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Biomedical subjects

S M Southwick

Publications and source records attributed to S M Southwick.

At least 73 records · Page 4Linked to original sources
PubMed1994

Depressive features in Holocaust survivors with post-traumatic stress disorder.

The present study was designed to explore several aspects of depressive phenomenology, including current symptoms, dependency (anaclitic) and self-criticism (introjective) themes, and issues of self-efficacy, in Holocaust survivors with and without posttraumatic stress disorder (PTSD). The Depressive Subscale of the Symptom Checklist-90 (SCL-90) and the Depressive Experiences Questionnaire (DEQ) were administered to 23 Holocaust survivors and 18 demographically-matched controls. Holocaust survivors with PTSD scored significantly higher on the SCL-90 depression scale, and portrayed more self-criticism on the DEQ, than Holocaust survivors without PTSD and demographically-matched non-exposed subjects. The data suggest that depressive symptoms in individuals who have been severely traumatized are more severe when associated with a concurrent PTSD. Furthermore, groups suffering different types of trauma may show similarities in psychological dimensions of depression.

Aged↗
PubMed1994

Psychobiologic research in post-traumatic stress disorder.

PTSD can be a chronic, devastating disorder for which treatment is only partially effective. For some, this disorder progressively worsens over time and appears to affect nearly every aspect of life, including work, interpersonal relationships, physical health, and view of self. Although generally understood as a psychological disorder, PTSD also may be viewed from a biologic perspective. There is now accumulating evidence to suggest that severe psychological trauma can cause alterations in the organism's neurobiologic response to stress even years after the original insult. Long-standing alterations in the biologic response to stress may contribute to a number of complaints commonly expressed by patients with PTSD. For example, increased sensitivity and sensitization of the noradrenergic system may leave the individual in a hyperaroused, vigilant, sleep-deprived, and, at times, explosive state that worsens over time. Being irritable and on edge makes it difficult to interact with family members, friends, coworkers, and employers. To quiet these symptoms of hyperarousal, PTSD patients often withdraw and use substances, particularly central nervous system depressants, that suppress peripheral and central catecholamine function. Alterations in other neurobiologic systems may further contribute to multiple symptoms, such as intrusive memories, dissociation phenomena, and even numbing. Characterization of the biologic underpinnings of PTSD relies to a large degree on available neurobiologic technology. Much of what has been discussed in this article has grown out of advances in physiologic, hormone, and receptor assay methodology. With further advances in neurobiologic technology, in areas such as brain imaging, it soon will be possible to better delineate acute and long-term stress-induced changes in central and peripheral nervous system functioning. Undoubtedly a far richer, more complex understanding of neurobiologic responses and alterations will emerge in the near future. It is believed that an improved neurobiologic understanding will facilitate the development of more specific, effective treatments for individuals who have been severely traumatized.

Arousal↗
PubMed1993

Abnormal noradrenergic function in posttraumatic stress disorder.

To evaluate possible abnormal noradrenergic neuronal regulation in patients with posttraumatic stress disorder (PTSD), the behavioral, biochemical, and cardiovascular effects of intravenous yohimbine hydrochloride (0.4 mg/kg) were determined in 18 healthy male subjects and 20 male patients with PTSD. A subgroup of patients with PTSD were observed to experience yohimbine-induced panic attacks (70% [14/20]) and flashbacks (40% [8/20]), and they had larger yohimbine-induced increases in plasma 3-methoxy-4-hydroxyphenylglycol levels, sitting systolic blood pressure, and heart rate than those in healthy subjects. In addition, in the patients with PTSD, yohimbine induced significant increases in core PTSD symptoms, such as intrusive traumatic thoughts, emotional numbing, and grief. These data were consistent with a large body of preclinical data that indicated that uncontrollable stress produces substantial increases in noradrenergic neuronal function. We discuss the implications of these abnormalities in noradrenergic functional regulation in relation to the long-term neurobiological sequelae of severe uncontrollable stress and the pathophysiological relationship between PTSD and other anxiety disorders, such as panic disorder.

Adult↗
PubMed1993

Yohimbine-facilitated acoustic startle reflex in humans.

