PubMed - as supplied by publisher]

 

J Subst Abuse Treat. 2008 Jul 25. [Epub ahead of print]

Can emotion-focused coping help explain the link between posttraumatic stress disorder severity and triggers for substance use in young adults?

Staiger PK, Melville F, Hides L, Kambouropoulos N, Lubman DI.

School of Psychology, Deakin University, Burwood, Victoria 3125, Australia.

High rates of posttraumatic stress disorder (PTSD) have been reported among people seeking treatment for substance use disorders (SUDs), although few studies have examined the relationship between PTSD and substance use in young drug users. This study compared levels of substance use, coping styles, and high-risk  triggers for substance use among 66 young adults with SUD, with or without comorbid PTSD. Young people with current SUD-PTSD (n = 36) reported significantly higher levels of substance use in negative situations, as well as emotion-focused coping, compared to the current SUD-only group (n = 30). Severity of PTSD was a significant predictor of negative situational drug use, and emotion-focused coping was found to mediate this relationship. The findings underscore the need for youth substance abuse treatment programs to include coping skills training and management of affect regulation for those individuals with comorbid SUD-PTSD.

PMID: 18657937 [PubMed - as supplied by publisher]

 

BMC Psychiatry. 2008 Jul 23;8:63.

Stress load during childhood affects psychopathology in psychiatric patients.

Weber K, Rockstroh B, Borgelt J, Awiszus B, Popov T, Hoffmann K, Schonauer K, Watzl H, Pröpster K.

Department of Psychology, University of Konstanz, Germany. Katja.Weber@uni-konstanz.de

BACKGROUND: Childhood stress and trauma have been related to adult psychopathology in different psychiatric disorders. The present study aimed at verifying this relationship for stressful experiences during developmental periods by screening stress load across life in adult psychiatric inpatients with different diagnoses compared to healthy subjects. In addition, a relationship between the amount of adverse experiences and the severity of pathology, which has been described as a 'building block' effect in posttraumatic stress disorder  (PTSD), was explored for non-traumatic events in psychiatric disorders other than PTSD. METHODS: 96 patients with diagnoses of Major Depressive Disorder (MDD), schizophrenia, drug addiction, or personality disorders (PD) and 31 subjects without psychiatric diagnosis were screened for adverse experiences in childhood  (before the age of six years), before onset of puberty, and in adulthood using the Early Trauma Inventory and the Posttraumatic Stress Diagnostic Scale. Effects of stress load on psychopathology were examined for affective symptoms, PTSD, and severity of illness by regression analyses and comparison of subgroups with high  and low stress load. RESULTS: High stress load in childhood and before puberty, but not in adulthood, was related to negative affect in all participants. In patients, high stress load was related to depressive and posttraumatic symptoms,  severity of disorder, and the diagnoses of MDD and PD. CONCLUSION: Results support the hypothesis of stress-sensitive periods during development, which may  interact with genetic and other vulnerability factors in their influence on the progress of psychiatric disorders. A 'dose' effect of stress load on the severity of psychopathology is not restricted to the relationship between traumata and PTSD.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18651952 [PubMed - indexed for MEDLINE]

 

J Anxiety Disord. 2008 Jul 22. [Epub ahead of print]

Numbing symptoms as predictors of unremitting posttraumatic stress disorder.

Malta LS, Wyka KE, Giosan C, Jayasinghe N, Difede J.

Weill Medical College of Cornell Department of Psychiatry, Program for Anxiety and Traumatic Stress Studies, 525 East 68th Street, Box 200 - Psychiatry, New York, NY 10065, United States.

This prospective longitudinal study examined the ability of re-experiencing, avoidance, numbing, and hyperarousal symptoms to predict persistence of posttraumatic stress disorder (PTSD) in disaster workers followed for 2 years. Cluster analyses suggested that overall severity was the best predictor of PTSD at follow up, but for groups with PTSD of moderate severity, numbing symptoms were also associated with PTSD at the 2-year follow up. Regression analyses with  all four symptom groups as independent variables found that only numbing and re-experiencing symptoms predicted PTSD at the 1 year follow up, and only numbing symptoms predicted PTSD at the 2-year follow up. Findings suggest that numbing symptom severity could be used as a risk index of very chronic PTSD, especially when the overall PTSD severity falls in the moderate range.

PMID: 18755571 [PubMed - as supplied by publisher]

 

Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005601.

Psychosocial interventions for prevention of psychological disorders in law enforcement officers.

Peñalba V, McGuire H, Leite JR.

Psicobiologia, Universidade Federal de São Paulo, Rua Napoleao de Barros 925 1st  floor, São Paulo, São Paulo, Brazil. vpenalba@psicobio.epm.br

BACKGROUND: Psychosocial interventions are widely used for the prevention of psychological disorders in law enforcement officers. OBJECTIVES: To assess the effectiveness and comparative effectiveness of psychosocial interventions for the prevention of psychological disorders in law enforcement officers. SEARCH STRATEGY: CCDANCTR-References was searched on 12/5/2008, electronic databases were searched, reference lists of review articles and included studies were checked, a specialist journal was handsearched, specialist books were checked and we contacted experts and trialists. SELECTION CRITERIA: Randomised and quasi randomised controlled trials were eligible. The types of participants were people employed directly in law enforcement, including police officers and military police, regardless of gender, age and country of origin, and whether or not they  had experienced some psychological trauma. All types of psychosocial intervention were eligible. The relevant outcome measures were psychological symptoms, adverse events and acceptability of interventions. DATA COLLECTION AND ANALYSIS: Data was entered into Review Manager 4.2 for analysis, but this review was converted to RevMan 5.0 for publication. Quality assessments were performed. Two authors independently selected studies, extracted data and assessed the quality of studies. Summary effects were to be calculated using RevMan but no meta-analyses  were possible. For individual studies, dichotomous outcome data are presented using relative risk, and continuous outcome data are presented using the weighted mean difference. These results are given with their 95% confidence intervals (CI). MAIN RESULTS: Ten studies were included in the review but only five reported data that could be used. Three of the ten studies were related to exercise-based psychological interventions. Seven were related to psychological interventions. No meta-analyses were possible due to diversity of participants, interventions and outcomes. Two studies compared a psychosocial intervention versus another intervention. Three studies compared a psychosocial intervention to a control group. Only one primary prevention trial reported data for the primary outcomes and, although this study found a significant difference in depression in favour of the intervention at endpoint, this difference was no longer evident at 18 months. No studies of primary prevention comparing different interventions and reporting primary outcomes of interest were identified.The methodological quality of the included studies was summarised. No study met our full quality criteria and one was regarded as low-quality. The remainder could not be rated because of incomplete data in the published reports and inadequate responses from the trialists. AUTHORS' CONCLUSIONS: There is evidence only from individual small and low quality trials with minimal data suggesting that police  officers benefit from psychosocial interventions, in terms of physical symptoms and psychological symptoms such as anxiety, depression, sleep problems, cynicism, anger, PTSD, marital problems and distress. No data on adverse effects were available. Meta-analyses of the available data were not possible. Further well-designed trials of psychosocial interventions are required. Research is needed on organization-based interventions to enhance psychological health among  police officers.

