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Biomedical subjects

R K Pitman

Publications and source records attributed to R K Pitman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Psychophysiological alterations in post-traumatic stress disorder.

Psychophysiological research in trauma-exposed populations has provided objective data supporting the validity of the post-traumatic stress disorder (PTSD) diagnostic concept. Consistent with a conditioning model, PTSD patients show specific increased peripheral physiological responding to audio-visually and imaginally presented stimuli symbolizing or resembling the etiologic traumatic event. PTSD patients respond to startling stimuli with larger autonomic and electromyographic responses, especially under threat conditions. Electroencephalographic event-related potential (ERP) response abnormalities in PTSD include reduced P2 amplitude at high stimulus intensities, impaired P1 habituation, and attenuated P3 amplitude to target auditory stimuli. However, larger P3 and N1 amplitude responses and shorter P3 and N1 latencies have been reported in PTSD subjects in response to trauma-related stimuli. These ERP findings suggest sensory, cognitive, and affective processing abnormalities in PTSD. Polysomnographic sleep studies have revealed increased awakenings, reduced sleep time, and increased motor activity, or in some cases, paradoxical deepening of sleep. There is also evidence for increased phasic eye movement activity during rapid eye movement (REM) sleep and disrupted REM continuity in PTSD. Psychophysiological studies are offering valuable insights into the pathophysiology of this important neuropsychiatric condition.

Electroencephalography↗
PubMed1998

Predictors of cortisol and 3-methoxy-4-hydroxyphenylglycol responses in the acute aftermath of rape.

BACKGROUND: Prospective studies of trauma survivors can provide information about the relationship between rape characteristics and the development of subsequent symptoms. METHODS: The present study examined the relationship of prior assault, rape severity, posttraumatic stress disorder (PTSD) symptoms following rape, and subsequent PTSD diagnosis, to the acute cortisol and 3-methoxy-4-hydroxyphenylglycol (MHPG) response to this traumatic event in 20 women. RESULTS: Women with a history of prior physical or sexual assault showed a significantly attenuated cortisol response to the acute stress of rape compared to women without such a history. MHPG appeared to be associated with injury-related rape characteristics, and symptoms of active avoidance, but not prior history. PTSD status at the 3-month follow-up was predicted by both a prior history of assault and high injury rape, but was not directly predicted by either cortisol or MHPG levels. MHPG and cortisol were not correlated in the sample as a whole, but were correlated among individuals who did not subsequently develop PTSD (p = .04) CONCLUSIONS: The results suggest that different neuroendocrine systems may mediate different components of the response to traumatic stress.

Adolescent↗
PubMed1998

A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.

BACKGROUND: Physiological arousal during traumatic events may trigger the neurobiological processes that lead to posttraumatic stress disorder (PTSD). This study prospectively examined the relationship between heart rate and blood pressure recorded immediately following a traumatic event and the subsequent development of PTSD. METHODS: Eighty-six trauma survivors who presented at the emergency department of a general hospital were followed up for 4 months. Heart rate and blood pressure were recorded on arrival at the emergency department. Heart rate, anxiety, depression, and PTSD symptoms were assessed 1 week, 1 month, and 4 months later. The clinician-administered PTSD scale defined PTSD status at 4 months. RESULTS: twenty subjects (23%) met PTSD diagnostic criteria at the 4-month assessment (PTSD group), and 66 (77%) did not (non-PTSD group). Subjects who developed PTSD had higher heart rates at the emergency department (95.5+/-13.9 vs 83.3+/-10.9 beats per minute, t=4.4, P<.001) and 1 week later (77.8+/-11.9 vs 72.0+/-9.5 beats per minute, t=2.25, P<.03), but not after 1 and 4 months. The groups did not differ in initial blood pressure measurement. Repeated-measures analysis of variance (ANOVA) for heart rate showed a significant group effect (P<.02), time effect (P<.001), and group x time interaction (P<.001). The time effect and group x time interaction remained significant when adjusted for sex, age, trauma severity, immediate response, and dissociation during the traumatic event. CONCLUSION: Elevated heart rate shortly after trauma is associated with the later development of PTSD.