Preclinical studies have suggested the acoustic startle reflex (ASR) may be a useful animal model to investigate the neurochemical basis of anxiety and fear states. This work has revealed that the anxiogenic alpha-2 receptor antagonist, yohimbine, increases the amplitude of the ASR in laboratory animals. The present investigation evaluated the effects of yohimbine on the ASR in healthy subjects. Seven healthy subjects received IV yohimbine (0.4 mg/kg) or saline placebo on two separate days in a randomized double blind placebo control design. A trial of 2 tone frequencies with varied intensity (90, 96, 102, 108, 114 dB) white noise, instantaneous rise time, was delivered binaurally through headphones. Tones were delivered every 25-60 sec, for a 30 ms duration. Startle testing was done 80 minutes post infusion and lasted 15-20 minutes. Sign rank testing indicated yohimbine caused an overall increase in startle amplitude, as well as significant augmentation of startle amplitude at 96, 102, 108, 114 decibels but not at the 90 dB intensity. Sign rank tests indicated a significant reduction of startle latency by yohimbine at only the 96 dB intensity. Significant correlations were observed between startle and peak anxiety, startle and plasma MHPG, peak anxiety and plasma MHPG. This study demonstrates in healty human subjects an excitatory effect of yohimbine on the magnitude of the ASR and a decrease in its latency. In the context of the key role of this reflex in the alarm response, this finding adds to the array of documented behavioral, biochemical and cardiovascular effects of yohimbine in humans which support the relationship between increased noradrenergic function and anxiety states.

Acoustic Stimulation↗
PubMed1993

Effects of cocaine on hospital course in schizophrenia.

The authors selected at random every fourth inpatient chart (N = 79) of patients enrolled in a schizophrenia clinic for analysis of substance use patterns and psychiatric hospitalizations. Patients were divided into three groups based on operationally defined lifetime drug use histories: a) cocaine and other substance use; b) substance use without cocaine; and c) no substance use. All available hospital records were examined for presenting symptoms and psychosocial functioning at admission, neuroleptic dosing, and hospital management. Cocaine-using schizophrenics had significantly higher hospitalization rates than other substance-using or non-using patients. No differences were found in hospital presenting symptoms among any cohort. However, the cocaine-using schizophrenic patients demonstrated significantly higher rates of suicidal ideation after cocaine use compared with their own non-cocaine-associated hospitalizations or the other groups. The cocaine group also received higher neuroleptic doses by the fifth and sixth weeks of hospitalization compared with their own non-cocaine-associated hospitalizations and with the other groups. This suggests that cocaine use in schizophrenia is associated with poorer illness course and increased hospitalization, including higher rates of suicidal ideation and greater neuroleptic dose.

Adult↗
PubMed1993

Enhanced suppression of cortisol following dexamethasone administration in posttraumatic stress disorder.

OBJECTIVE: The authors investigated the possibility of enhanced negative feedback sensitivity of the hypothalamic-pituitary-adrenal (HPA) axis in posttraumatic stress disorder (PTSD) by using a low dose of dexamethasone. METHOD: Baseline blood samples were obtained at 8:00 a.m., and 0.5 mg of dexamethasone was administered to 21 male patients with PTSD and 12 normal age-comparable men at 11:00 p.m. Cortisol and dexamethasone levels were measured 9 and 17 hours after dexamethasone administration. RESULTS: After correction for differences in dexamethasone levels, the PTSD patients showed greater suppression of cortisol in response to dexamethasone than did the normal subjects. This was true even in patients meeting concurrent diagnostic criteria for major depression. CONCLUSIONS: The data support earlier studies showing that HPA abnormalities in PTSD are different from those seen in depression and suggest that the low-dose dexamethasone suppression test may be a potentially useful tool for differentiating the two syndromes and further exploring differences in their pathophysiology.

Adult↗
PubMed1993

Trauma-related symptoms in veterans of Operation Desert Storm: a preliminary report.