Publication Types:      Review

PMID: 18646132 [PubMed - indexed for MEDLINE]

 

Psychiatry Res. 2008 Jul 15;163(2):156-70. Epub 2008 May 1.

Abnormal recruitment of working memory updating networks during maintenance of trauma-neutral information in post-traumatic stress disorder.

Moores KA, Clark CR, McFarlane AC, Brown GC, Puce A, Taylor DJ.

Cognitive Neuroscience Laboratory, School of Psychology, Flinders University, Adelaide, SA, Australia.

Post-traumatic stress disorder (PTSD) is characterised by disturbances in concentration and memory, symptoms which are a source of further distress for patients. Related to this, abnormalities in underlying working memory (WM) systems have been identified [Clark, C.R., McFarlane, A.C., Morris, P., Weber, D.L., Sonkkilla, C., Shaw, M.E., Marcina, J., Tochon-Danguy, H.J., Egan, G.F., 2003. Cerebral function in posttraumatic stress disorder during verbal working memory updating: a positron emission tomography study. Biological Psychiatry 53,  474-481.], indicating dysfunction in left hemisphere brain regions. In this study, we performed functional magnetic resonance imaging (fMRI) in 13 patients with severe PTSD and matched non-traumatized Controls, during performance of visuo-verbal tasks that involved either maintenance or continual updating of word stimuli in WM. The PTSD group failed to show differential activation during WM updating, and instead appeared to show abnormal recruitment of WM updating network regions during WM maintenance. These regions included the bilateral dorsolateral prefrontal cortex (DLPFC) and the inferior parietal lobe (IPL). Several other regions were significantly more activated in Controls than in PTSD  during WM updating, including the hippocampus, the anterior cingulate (AC), and the brainstem pons, key regions that are consistently implicated in the neurobiology of PTSD. These findings suggest compensatory recruitment of networks in PTSD normally only deployed during updating of WM and may reflect PTSD patients' difficulty engaging with their day-to-day environment.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18455372 [PubMed - indexed for MEDLINE]

 

Soc Psychiatry Psychiatr Epidemiol. 2008 Jul 11. [Epub ahead of print]

Acculturation, psychiatric comorbidity and posttraumatic stress disorder in a Taiwanese aboriginal population.

Lee CS, Chang JC, Liu CY, Chang CJ, Chen TH, Chen CH, Cheng AT.

Dept. of Psychiatry, Lo-Tung Poh-Ai Hospital, Yilan, Taiwan.

BACKGROUND: This study investigates acculturation and other antecedent psychiatric and socio-environmental risk factors for posttraumatic stress disorder (PTSD) in one aboriginal group (the Bunun) exposed to an earthquake disaster in Taiwan. METHOD: Respondents (n = 196) were assessed 5 months after the disaster, using a Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry and the Taiwan Aboriginal Acculturation Scale. RESULT: Four risk  factors exerted independent effect on the risk of PTSD, including magnitude of the earthquake, subsequent traumas, antecedent major depressive disorder and acculturation status. CONCLUSION: Public mental health programs need to consider  the liability to PTSD in populations with different ethnicity and socio-cultural  environments.

PMID: 18622537 [PubMed - as supplied by publisher]

 

Brain Cogn. 2008 Jul 9. [Epub ahead of print]

Incidental retrieval of emotional contexts in post-traumatic stress disorder and  depression: An fMRI study.

Whalley MG, Rugg MD, Smith AP, Dolan RJ, Brewin CR.

Sub-Department of Clinical Health Psychology, University College London, Gower Street, London WC1E 6BT, UK.

In the present study, we used fMRI to assess patients suffering from post-traumatic stress disorder (PTSD) or depression, and trauma-exposed controls, during an episodic memory retrieval task that included non-trauma-related emotional information. In the study phase of the task neutral pictures were presented in emotional or neutral contexts. Participants were scanned during the  test phase, when they were presented with old and new neutral images in a yes/no  recognition memory task. fMRI results for the contrast between old and new items  revealed activation in a predominantly left-sided network of cortical regions including the left middle temporal, bilateral posterior cingulate, and left prefrontal cortices. Activity common to all three groups when correctly judging pictures encoded in emotional contexts was much more limited. Relative to the control and depressed groups the PTSD group exhibited greater sensitivity to correctly recognised stimuli in the left amygdala/ventral striatum and right occipital cortex, and more specific sensitivity to items encoded in emotional contexts in the right precuneus, left superior frontal gyrus, and bilateral insula. These results are consistent with a substantially intact neural system supporting episodic retrieval in patients suffering from PTSD. Moreover, there was little indication that PTSD is associated with a marked change in the way negatively valenced information, not of personal significance, is processed.

PMID: 18614265 [PubMed - as supplied by publisher]

 

Acta Paediatr. 2008 Jul;97(7):884-8.

Comment in:     Acta Paediatr. 2008 Jul;97(7):851-2.

Posttraumatic stress among children in Kurdistan.

Ahmad A.

Department of Child Mental Health, College of Medicine, University of Dohuk, Kurdistan Region, Iraq. abdulbaghi.ahmad@bupinst.uu.se.Sweden

AIM: To identify a posttraumatic stress disorder profile for the Child Behaviour  Checklist. METHOD: Checklist item scores for 806 school-aged children in Iraqi Kurdistan (201 randomly selected from the general population, 241 orphans, 199 primary medical care visitors and 165 hospital in-patients) were analysed against the Posttraumatic Stress Symptom Scale for Children (PTSS-C) scores, estimating not only stress diagnoses, but also nonstress-related, child-specific posttraumatic symptoms. RESULTS: Twenty checklist items, which revealed significant correlations with the stress diagnoses, formed the checklist-stress profile with acceptable reliability and validity, and significant correlation to  the PTSS-C estimates. CONCLUSION: A child-specific stress profile for the checklist is recommended for use as a screening instrument.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18532935 [PubMed - indexed for MEDLINE]

 

Acta Paediatr. 2008 Jul;97(7):851-2. Epub 2008 Apr 28.

