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PubMed1985

Combat-related flashbacks in posttraumatic stress disorder: phenomenology and similarity to panic attacks.

Combat veterans (N = 25) with posttraumatic stress disorder had flashbacks related to their combat stressors, which included major losses and exposure to danger. Certain affects, loud noises, fatigue, and personal stress tended to precipitate flashback episodes. Flashbacks began a year or more after exposure to combat in 50% of patients; 56% of patients experienced daily flashbacks. Flashback phenomenology met DSM-III criteria for panic attacks. The similarity of flashbacks to panic attacks suggests treatment trials with monoamine oxidase inhibitors or imipramine for these selected symptoms.

Adult↗
PubMed2001

A "cure" for chronic combat-related posttraumatic stress disorder secondary to a right frontal lobe infarct: a case report.

A 48-year-old combat veteran sustained a right frontal cerebral infarct at the age of 45 years. The patient's family reports that prior to the infarct he had a preoccupation with memories of combat, as well as nightmares, avoidance of reminders, and multiple arousal symptoms. Since his recovery from the infarct, the patient and his family continue to relate significant arousal symptoms but deny any continued history of preoccupation with traumatic memories, reminder avoidance, or nightmares. The resolution of a limited number of symptoms in this patient following damage to the right frontal cortex suggests that some of the symptoms of posttraumatic stress disorder may be amenable to current biological interventions.

Adaptation, Psychological↗
PubMed1998

Eye movement desensitization and reprocessing (EDMR) treatment for combat-related posttraumatic stress disorder.

Despite the clinical and social impact of posttraumatic stress disorder (PTSD), there are few controlled studies investigating its treatment. In this investigation, the effectiveness of two psychotherapeutic interventions for PTSD were compared using a randomized controlled outcome group design. Thirty five combat veterans diagnosed with combat-related PTSD were treated with either (a) 12 sessions of eye movement desensitization and reprocessing, EMDR (n = 10), (b) 12 sessions of biofeedback-assisted relaxation (n = 13), or (c) routine clinical care, serving as a control (n = 12). Compared with the other conditions, significant treatment effects in the EMDR condition were obtained at posttreatment on a number of self-report, psychometric, and standardized interview measures. Relative to the other treatment group, these effects were generally maintained at 3-month follow-up. Psychophysiological measures reflected an apparent habituation effect from pretreatment to posttreatment but were not differentially affected by treatment condition.

Adult↗
PubMedDate not supplied

Sustained attention in combat-related posttraumatic stress disorder.

There is substantial evidence that PTSD patients have information processing abnormalities for stimuli that are highly relevant to the traumas they have endured. The goal of the present study was to examine whether this extends to neutral stimuli as well. Twenty-four male Vietnam combat veterans with PTSD were compared to fifteen normal male comparison subjects on their performance on a sensitive measure of sustained attention, the Continuous Performance Test-Identical Pairs version (CPT-IP). PTSD subjects did not differ from controls in their ability to discriminate target stimuli from background noise on the CPT. Additionally they performed as well as controls, even in the presence of external distraction. Thus, this study did not find a generalized deficit in attention associated with PTSD on the CPT-IP. Nevertheless, further clarification of the nature of the information processing disturbance in PTSD is warranted.

Adult↗
PubMed2005

Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder.

BACKGROUND: The efficacy and safety of risperidone was evaluated in veteran patients with chronic combat-related posttraumatic stress disorder (PTSD) who were referred to a residential treatment program. METHODS: Seventy-three subjects volunteered to participate in this double-blind, placebo-controlled study, which comprised of a 5 week residential program followed by a 3-month outpatient follow-up. Risperidone was added to a stable psychotropic medication regimen in 92% of subjects. Primary outcome measures were the Clinician-Administered PTSD scale (CAPS-total) and its three subscales; B (Re-experiencing), C (Avoidance) and D (Arousal). Secondary outcome measures were the Hamilton Anxiety (HAM-A) and Depression (HAM-D) scales, and the Positive and Negative Syndrome Scale, Positive Subscale (PANSS-P). RESULTS: Sixty-five subjects were randomized and 48 completed the 4-month study. Significantly greater improvement in symptoms was observed in subjects receiving risperidone compared to placebo on the CAPS-total and CAPS-D subscale scores and also on HAM-A and PANSS-P. Numerically greater improvements in all the remaining measures were noted with risperidone, but the differences did not reach statistical significance. Risperidone was well tolerated. CONCLUSIONS: These results suggest that adjunctive risperidone improved a broad range of psychiatric symptoms in patients with chronic combat-related PTSD. The data support the concept that atypical antipsychotic medications may have a wider therapeutic spectrum that goes beyond the treatment of psychosis.

Adult↗
PubMed1999

Comparison of outcome between homogeneous and heterogeneous treatment environments in combat-related posttraumatic stress disorder.

This study compared treatment outcome at discharge, and 4, 8, and 12 month follow-up between an inpatient program consisting of a mixture of Vietnam combat veterans with posttraumatic stress disorder (PTSD) and general psychiatric patients (N = 42), and the same program at a later period, consisting of only Vietnam combat veterans with PTSD (N = 33). Veterans rated the homogeneous environment higher in satisfaction, support, order, clarity, and amount of discussion of combat, and lower in hostility, than the heterogeneous condition. However, veterans showed no improvement in condition at 12 month follow-up, with the exception of decreased violence, replicating earlier studies. No differences in outcome were found between homogeneous or heterogeneous treatment environments. This study underscores the enduring nature of chronic posttraumatic stress disorder in the veteran population.

Adult↗
PubMed1996

Personality disorder symptomatology among Vietnam veterans with combat-related PTSD.