OBJECTIVE: This study was designed to examine prospectively the development of trauma-related symptoms over time in two reserve units of Operation Desert Storm veterans. METHOD: One month and 6 months after returning from the Persian Gulf area, 84 National Guard reservists, from one medical unit and one military police unit, completed questionnaires on their exposure to combat and to specific stressors and rated the severity of their symptoms of posttraumatic stress disorder (PTSD) on two different scales. Differences in symptom severity at the two time points were analyzed. RESULTS: Scores on the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder, but not severity ratings on a symptom scale based on DSM-III-R PTSD criteria, increased significantly from the 1-month to the 6-month rating time. At both time points, symptoms of hyperarousal were more severe than symptoms of reexperiencing or avoiding trauma-related events. Level of exposure to combat, as reflected by the Combat Exposure Scale and a Desert Storm trauma questionnaire, was significantly associated with score on the Mississippi PTSD scale. There were no significant differences in combat exposure and PTSD symptoms between the male and female subjects or between the medical and police units. CONCLUSIONS: These preliminary findings suggest that a high percentage of Desert Storm veterans experienced some trauma-related symptoms after returning to the United States. Six months after the war, these symptoms, although relatively mild, had not significantly improved in this study group as a whole. For research on longer-term outcome, follow-up of these 84 reservists continues.

Combat Disorders↗
PubMed1993

Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans.

OBJECTIVE: Early trauma in the form of childhood physical or sexual abuse has been associated with adult psychopathology. The purpose of this study was to compare rates of childhood abuse in Vietnam veterans with and without combat-related posttraumatic stress disorder (PTSD). METHOD: Premilitary stressful and traumatic events including childhood abuse and other potential predisposing factors were assessed in Vietnam combat veterans who sought treatment for PTSD (N = 38) and Vietnam combat veterans without PTSD who sought treatment for medical disorders (N = 28). Stressful and traumatic events including childhood physical abuse were assessed with the Checklist of Stressful and Traumatic Events and a clinician-administered interview for the assessment of childhood abuse. Level of combat exposure was measured with the Combat Exposure Scale. RESULTS: Vietnam veterans with PTSD had higher rates of childhood physical abuse than Vietnam veterans without PTSD (26% versus 7%). The association between childhood abuse and PTSD persisted after controlling for the difference in level of combat exposure between the two groups. Patients with PTSD also had a significantly higher rate of total traumatic events before joining the military than patients without PTSD (mean = 4.6, SD = 4.5, versus mean = 2.8, SD = 2.9). CONCLUSIONS: These findings suggest that patients seeking treatment for combat-related PTSD have higher rates of childhood physical abuse than combat veterans without PTSD. Childhood physical abuse may be an antecedent to the development of combat-related PTSD in Vietnam combat veterans.

Causality↗
PubMed1993

Use of the Structured Clinical Interview for DSM-IV Dissociative Disorders for systematic assessment of dissociative symptoms in posttraumatic stress disorder.

OBJECTIVE: This study compared dissociative symptom areas in Vietnam combat veterans with posttraumatic stress disorder (PTSD) and in Vietnam combat veterans without PTSD. METHOD: The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) was used to compare dissociative symptoms in 40 Vietnam combat veterans with PTSD and 15 Vietnam combat veterans without PTSD. The SCID-D yields a total score and scores in five symptom areas: amnesia, depersonalization, derealization, identity confusion, and identity alteration. RESULTS: The PTSD patients had more severe dissociative symptoms in each of the five symptom areas of the SCID-D and higher total symptom scores. Amnesia was the symptom area with the greatest difference in scores between the PTSD patients (mean = 3.68, SD = 0.73) and the non-PTSD veterans (mean = 1.06, SD = 0.26). CONCLUSIONS: The finding of higher levels of dissociative symptoms in Vietnam combat veterans with PTSD than in Vietnam veterans without PTSD is consistent with a level of dissociative symptoms in PTSD similar to that in dissociative disorders.

Adult↗
PubMed1993

Deficits in short-term memory in posttraumatic stress disorder.

OBJECTIVE: The purpose of this study was to compare the memory function of patients with posttraumatic stress disorder (PTSD) to that of matched comparison subjects. METHOD: Vietnam veterans with combat-related PTSD (N = 26) were compared to physically healthy comparison subjects (N = 15) matched for age, race, sex, years of education, handedness, socioeconomic status, and alcohol abuse. Memory and intelligence were assessed with a battery of neuropsychological tests, including the Russell revision of the Wechsler Memory Scale, the Selective Reminding Test, and subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). RESULTS: The PTSD patients scored significantly lower than the comparison subjects on the Wechsler Memory Scale logical memory measures for immediate recall (mean = 11.6, SD = 3.3 versus mean = 20.9, SD = 6.6) and delayed recall (mean = 8.0, SD = 3.3 versus mean = 17.8, SD = 6.4). The PTSD patients also scored significantly lower on the total recall, long-term storage, long-term retrieval, and delayed recall measures for the verbal component of the Selective Reminding Test and on the recall, long-term storage, long-term retrieval, and continuous long-term retrieval measures for the visual component of the Selective Reminding Test. There was no significant difference between the PTSD patients and comparison subjects in prorated full-scale IQ as measured by the WAIS-R. CONCLUSIONS: Patients with PTSD may have deficits in short-term memory. Counseling and rehabilitation that address these deficits may be of value for PTSD patients.