Comment on:     Acta Paediatr. 2008 Jul;97(7):884-8.

Post-traumatic stress disorder in Dohuk, Kurdistan.

Söndergaard HP.

Department of Public Health, Karolinska Institutet, Stockholm, Sweden. hpsondergaard@krisochtraumacentrum.se

Publication Types:      Comment

PMID: 18452564 [PubMed - indexed for MEDLINE]

 

Aging Ment Health. 2008 Jul;12(4):494-8.

The phenomenology of reactivated trauma memories in older adults: a preliminary study.

Hiskey S, Luckie M, Davies S, Brewin CR.

Department of Clinical Psychology, North Essex Partnership NHS Foundation Trust,  Colchester, UK. sydhiskey@hotmail.com

Empirical literature concerning reactivated memories of trauma among older adults is sparse. Twelve elderly participants with re-emergent, involuntary, memories of previous adversity were given a structured interview exploring phenomenological aspects of the experience. Intense and highly vivid sensory components of memory  were common as was a sense of current threat. This was compared with data available from the adult literature on post-traumatic stress disorder (PTSD) and  we conclude that the process of trauma memory reactivation after years of attenuation seems not to have affected involuntary intrusive representations of what happened. Recommendations to extend the current research are suggested.

PMID: 18791897 [PubMed - in process]

 

Alcohol Alcohol. 2008 Jul-Aug;43(4):460-9. Epub 2008 Mar 25.

Childhood and current determinants of heavy drinking in early adulthood.

Kestilä L, Martelin T, Rahkonen O, Joutsenniemi K, Pirkola S, Poikolainen K, Koskinen S.

Department of Health and Functional Capacity, National Public Health Institute (KTL), Mannerheimintie 166, FI-00300 Helsinki, Finland. laura.kestila@ktl.fi

AIMS: To explore the association of parental education, childhood living conditions and several adversities with heavy drinking in early adulthood, and to analyze the effect of the respondent's current circumstances on these associations. METHOD: The analyses were conducted in a sample of 1234 adults aged 18-29 years participating in the Finnish Health 2000 Survey (65% of the original  representative two-stage cluster sample, N = 1894). The outcome measure was heavy drinking measured by g/week for pure alcohol (for men >or=280 g/week and for women >or=140 g/week). RESULTS: 8% of young adult men and 5% of women were heavy  drinkers. In both genders, parental alcohol problems and other childhood adversities, poor own education, and unemployment status increased the risk of heavy drinking. The impact of childhood on heavy drinking was partly independent  and partly mediated by adult characteristics, in particular, for both genders, low level of education. CONCLUSIONS: Childhood adversities are associated with heavy drinking in early adulthood among both genders. Childhood social circumstances as well as low educational level and unemployment should be taken into account in planning preventive policies to tackle the harms caused by excessive alcohol use at the individual and population level.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18364362 [PubMed - indexed for MEDLINE]

 

Am J Disaster Med. 2008 Jul-Aug;3(4):235-40.

Application of a needs-driven, competencies-based mental health training program  to a post-disaster situation: the Grenada experience.

Kutcher S, Chehil S.

Department of Psychiatry, WHO/PAHO Collaborating Center in Mental Health Training and Policy Development, Dalhousie University, AJLB H Halifax, Nova Scotia, Canada.

This report outlines an innovative approach to address post-natural disaster mental health needs in a region in which natural disasters are common---the Caribbean. Instead of traditional external vertical psychosocial interventions commonly used in this region, the authors developed and implemented a mental health interventions training program, in the island country of Grenada, which is focused on enhancing the capacity of local community-based health service providers to provide immediate and continued mental healthcare following a natural disaster. Soon after this training, a hurricane stuck the island of Grenada. A review of the self-confidence in the application of this training and  the mental health intervention activities of these community health providers demonstrated that they felt able to effectively identify, intervene, and address  post-disaster mental health needs within their communities and that their care of individuals affected continued beyond the immediate post-disaster period, suggesting that enhancing the capacity of local community-based health providers  to deal with post-natural disaster mental health needs may be a useful model that may be applicable in other jurisdictions.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18822841 [PubMed - indexed for MEDLINE]

 

Am J Disaster Med. 2008 Jul-Aug;3(4):201-12.

Validation of the Short Posttraumatic Stress Disorder Rating Interview (expanded  version, Sprint-E) as a measure of postdisaster distress and treatment need.

Norris FH, Hamblen JL, Brown LM, Schinka JA.

Department of Psychiatry, Dartmouth Medical School, National Center for Disaster  Mental Health Research, Department of Veterans Affairs National Center for PTSD,  White River Junction, Vermont, USA.

OBJECTIVE: Professionals and paraprofessionals working in disaster settings need  tools to identify persons with mental health needs. To validate the Sprint-E as a measure of postdisaster distress and treatment need, the authors tested (1) the concurrent validity of the measure compared with other measures of distress, (2)  the sensitivity and specificity of a "3/7 rule" on the Sprint-E relative to probable PTSD diagnosis, and (3) the hypothesis that Sprint-E scores would be stable in the absence of treatment but would improve in its presence. METHOD: In  Study 1, data were collected at the point of enrollment from 165 adults participating in a Florida treatment program implemented in response to the 2004  hurricanes. In Study 2, data were collected at points of referral, pretreatment,  and intermediate treatment from 128 adults participating in a Baton Rouge Louisiana treatment program implemented in response to the 2005 hurricanes, Katrina and Rita. RESULTS: The utility of a 3/7 rule for the Sprint-E, with 3 suggesting possible and 7 suggesting probable treatment needs, was supported in Study 1. Tested against the PTSD Checklist, the Sprint-E performed well in ROC analyses (area under the curve = 0.87); a score of 7 achieved sensitivity of 78 percent and specificity of 79 percent. In Study 2, Sprint-E scores evidenced little change between referral and pretreatment but substantial change between pretreatment and intermediate treatment. CONCLUSION: The Sprint-E is useful as an assessment and referral tool in situations where more in-depth assessment is not  feasible and mental health services are available.