Adult↗
PubMed1998

Heart rate and blood pressure resting levels and responses to generic stressors in Vietnam veterans with posttraumatic stress disorder.

Resting heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured on 3 successive mornings in the homes of drug-free Vietnam combat veterans, classified on the basis of DSM-III-R criteria into current posttraumatic stress disorder (PTSD; n = 20) or non-PTSD (n = 15). Responses to three generic stressor challenges (orthostatic, mental arithmetic, and cold pressor) were also measured. In the orthostatic stressor condition, DBP increased over time in the non-PTSD, but not in the PTSD, veterans, suggesting a paradoxically reduced autonomic response in PTSD. There were no other significant group differences in resting levels or responses to any of the challenges for any measure.

Adult↗
PubMed1998

Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder.

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information.

Adult↗
PubMed1998

Lower precombat intelligence is a risk factor for posttraumatic stress disorder.

The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests.

Adult↗
PubMed1998

Psychophysiologic assessment of women with posttraumatic stress disorder resulting from childhood sexual abuse.

Heart rate, skin conductance, and left lateral frontalis and corrugator facial electromyogram responses were measured during script-driven imagery of personal childhood sexual abuse (CSA) and other life experiences among women with and without Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., American Psychiatric Association, 1987)--diagnosed posttraumatic stress disorder (PTSD) resulting from CSA. Women with current PTSD (n = 29) showed larger physiologic responses than those who never had PTSD (n = 18) during personal sexual abuse imagery but not during imagery of stressful, nonabuse-related life experiences. Responses of individuals with lifetime, but not current, PTSD (n = 24) fell between the other groups. An a priori discriminant function, derived from physiologic responses of previously studied individuals, correctly classified 66% of women with current PTSD and 78% of women who never had PTSD.

Adult↗
PubMed1998

Prospective study of posttraumatic stress disorder and depression following trauma.

OBJECTIVE: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) and major depression following traumatic events. METHOD: The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview for DSM-III-R and the Clinician-Administered PTSD Scale) were administered 1 week, 1 month, and 4 months after the traumatic event. Heart rate was assessed upon arrival at the emergency room for subjects with physical injury. Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year. RESULTS: Major depression and PTSD occurred early on after trauma; patients with these diagnoses had similar recovery rates: 63 survivors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met criteria for major depression at 1 month, and 30 (14.2%) had major depression at 4 months. Comorbid depression occurred in 44.5% of PTSD patients at 1 month and in 43.2% at 4 months. Comorbidity was associated with greater symptom severity and lower levels of functioning. Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms, exaggerated startle, and peritraumatic dissociation than those with major depression. Prior depression was associated with a higher prevalence of major depression and with more reported symptoms. CONCLUSIONS: Major depression and PTSD are independent sequelae of traumatic events, have similar prognoses, and interact to increase distress and dysfunction. Both should be targeted by early treatment interventions and by neurobiological research.

Accidents, Home↗
PubMed1997

Auditory event-related potentials to tone stimuli in combat-related posttraumatic stress disorder.

This study attempted to replicate findings of abnormal auditory event-related potentials (ERPs) in posttraumatic stress disorder (PTSD) in a sample of Vietnam combat veterans. Veterans with combat-related PTSD, divided into unmedicated (unmed-PTSD, n = 12) and medicated (med-PTSD, n = 22) groups, and veterans without PTSD (non-PTSD, n = 10) completed a three-tone "oddball" target detection task while ERPs were measured. Individuals with comorbid panic disorder (PD) were excluded from the primary analyses. Parietal P3 amplitude to the target tone was significantly smaller in unmed-PTSD compared to med-PTSD and non-PTSD groups. These differences did not remain significant when an adjustment was made for level of depression. Parietal P3 amplitude was also negatively correlated with state anxiety. Secondary analyses within the unmed-PTSD group indicated that participants with comorbid PD (n = 3) had the largest parietal P3 amplitudes to target tones. Results are consistent with attentional or concentration deficits in PTSD and highlight the importance of considering comorbid diagnoses. The absence of ERP differences between med-PTSD and non-PTSD participants suggests that psychotropic medication may normalize these deficits.