Humans↗
PubMed1993

Personality disorders in treatment-seeking combat veterans with posttraumatic stress disorder.

OBJECTIVE: Many patients with posttraumatic stress disorder (PTSD) appear to have co-occurring symptoms of character pathology; however, to date there have been no empirical studies of comorbid clinician-rated axis II personality disorders in war veterans with chronic PTSD. The authors' objective was to assess DSM-III-R personality disorders in treatment-seeking combat veterans with PTSD. METHOD: They used the Personality Disorder Examination, a standardized diagnostic interview for DSM-III-R axis II disorders, to assess DSM-III-R personality disorders in 34 patients with PTSD; 18 of the subjects were inpatients and 16 were outpatients. RESULTS: A high rate of character pathology was observed in both inpatient and outpatient groups. The most frequent disorders for which criteria were met were borderline, obsessive-compulsive, avoidant, and paranoid personality disorders. Inpatients had a higher rate of nearly every personality disorder than did outpatients. Inpatients were significantly more likely to meet diagnostic criteria for paranoid, schizotypal, avoidant, and self-defeating personality disorders. CONCLUSIONS: War-related PTSD in treatment-seeking Vietnam veterans is often accompanied by diffuse, debilitating, and enduring impairments in character. Subtyping patients with PTSD on the basis of specific axis II profiles may aid in the selection of more specific and effective treatments.

Ambulatory Care↗
PubMed1993

The interaction between pharmacotherapy and psychotherapy in the treatment of posttraumatic stress disorder.

For patients with PTSD, the effective initiation of additional therapeutic modalities to ongoing individual psychotherapy is challenging. When pharmacologic agents are added, the therapist must carefully consider and monitor the impact of medications on PTSD core symptoms and on adjunctive symptoms such as depression. Further considerations include issues of countertransference, the possible symbolic meaning of medications for both the patient and the therapist, and the appropriate staging of medications. When nonphysician treaters work together with a medical back-up, both parties should frequently communicate with one another in order to avoid unnecessary treatment distortions and disruptions.

Combined Modality Therapy↗
PubMed1993

Pharmacotherapy for recently evacuated military casualties.

In late 1990 during the massive Operation Desert Shield/Storm (ODS) deployment of United Nations troops, the VA/DoD Joint Contingency Plan was activated. Worst case scenarios projected tens of thousands of medical evacuees from the Persian Gulf and predicted that U.S. Military Communication Zone and CONUS bed capacity would quickly be saturated. As a result, a massive educational program was rapidly implemented to prepare 80 VA hospitals to receive ODS personnel within 1-3 weeks of their evacuation from battalion aid stations or other front-echelon medical facilities. This article was written as part of this educational effort. Noting that there were no published articles on pharmacotherapy for recently evacuated military casualties, the authors wrote the present manuscript for inclusion in the ODS Clinical Packet prepared by the VA's National Center for PTSD and circulated to VA mental health professionals. Since the published literature still lacks an article on this subject and since we believe that our comments on pharmacotherapy apply to survivors of most acute traumatic events, we present our observations and recommendations with the hope that they may be useful to military, VA, and civilian practitioners.

Clinical Protocols↗
PubMed1993

Open prospective trial of fluoxetine for posttraumatic stress disorder.