Publication Types:      Validation Studies

PMID: 18822839 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Jul;21(3):213-25.

Psychological factors predicting stress symptoms: metacognition, thought control, and varieties of worry.

Roussis P, Wells A.

Academic Division of Clinical Psychology, University of Manchester, Manchester, UK.

This study tested predictions of the metacognitive model of post-traumatic stress disorder (Wells, 2000) concerning relationships between stress symptoms and maladaptive control of thoughts. We tested the hypothesis that the tendency to use worry as a means of controlling thoughts will be positively predictive of stress symptoms. In doing so, overlaps with symptomatic worry, stress symptoms, and stress exposure at time 1 was controlled. One hundred and ten (110) college students were assessed twice, over a three-month period. Consistent with predictions, use of worry as a thought control strategy made a significant and independent contribution to the prediction of stress symptoms. The findings provide further support for Wells' metacognitive model of stress reactions.

PMID: 18938290 [PubMed - indexed for MEDLINE]

 

Anxiety Stress Coping. 2008 Jul;21(3):295-307.

Personal resources of mastery-optimism, and communal support beliefs, as predictors of posttraumatic stress in uprooted Israelis.

Ben-Zur H.

School of Social Work, University of Haifa, Israel. zbz@netvision.net.il

The study aims to assess the personal resources of mastery-optimism, and communal support beliefs, as predictors of posttraumatic stress and adaptation in uprooted Israelis following Israel's disengagement from the Gaza Strip and northern Samaria in the summer of 2005. A telephone interview of a sample of 104 respondents slated to be uprooted was conducted several weeks before the disengagement (TI), and again 9 months after the event (T2). At T1, respondents answered a questionnaire which included assessments of dispositional optimism and mastery, beliefs in the availability of community-family and governmental-societal support, nation-related anxiety, and demographic data. Posttraumatic stress levels were assessed at T2. The main findings showed that high levels of mastery-optimism and low nation-related anxiety at T1 predicted a  low severity of total posttraumatic stress scores at T2. A high educational level and a secular identity also predicted low posttraumatic stress. In contrast, communal support beliefs were not related to posttraumatic stress. These findings point to the importance of personal resources and education as protective factors against posttraumatic stress following an event such as forced uprooting.

PMID: 18938288 [PubMed - indexed for MEDLINE]

 

ANZ J Surg. 2008 Jul;78(7):583-7.

Predictors of post-traumatic stress disorder following major trauma.

Harris IA, Young JM, Rae H, Jalaludin BB, Solomon MJ.

Orthopaedic Department, Liverpool Hospital, Sydney, New South Wales, Australia. ian.harris@sswahs.nsw.gov.au

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common sequel to physical  trauma, but there is disagreement regarding the predictors of this condition. This study aims to examine the role of physical, psychosocial and compensation-related factors in the development of PTSD following major trauma. METHODS: Participants were consecutive adult patients presenting to one major trauma centre with major trauma (Injury Severity Score 16 or higher). Baseline characteristics and clinical data were obtained from the hospital trauma database. The presence of PTSD (as measured by the PTSD Checklist, civilian version) and additional data were obtained from a questionnaire mailed to patients between 1 and 6 years after the injury. Multiple linear regression was used to identify significant independent associations with PTSD. RESULTS: Among 355 patients (61.0% response fraction), 129 (36.3%, 95% confidence interval 43.2-53.2%) were classed as having PTSD. Symptoms of PTSD were not significantly  related to measures of injury severity, the time since the injury, education level, household income or employment status at the time of injury. PTSD was significantly associated with younger age (P < 0.0001), the presence of chronic illnesses (P < 0.0001), unemployment at the time of follow up (P < 0.0001), use of a lawyer (P < 0.0001), blaming others for the injury (P = 0.003) and having an unsettled compensation claim (P = 0.007). CONCLUSION: Post-traumatic stress disorder after major trauma was not related to measures of injury severity, but was related to other factors, such as blaming others for the accident and the processes involved in claiming compensation.

PMID: 18593415 [PubMed - indexed for MEDLINE]

 

Arch Pediatr Adolesc Med. 2008 Jul;162(7):642-8.

Association between posttraumatic stress and depressive symptoms and functional outcomes in adolescents followed up longitudinally after injury hospitalization.

Zatzick DF, Jurkovich GJ, Fan MY, Grossman D, Russo J, Katon W, Rivara FP.

Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Campus Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. dzatzick@u.washington.edu

OBJECTIVE: To assess the association between early posttraumatic stress disorder  (PTSD) and depressive symptoms and functional and quality-of-life outcomes among  injured youth. DESIGN: Prospective cohort study. SETTING: Combined pediatric-adult level I trauma center. PARTICIPANTS: Randomly sampled adolescent  injury survivors aged 12 to 18 years (N = 108) were recruited from surgical inpatient units. MAIN EXPOSURES: Posttraumatic stress disorder and depressive symptom levels in the days and weeks immediately following injury. We also collected relevant adolescent demographic, injury, and clinical characteristics.  MAIN OUTCOME MEASURE: Multiple domains of adolescent functional impairment were assessed with the 87-item Child Health Questionnaire (CHQ-87) at 2, 5, and 12 months after injury. RESULTS: The investigation attained greater than 80% adolescent follow-up at each assessment after injury. Mixed-model regression was  used to assess the association between baseline levels of PTSD and depressive symptoms and subsequent functional outcomes longitudinally. High baseline PTSD symptom levels were associated with significant impairments in CHQ-87 Role/Social Behavioral, Role/Social Physical, Bodily Pain, General Behavior, Mental Health, and General Health Perceptions subscales. High baseline depressive symptoms were  associated with significant impairments in CHQ-87 Physical Function, Role/Social  Emotional, Bodily Pain, Mental Health, Self-esteem, and Family Cohesion subscales. CONCLUSIONS: Early PTSD and depressive symptoms are associated with a  broad spectrum of adolescent functional impairment during the year after physical injury. Coordinated investigative and policy efforts that refine mental health screening and intervention procedures have the potential to improve the functioning and well-being of injured youth treated in the acute care medical setting.

Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't     Research Support, U.S. Gov't, P.H.S.

PMID: 18606935 [PubMed - indexed for MEDLINE]

 

Bull Menninger Clin. 2008 Summer;72(3):179-90.