Acoustic Stimulation↗
PubMed1997

Physiologic responses to non-startling tones in Vietnam veterans with post-traumatic stress disorder.

We evaluated eyeblink and autonomic reactivity to non-startling acoustic stimuli in a convenience sample of Vietnam combat veterans. Twenty veterans with current PTSD and 19 veterans who never had PTSD were exposed to 15 consecutive 86-dB, 500-ms, 100-Hz tones with 40-ms rise and fall times, while orbicularis oculi electromyogram (EMG), skin conductance (SC) and heart rate (HR) responses were measured. PTSD subjects had higher resting HR levels and produced larger averaged HR responses across the 15 tone presentations compared to non-PTSD subjects. Skin conductance and EMG responses did not differ between the groups. Results suggest that previous findings of larger HR responses to loud tones in PTSD extend to lower intensity, non-startling stimuli, but that the magnitude of the HR response appears smaller to the lower intensity stimuli. Previously observed differences in the magnitude of the eyeblink response and rate of decline of SC responses in PTSD to high intensity stimuli appear to disappear when using non-startling stimuli.

Acoustic Stimulation↗
PubMed1997

Neurological status of combat veterans and adult survivors of sexual abuse PTSD.

We found higher levels of positive soft neurological signs in PTSD participants than in participants who also experienced similar trauma but did not develop PTSD. This finding was replicated in two samples, that is, Vietnam combat veterans and adult female survivors of childhood sexual abuse, despite differences in gender, age, nature of trauma, and period of life when the trauma occurred. Past developmental history of participants and a substance abuse history of first-degree relatives also differentiated PTSD from non-PTSD groups in both combat and sexual abuse samples. Evidence for neurological impairment and compromised developmental history raises the possibility of pretrauma impairment as a risk factor for the development of PTSD.

Adult↗
PubMed1997

Auditory startle responses in help-seeking trauma survivors.

Studies of the acoustic startle reflex in post-traumatic stress disorder (PTSD) yielded controversial results, whilst PTSD patients consistently report exaggerated startle. Addressing methodological difficulties of previous studies, the authors investigated the eyeblink, skin conductance and heart rate responses to 15 consecutive 95-dB, 500-ms, 1000-Hz sudden tones in 58 consecutive referrals of unmedicated help-seeking trauma survivors (30 with PTSD and 28 without PTSD). PTSD patients had higher average eyeblink and skin conductance responses to the tones. Differences between reports of exaggerated startle in PTSD and negative experimental findings may be explained by specific experimental conditions, such as reduced environmental input, and by concurrent use of medication.

Adult↗
PubMed1997

Physiologic responses to loud tones in Israeli veterans of the 1973 Yom Kippur War.

Eyeblink and autonomic components of the acoustic startle response were evaluated in a community sample of Israeli veterans of the Yom Kippur war. Individuals were solicited by mail and telephone to participate in the study; they were not seeking treatment or compensation. Nineteen Israeli veterans with current posttraumatic stress disorder (PTSD) and 74 veterans without PTSD were exposed to 15 consecutive 95-dB, 500-msec, 1000-Hz tones with 0-msec rise and fall times, while orbicularis oculi electromyogram, skin conductance, and heart rate responses were measured. Individuals with PTSD produced larger averaged heart rate responses, and a slower decline in skin conductance responses, across the 15 tone presentations compared to non-PTSD subjects. There was no group difference in the magnitude of the averaged electromyogram response. Results of this study replicate previous findings of increased autonomic responses to loud tone stimuli in this disorder.

Acoustic Stimulation↗