Twenty-seven patients with combat-related posttraumatic stress disorder (PTSD) entered an open, prospective, 10-week trial of fluoxetine, beginning with 20 mg/day and increasing to 80 mg/day until response was optimal or side effects prohibited dose increase. Nineteen patients completed 3 or more weeks and were included in the data analysis. Total Clinician-Administered PTSD Scale scores decreased from a mean of 64.5 at baseline to 42.7 at endpoint (F = 7.17, p < 0.001), and improvement was significant in each of the three PTSD subscales (reexperiencing, avoidance/numbing, and hyperarousal). Depression and anxiety ratings showed similar improvements, and suicidality ratings did not increase. Global improvement scores decreased from 4.0 at baseline to 2.67 at endpoint (F = 12.08, p < 0.001); however, improvement in social and occupational functioning was minimal. Appreciable improvement tended to occur after 6 weeks, suggesting that higher fluoxetine doses and/or duration than that used for depression may be indicated in this population. Panic attack frequency decreased by at least 50% in six of eight patients who kept panic diaries. The high dropout rate reflects problems with side effects, anxiety symptoms, external events, and substance abuse. Our data suggest that fluoxetine is effective in reducing reexperiencing, avoidance, and hyperarousal symptoms of PTSD, and this improvement is independent of comorbid panic disorder. In addition, fluoxetine appears to be effective in reducing panic attacks in PTSD patients. The efficacy of fluoxetine for some PTSD patients is interesting in light of emerging neuropharmacologic data suggesting serotonergic dysregulation in some PTSD patients. Noradrenergic hypotheses are also discussed. The findings should be confirmed by double-blind, placebo-controlled studies.

Adult↗
PubMed1992

Exposure to atrocities and severity of chronic posttraumatic stress disorder in Vietnam combat veterans.

OBJECTIVE: The authors' objective was to explore aspects of trauma associated with severity of posttraumatic stress disorder (PTSD) in Vietnam veterans. METHOD: Several ratings of stress exposure and symptom severity were administered to 40 patients with combat-related PTSD. RESULTS: A significant relationship was observed between exposure to atrocities and the impact of PTSD on veterans' lives, as measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. Exposure to atrocities was also significantly correlated with current symptom severity. In contrast, combat exposure alone was not significantly associated with overall symptom severity. Both atrocity and combat exposure, however, were significantly related to reexperiencing symptoms. CONCLUSIONS: The data suggest that the enduring effect and severity of PTSD symptoms on an individual are associated more with exposure to brutal human death and suffering than the threat of death associated with combat.

Adult↗
PubMed1991

Hypothalamic-pituitary-adrenal dysfunction in posttraumatic stress disorder.

Neuroendocrine studies examining the hypothalamic-pituitary-adrenal (HPA) axis under baseline conditions and in response to neuroendocrine challenges have supported the hypothesis of altered HPA functioning in posttraumatic stress disorder (PTSD). However, to date, there is much debate concerning the nature of HPA changes in PTSD. Furthermore, in studies showing parallel findings in PTSD and major depressive disorder there is controversy regarding whether the HPA alterations suggest a specific pathophysiology of PTSD, or, rather, reflect comorbid major depressive disorder. This review summarizes findings of HPA axis dysfunction in both PTSD and major depressive disorder, and shows distinct patterns of HPA changes, which are probably due to different mechanisms of action for cortisol and its regulatory factors.

Adrenocorticotropic Hormone↗
PubMed1991

Characterization of depression in war-related posttraumatic stress disorder.

OBJECTIVE: Many patients with posttraumatic stress disorder (PTSD) have symptoms of depression, but operationalized psychological constructs related to depression have not been used extensively in characterizing affective symptoms of PTSD. The authors' objective is to better characterize the affective component of PTSD. METHOD: The subjects were 45 male psychiatric inpatients at a Veterans Administration medical center; 28 met DSM-III-R criteria for PTSD and 17 met Research Diagnostic Criteria (RDC) for major depressive disorder. All of the subjects with PTSD were Vietnam veterans. The 21-item Hamilton Rating Scale for Depression was used to assess state measures of symptom severity, and the Depressive Experiences Questionnaire was used to measure dimensions of dependency, self-criticism, and self-efficacy. RESULTS: The mean total Hamilton scale score of the patients with PTSD was nonsignificantly higher than that of the patients with major depressive disorder; patients with PTSD had higher scores on almost all individual Hamilton symptoms, particularly insomnia, somatic anxiety, and diurnal variation. Patients with PTSD had significantly higher scores on the self-criticism scale but not on the dependency and self-efficacy scales of the Depressive Experiences Questionnaire. The scores of patients with PTSD on the dependency and self-criticism scales were negatively correlated. No significant differences between patients with PTSD with and without concurrent major depressive disorder were observed. CONCLUSIONS: Characterization of such depressive dimensions of PTSD as dependency and self-criticism may have important clinical implications.

Adult↗