Posttraumatic stress disorder following traumatic injury: narratives as unconscious indicators of psychopathology.

Hashemi B, Shaw RJ, Hong DS, Hall R, Nelson K, Steiner H.

Division of Child & Adolescent Psychiatry, Stanford University School of Medicine and Lucile Salter Packard Children's Hospital, Palo Alto, California, USA.

Current conventional assessment methodologies used to diagnose posttraumatic stress disorder (PTSD) rely heavily on symptom counts obtained from clinical interviews or self-report questionnaires. Such measures may underestimate the impact of traumatic events, particularly in individuals who deny or repress emotional distress. This case report illustrates the use of two methods of narrative analysis to assess unconscious representations of PTSD. Linguistic analysis and a computerized analysis of referential activity were able to capture unconscious aspects of the traumatic experience.

Publication Types:      Case Reports

PMID: 18990054 [PubMed - indexed for MEDLINE]

 

Child Abuse Negl. 2008 Jul;32(7):732-7. Epub 2008 Jul 9.

Trauma-related predictors of deontic reasoning: a pilot study in a community sample of children.

DePrince AP, Chu AT, Combs MD.

Department of Psychology, University of Denver, 2155 S. Race Street, Denver, CO 80208, USA.

OBJECTIVE: Deontic reasoning (i.e., reasoning about duties and obligations) is essential to navigating interpersonal relationships. Though previous research demonstrates links between deontic reasoning abilities and trauma-related factors (i.e., dissociation, exposure to multiple victimizations) in adults, studies have yet to examine deontic reasoning abilities in children exposed to trauma. Given that social and safety rules (exemplars of deontic reasoning rules) may appear arbitrary for children in the face of trauma exposure, particularly interpersonal violence perpetrated by adults (i.e., caregivers, close relatives), we predicted  that the ability to detect violations of these rules would vary as a function of  trauma exposure type (no, non-interpersonal, and interpersonal). Additionally, given previous research linking dissociation and deontic reasoning in adults, we  predicted that higher levels of dissociation would be associated with more errors in deontic problems. METHODS: Children exposed to interpersonal violence (e.g., sexual abuse by an adult family member, witnessing domestic violence, or physical abuse in the home) were compared to children exposed to non-interpersonal trauma  (e.g., motor vehicle accident, natural disaster) or no trauma on their ability to detect violations of deontic and descriptive rules in a Wason Selection Task and  assessed for their level of dissociative symptoms. RESULTS: Dissociation (but not trauma exposure type) predicted errors in deontic (but not descriptive) reasoning problems after controlling for estimated IQ, socio-economic status, and children's ages. CONCLUSIONS: The current study provides preliminary evidence that deontic reasoning is associated with dissociation in children. This pilot study points to the need for future research on trauma-related predictors of deontic reasoning. PRACTICE IMPLICATIONS: Deontic rules are essential to navigating interpersonal relationships; errors detecting violations of deontic rules have been associated with multiple victimizations in adulthood. Future research on violence exposure, dissociation, and deontic reasoning in children may have important implications for intervention and prevention around interpersonal functioning and later interpersonal risk.

Publication Types:      Research Support, Non-U.S. Gov't

PMID: 18617265 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):685-702, x.

The traumatic impact of Hurricane Katrina on children in New Orleans.

Drury SS, Scheeringa MS, Zeanah CH.

Department of Psychiatry and Neurology, Tulane University School of Medicine, Health Science Center, 1440 Canal Street, TB 52, New Orleans, LA 70112, USA. sdrury@tulane.edu

This article reviews the traumatic impact of Hurricane Katrina on the children of New Orleans. After describing the events comprising the trauma, it reviews the historical context of hurricanes in New Orleans and the social and political challenges that affected the area's response. It then considers the consequences  of Hurricane Katrina in terms of disruption of services and governmental and nongovernmental responses to the psychologic needs created by the storm. The authors review preliminary studies about the affects of the hurricane on children and adolescents and conclude with a consideration of the lessons learned from both practice and policy perspectives.

PMID: 18558319 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):665-83, x.

The child asylum seeker: psychological and developmental impact of immigration detention.

Newman LK, Steel Z.

Perinatal and Infant Psychiatry, School of Medicine and Public Health Faculty of  Health, The University of Newcastle, Callaghan Campus, Locked Bag 1014, Wallsend, New South Wales 2308, Australia. louise.newman@newcastle.edu.au

Asylum-seeking children are one of the most vulnerable groups of displaced persons. The experience of being a detainee, with limited ways of communicating one's plight, shapes the expression of distress. Clinicians need to see the distress and symptoms of mental disorder as emerging in the context of the detention environment rather than within a traditional medical model. The use of  diagnostic labels without elaboration does not provide an adequate account of the child's difficulties. The clinician has an important role in bearing witness to the harm done to detainees as well as trying to prevent harm in whatever way possible.

Publication Types:      Case Reports

PMID: 18558318 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):641-64, x.

Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): from neurocognitive theory to field intervention.

Neuner F, Catani C, Ruf M, Schauer E, Schauer M, Elbert T.

Department of Psychology, University of Konstanz, Box D25, D-78457 Konstanz, Germany. frank.neuner@uni-konstanz.de

Many children in war-affected and refugee populations have experienced multiple traumatic experiences, and high rates of psychologic disorders, especially posttraumatic stress disorder (PTSD), are found. Intervention strategies require  pragmatic and effective approaches to treatment. This article describes the rationale for and the use of narrative exposure therapy in children (KidNET). KidNET is a short-term treatment for PTSD based on a neurocognitive theory of traumatic memory. Early treatment trials, including randomized controlled studies, show promising results for the treatment of children and adolescents who have PTSD living in war-affected countries and refugee communities.

Publication Types:      Review

PMID: 18558317 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):625-40, ix.

Acute interventions for refugee children and families.

Brymer MJ, Steinberg AM, Sornborger J, Layne CM, Pynoos RS.

National Center for Child Traumatic Stress, University of California, Los Angeles, 11150 West Olympic Boulevard, Suite 650, Los Angeles, CA 90064, USA. mbrymer@mednet.ucla.edu

This article describes the exposure of refugees, and particularly refugee children, to trauma, loss, and severe hardship in their countries of origin, while fleeing to their host countries, and after arrival in the host country. It  then discusses acute psychosocial interventions for traumatized children and families, in particular the "Psychological First Aid" and "Skills for Psychological Recovery" guidelines developed by the National Child Traumatic Stress Network and the National Center for Posttraumatic Stress Disorder. It concludes by discussing the need to establish an evidence base for the effectiveness of such interventions.

PMID: 18558316 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):585-604, ix.

Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth.

Murray LK, Cohen JA, Ellis BH, Mannarino A.

Boston University School of Public Health, Center for International Health and Development, 85 E. Concord Street, 5th Floor, Boston, MA 02118, USA. lkmurray@bu.edu

The diverse clinical presentation of refugee children and adolescents after their traumatic experiences requires a treatment model that can mitigate a number of internalizing and externalizing symptoms. Refugee populations also require interventions that can adjust to the wide-ranging experiences likely encountered  during preflight, flight, and resettlement. There is some evidence that immigration stressors or social stressors, such as discrimination, are associated with symptoms of posttraumatic stress disorder in refugee youth. Therefore refugee youth may benefit from multiple levels of services, ideally integrated. This article focuses on the mental and behavioral health component of services for refugee youth.

Publication Types:      Review

PMID: 18558314 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):569-84, viii.

Testimonials, narratives, stories, and drawings: child refugees as witnesses.

Lustig SL, Tennakoon L.

Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, Box 0984F, San Francisco, CA, 94143, USA. slustig@lppi.ucsf.edu

An estimated 80% of the world's war victims are women and children, a significant proportion of whom suffer from social and psychiatric sequelae of traumatic experiences. Various treatments for psychiatric symptoms related to trauma among  refugees have been studied. This article summarizes the literature on therapies involving the creation of stories, such as narrative therapy and testimonial therapies, and other storytelling techniques described on the World Wide Web in the absence of an academic literature. At this point, longer and larger studies of the efficacy of all these approaches are warranted.

Publication Types:      Review

PMID: 18558313 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):551-68, viii.

Addressing the mother-infant relationship in displaced communities.

Rezzoug D, Baubet T, Broder G, Taïeb O, Moro MR.

Department of Child and Adolescent Psychiatry (Bobigny, France), University Paris 13, 125 Rue de Stalingrad, 93000 Bobigny, France. dalila.rezzoug@avc.aphp.fr

Delivering appropriate care to refugee families requires complex care systems and models that take account of the social, cultural, and political dimensions as well as the psychologic dimension. Children born into these families are exposed  to consequences of their own past experiences and also may be subject to the transmission of the traumas experienced by their parents. This exposure can lead  to alterations in these children's individual creative resources. Early, tailored care should be provided for these families, so that the transmission of the trauma and its consequences can be managed or ameliorated.

Publication Types:      Review

PMID: 18558312 [PubMed - indexed for MEDLINE]

 

Child Adolesc Psychiatr Clin N Am. 2008 Jul;17(3):497-514, vii.

Political violence and development: an ecologic approach to children in war zones.

Boothby N.

Mailman School of Public Health, Columbia University, 60 Haven Avenue B-4, New York, NY 10032, USA. nb2101@columbia.edu

This article looks at the experiences of children in war from a psychosocial and  social ecologic perspective. In contrast to clinical approaches, it offers a conceptualization of how the impacts of political violence and war are socially mediated. It suggests that psychologic assistance to war-affected children often  occurs not through the provision of therapy by outsiders but via support from insiders.

PMID: 18558309 [PubMed - indexed for MEDLINE]

 

Clin Child Psychol Psychiatry. 2008 Jul;13(3):435-48.

Active multimodal psychotherapy in children and adolescents with suicidality: description, evaluation and clinical profile.

Högberg G, Hällström T.

Karolinska Institute, Stockholm, Sweden. gor.hogberg@gmail.com

The aim of this study was to describe and evaluate the clinical pattern of 14 youths with presenting suicidality, to describe an integrative treatment approach, and to estimate therapy effectiveness. Fourteen patients aged 10 to 18  years from a child and adolescent outpatient clinic in Stockholm were followed in a case series. The patients were treated with active multimodal psychotherapy. This consisted of mood charting by mood-maps, psycho-education, wellbeing practice and trauma resolution. Active techniques were psychodrama and body-mind  focused techniques including eye movement desensitization and reprocessing. The patients were assessed before treatment, immediately after treatment and at 22 months post treatment with the Global Assessment of Functioning Scale. The clinical pattern of the group was observed. After treatment there was a significant change towards normality in the Global Assessment of Functioning scale both immediately post-treatment and at 22 months. A clinical pattern, post  trauma suicidal reaction, was observed with a combination of suicidality, insomnia, bodily symptoms and disturbed mood regulation. We conclude that in the  post trauma reaction suicidality might be a presenting symptom in young people. Despite the shortcomings of a case series the results of this study suggest that  a mood-map-based multimodal treatment approach with active techniques might be of value in the treatment of children and youth with suicidality.

Publication Types:      Comparative Study

PMID: 18783125 [PubMed - indexed for MEDLINE]

 

Clin Psychol Rev. 2008 Jul;28(6):1009-20. Epub 2008 Mar 4.

The independent predictive value of peritraumatic dissociation for PTSD symptomatology after type I trauma: a systematic review of prospective studies.

van der Velden PG, Wittmann L.

Institute for Psychotrauma, Van Heemstraweg-west 5, 5301 PA Zaltbommel, The Netherlands. peter.vdvelden@ivp.nl

We conducted a systematic review of prospective studies examining the independent predictive value of peritraumatic dissociation (PD) for posttraumatic stress disorder (PTSD) symptomatology following single traumatic events. Insight into the independent predictive value may help to identify victims at risk for PTSD symptomatology. For this purpose a literature search was carried out using the online databases PsycINFO, Medline/Pubmed, and PILOTS. Studies were included if they were published in peer-reviewed journals (before 2007), focused on more or less single traumatic events (Type I trauma), assessed PD within 1 month, had follow-ups 3 months or later, and which controlled for mental health problems at  the time PD was assessed. The majority of the 17 identified studies showed no or  only weak indications of an independent predictive value of PD for PTSD symptomatology following type I traumas. Only 3 of the 6 studies with positive results reported a strong independent predictive value of PD. Although bivariately associated with PTSD symptomatology, there is no general consensus across prospective Type I trauma studies that PD qualifies as an important independent predictor of PTSD symptomatology. Results indicate that initial mental health problems, among other factors, are better predictors of PTSD symptomatology than PD.

Publication Types:      Review

PMID: 18406027 [PubMed - indexed for MEDLINE]

 

CNS Spectr. 2008 Jul;13(7):585-91.

The role of the glutamatergic system in posttraumatic stress disorder.

Nair J, Singh Ajit S.

Child and Youth Services, Burrell Behavioral Health, Springfield, Missouri, USA.

Antiglutamatergic agents, such as lamotrigine, have been used successfully for the treatment of posttraumatic stress disorder (PTSD). They could be potentially acting through the stabilization of the corticotropin-releasing factor (CRF) systems. Glutamate mediates CRF release in various brain regions involved in the pathophysiology of PTSD, antiglutamatergic agents could stabilize the CRF system  and, thereby, improve the symptom complex of PTSD (reexperiencing, hyperarousal,  and avoidance). The role of glutamate and CRF in PTSD and other anxiety disorders are still being elucidated. However, it is clear that the glutamatergic systems play a role in the pathophysiology of PTSD.

Publication Types:      Review

PMID: 18622363 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 Jul-Aug;49(4):413-9. Epub 2008 Mar 28.

The impairment of Presidents Pierce and Coolidge after traumatic bereavement.

Davidson JR, Connor KM.

Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, Durham, NC 22705, USA. david011@mc.duke.edu

The impact of bereavement in heads of government has been little studied. Two US  presidents lost their teenaged sons in a traumatic manner, leaving them profoundly affected as they struggled to serve in office. We describe the bereavements of Presidents Franklin Pierce and Calvin Coolidge, using biographical and source material. Pierce and Coolidge were adversely affected by  their bereavements, which almost certainly rendered them less effective in the discharge of their duties. The loss of their sons had a devastating effect on both men and deprived their presidential service of significant personal meaning. Lincoln's resilience in similar circumstances offers a contrasting perspective, however. We conclude that the psychiatric consequences of losing a child can adversely affect heads of government, may cause clinically significant distress,  altered behavior, and reduced ability to provide effective leadership.

Publication Types:      Biography     Historical Article

Personal Name as Subject:      Pierce F     Coolidge C

PMID: 18555064 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 Jul-Aug;49(4):393-8. Epub 2008 Apr 1.

Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder?

Nishi D, Matsuoka Y, Nakajima S, Noguchi H, Kim Y, Kanba S, Schnyder U.

Department of Psychiatry, National Disaster Medical Center, Tokyo 190-0014, Japan.

In longitudinal studies of traumatic stress, it is particularly important to examine the data for any differences between those who drop out and those who continue to participate, because reluctance to participate might reflect symptoms of avoidance frequently seen in posttraumatic stress disorder (PTSD). However, whether those who drop out are at high risk of PTSD remains unclear. Over a 25-month period, 188 consecutive patients with motor vehicle accident (MVA)-related injuries admitted emergently were enrolled and followed for 4 to 6  weeks. Baseline characteristics were compared between subjects who did and did not participate in the follow-up study. At 4 to 6 weeks, 66 (35.1%) of the participants had dropped out. Bivariate analyses revealed that those who dropped  out were likely to be men, alcohol drinkers, smokers, and unconscious just after  MVA and to have fewer years of education, less severe injuries, less posttraumatic symptoms, and lower cooperativeness as assessed by the Temperament  and Character Inventory. Logistic regression analysis revealed that male sex, unconsciousness during MVA, low cooperativeness, and less severe injuries were significant predictors of dropout. The literature says that male sex and unconsciousness just after MVA might be protective factors against MVA-related PTSD, whereas low cooperativeness is a risk factor for general mental problems. To summarize, it is expected that those who drop from the follow-up are unlikely  to have MVA-related PTSD, but might have mental problems independent of injury.

PMID: 18555061 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 Jul-Aug;49(4):330-4. Epub 2008 Mar 19.

The prevalence and correlates of trauma-related symptoms in schizophrenia spectrum disorder.

Lysaker PH, Larocco VA.

Roudebush Veterans Affairs Medical Center, Day Hospital 116H, Roudebush VA Medical Center, Indianapolis, IN 46202, USA. plysaker@iupui.edu

Research has suggested that many with schizophrenia have been exposed to significant trauma, both after and before the onset of their illness. Less clear  is how commonly significant levels of trauma symptoms are found in schizophrenia, how often they co-occur, and what their relationship is with positive and negative symptoms. To examine these issues, we concurrently assessed trauma history, trauma symptoms using the Trauma Symptom Inventory, and symptoms using the Positive and Negative Syndrome Scale. Participants were 68 individuals with schizophrenia spectrum disorders who provided reliable reports of at least one traumatic event from an original sample of 81 individuals. Results revealed that  two thirds of participants reported clinically significant trauma symptoms that included at least intrusive experiences, defensive avoidance, or dissociation. Greater levels of depression and disturbance of volition were significantly correlated with greater levels of anxious arousal, intrusive experiences, defensive avoidance, dissociation, and total number of significantly elevated trauma scales. Delusions were correlated with intrusive experiences, dissociation, and number of significantly elevated trauma scales, whereas hallucinations were correlated with irritability and total number of significantly elevated trauma scales. Results suggest that trauma symptoms may be commonly experienced in schizophrenia and linked with the phenomenology of the disorder.

PMID: 18555051 [PubMed - indexed for MEDLINE]

 

Compr Psychiatry. 2008 Jul-Aug;49(4):319-20. Epub 2008 Mar 19.

Revisiting the Institute of Medicine report on the validity of posttraumatic stress disorder.

Spitzer RL, Rosen GM, Lilienfeld SO.

Publication Types:      Editorial

PMID: 18555049 [PubMed - indexed for MEDLINE]

 

Crit Care Med. 2008 Jul;36(7 Suppl):S284-92.

Critical care in the austere environment: providing exceptional care in unusual places.

Venticinque SG, Grathwohl KW.

Department of Anesthesiology (SGV), University of Texas Health Science Center, San Antonio, TX, USA. steven.venticinque@va.gov

BACKGROUND: War and other disasters are inexorably linked to illness and injury.  As a consequence of this, healthcare providers will be challenged to provide advanced physiological support to preserve human life. Given the mobility and modularity of modern medical systems, the ability to provide critical care outside of the confines of traditional hospitals under such circumstances has become not only a reality and periodic necessity, but an expectation. Austerity amplifies the complexity of providing high-level critical care, because resources are frequently limited, providers are asked to fill unexpected roles determined by necessity, security may be threatened, and the population at risk and their afflictions can be highly diverse. DISCUSSION: Our current deployed military medical experience and a review of published literature pertaining to civilian medical disaster response efforts support these stated challenges. The fundamentals of successful critical care practice in unusual settings include proper planning with an emphasis on attention to detail, the careful management of all resources, using the proper equipment, leveraging aeromedical evacuation assets, and employing the right people with the right skills. SUMMARY: Adherence  to sound, evidence-based, routine practice, within bounds of the circumstances, must underscore everything.

Publication Types:      Review

PMID: 18594254 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2008 Jul;21(4):370-8.

Use of mental health services among disaster survivors.

Rodriguez JJ, Kohn R.

Mental Health, Substance Abuse and Rehabilitation, Technology and Health Services Delivery, Pan American Health Organization, Washington, DC 20037, USA. rodrigjo@paho.org

PURPOSE OF REVIEW: A sizable proportion of individuals following a disaster develop mental health problems. The consequences of these disorders can be long lasting. Only recently has research focused on mental health service delivery following disasters. This review examines the rates, predictors, and barriers to  mental health service utilization following a disaster. RECENT FINDINGS: Most of  the data on mental health service delivery come from three sources: a fireworks disaster in The Netherlands, the September 11, 2001, attack on New York City, and hurricane Katrina. Most survivors of disasters are reluctant to utilize mental health services and face barriers to accessing care. Even among disaster victims  who are severely mentally ill, only a minority receive treatment. Among those who do receive assistance, more than half drop out shortly thereafter. Mental health  service utilization following a disaster is influenced by a set of predisposing characteristics, enabling resources, and perceived need. The model for mental healthcare delivery following a disaster that has gained acceptance is Psychological First Aid. SUMMARY: Research is evolving on mental health service utilization. It is limited however to developed countries, although most disasters occur in developing countries. More research is needed, particularly among populations with scarce resources.

Publication Types:      Review

PMID: 18520742 [PubMed - indexed for MEDLINE]

 

Curr Opin Psychiatry. 2008 Jul;21(4):338-44.

Children, resilience and disasters: recent evidence that should influence a model of psychosocial care.

Williams R, Alexander DA, Bolsover D, Bakke FK.

University of Glamorgan, Pontypridd, Wales, UK. rjwwilli@glam.ac.uk

PURPOSE OF REVIEW: This paper draws on articles and chapters published mainly in  2006 and 2007 to identify implications for designing sustainable programmes of psychosocial care for children and young people who are affected by disasters and terrorism. RECENT FINDINGS: Recent research confirms previous knowledge that most children and young people are resilient, but also very vulnerable to the psychosocial effects of disasters. Most children are distressed in the immediate  aftermath when they gain their sense of safety from adults, predictable routines  and consistent support systems. Others may develop serious mental disorders though post-traumatic mental disorders may not develop until weeks, months or years later. Research instruments may be sensitive to cultural variability; simply translating measures into other languages is insufficient. SUMMARY: International experience of different types of disaster and terrorist incidents suggests that the broad principles of good service design include integrating responses to the psychosocial needs of children and adolescents into general disaster preparedness and recovery plans; working with families rather than individual children to address their needs; identifying professionals who specialize in responding to disasters and are skilled in working with children prior to events; and focusing resources on increasing the capabilities of staff of community facilities to recognize and respond to children's common reactions to trauma and provide assistance.

Publication Types:      Review

PMID: 18520737 [PubMed - indexed for MEDLINE]

 

Epidemiol Infect. 2008 Jul;136(7):997-1007. Epub 2007 Jul 30.

Understanding, compliance and psychological impact of the SARS quarantine experience.

Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R.

Clinical Development, Sanofi Pasteur, Connaught Campus, Toronto, ON, Canada. donna.reynolds@sanofipasteur.com

This study examines a cohort of persons quarantined during the 2003 SARS outbreak in Canada and describes their understanding of, difficulties and compliance with, and the psychological impact of the quarantine experience. A mailed questionnaire was administered to 1912 eligible adults and included the Impact of Events Scale  - Revised (IES-R) to assess symptoms of post-traumatic stress disorder (PTSD). Self-reported compliance with all required quarantine measures was low (15.8+/-2.3%), although significantly higher when the rationale for quarantine was understood (P=0.018). Health-care workers (HCW) experienced greater psychological distress, including symptoms of PTSD (P<0.001). Increasing perceived difficulty with compliance, HCW, longer quarantine and compliance with  quarantine requirements were significant contributors to higher IES-R scores. The low compliance with quarantine requirements introduces concerns about the effectiveness of quarantine as a public health measure. Improvements in compliance and reduced psychological distress may be possible by minimizing duration, revising requirements, and providing enhanced education and support.

PMID: 17662167 [PubMed - indexed for MEDLINE]

 

Gen Hosp Psychiatry. 2008 Jul-Aug;30(4):349-55.

Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population.

Mewes R, Rief W, Brähler E, Martin A, Glaesmer H.

Department of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany. mewesr@staff.uni-marburg.de

OBJECTIVE: Somatization is related to elevated health care utilization (HCU) and  high health care costs. However, it is unclear whether HCU in somatizers and nonsomatizers in the general population is determined by existing symptoms or by  lower thresholds for doctor visits. METHOD: A representative sample of the German general population (N=2510) was screened for psychopathology and HCU in the prior 12 months. The sample was subdivided into somatizers (n=712) and controls (n=1796), using the Patient Health Questionnaire (PHQ-15). A general tendency to  visit doctors even for minor reasons was assessed. Demographic and psychopathological variables were additionally entered into regression analyses to predict HCU for the whole investigated sample and the two subsamples. RESULTS: Higher somatization, unemployment or retirement, a lower decision threshold for doctor visits and higher posttraumatic symptomatology were consistent and unique  positive predictors of HCU in the prior 12 months. CONCLUSION: Not only symptoms  per se but also a lower decision threshold for doctor visits contribute to increased HCU. Psychopathological and demographic variables can further predict HCU in somatizing persons and controls. Although somatization and reduced thresholds for doctor visits are associated, they have to be distinguished from each other and contribute independently to increased costs.

Publication Types:      Comparative Study     Research Support, Non-U.S. Gov't

PMID: 18585539 [PubMed - indexed for MEDLINE]