This research examined self-report personality profiles of 42 Vietnam veterans with combat-related posttraumatic stress disorder (PTSD) evaluated at an outpatient Veteran's Administration hospital PTSD clinic. Assessment was via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev; DSM-III-R) Personality Disorders-II (SCID-II) self-report. Self-reported personality disorder symptomatology of PTSD patients was contrasted with that of 51 outpatients with a primary diagnosis of an anxiety disorder other than PTSD and with 16 patients with a primary diagnosis of major depressive disorder (MDD). Symptomatology from each of the 11 DSM-III-R categories and from the three personality disorder "clusters" was calculated in terms of percentage of possible traits endorsed, thus creating personality "profiles" for the three groups. PTSD veterans endorsed more traits overall than did both the mixed anxiety and MDD groups, particularly on the Cluster A, avoidant, and borderline scales. Results suggest a PTSD-related personality profile characterized by emotional lability/poor anger control, paranoia/suspiciousness, identity disturbance/confusion, social withdrawal/avoidance, and feelings of emptiness and boredom.

Adult↗
PubMed1999

A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder.

This study tested a family-based skills-building intervention in veterans with chronic combat-related posttraumatic stress disorder (PTSD). Veterans and a family member were randomly assigned to 1 of 3 conditions: (a) waiting list, (b) 18 sessions of twice-weekly exposure therapy, or (c) 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy (BFT). Participation in exposure therapy reduced PTSD positive symptoms (e.g., reexperiencing and hyperarousal) but not PTSD negative symptoms. Positive symptom gains were maintained at 6-month follow-up. However, participation in BFT had no additional impact on PTSD symptoms.

Adult↗
PubMed1993

Effects of intranasal vasopressin and oxytocin on physiologic responding during personal combat imagery in Vietnam veterans with posttraumatic stress disorder.

This study measured heart rate, skin conductance, and lateral frontalis electromyographic (EMG) responses in 43 male Vietnam veterans with posttraumatic stress disorder during personal combat imagery. In a double-blind research design, subjects were randomly assigned to receive intranasal arginine vasopressin (20 IU), placebo, or oxytocin (20 IU) an hour before the experiment. The group order of physiologic responding was as predicted: vasopressin > placebo > oxytocin. The most specific effect was exerted by vasopressin on EMG responses. This drug effect was not accounted for by nonspecific changes in responsiveness. Results are consistent with enhancing and inhibiting effects on memory retrieval and conditioned responding of vasopressin and oxytocin, respectively.

Administration, Intranasal↗
PubMed1988

Combat-related posttraumatic stress disorder. Patterns of symptomatology in help-seeking Vietnam veterans.

Sixty-one Vietnam veterans who had sought outpatient psychological services were evaluated for posttraumatic stress disorder (PTSD) during two independent diagnostic interviews. Data were analyzed from only those 48 subjects for whom the two diagnoses agreed upon the presence or absence of PTSD. Subjects were administered the Symptom Checklist-90-R, a modified version of the Impact of Event Scale, and two measures of combat stress: the Combat Scale Revised and the Vietnam Experience Scale. Some support was generated for the reliability and validity of the PTSD construct as outlined in DSM-III. In our sample the diagnosis of PTSD was associated with excessive arousal characterized by anxiety, anger, paranoid ideation, intrusive images, and avoidance of stimuli reminiscent of the traumatic stressor. The findings are discussed in relation to previous studies of combat-related PTSD and studies of traumatically stressed civilians.

Combat Disorders↗
PubMed1998

In vivo proton magnetic resonance spectroscopy of the medial temporal lobes of subjects with combat-related posttraumatic stress disorder.

Recent findings using volumetric MRI techniques have revealed that patients with combat-related and noncombat-related posttraumatic stress disorder (PTSD) have reductions in right hippocampal volume. Twenty-one veterans with PTSD and eight age-matched control veterans were studied using proton magnetic resonance spectroscopy to test the hypothesis that the N-acetyl-L-aspartic acid/creatine (NAA/Cr) ratio would be decreased in the right medial temporal lobe structures of patients with PTSD compared to controls. Patients with PTSD displayed significantly lower NAA/Cr ratio for the right medial temporal lobe relative to the left (P < or = 0.011). Patients with PTSD also had lower NAA/Cr in right medial temporal lobe (P < or = 0.013) and lower choline/Cr in left medial temporal lobe (P < or = 0.030) compared to control subjects. Because NAA is regarded as an indicator of neuronal density, this finding suggests that the neuronal density of right-sided medial temporal structures in patients with combat-related PTSD may be decreased.

Adult↗
PubMed1994

The Numbing Scale: psychometric properties, a preliminary report.

This study explored the psychometric properties of a new self-report instrument, The Glover Numbing Scale. The scale measures a variety of behaviors reported by individuals experiencing an inability to access feelings other than hostility and rage. The scale was administered to inpatient Vietnam combat veterans with post-traumatic stress disorder (PTSD, n = 323), PTSD diagnosed Veterans Affairs (VA) outpatient and veterans' outreach center veterans (n = 208), two Vietnam veteran noncombat groups (n = 45), two psychiatric noncombat controls (anxiety disorder, n = 40; major depressive disorder, n = 31), and a nonpsychiatric never-in-Vietnam veteran control group (n = 48). Reliability information suggested that the scale was internally consistent with good test-retest correlations. Convergent and discriminant validations were assessed based on the pattern of the scale's correlations with relevant Minnesota Multiphasic Personality Inventory (MMPI) scales. The contrasting pattern of correlations provided by a subgroup of veterans who reported always feeling dead or shut down was highlighted. Principal component analysis resulted in a five factor solution that provided evidence for the scale's factorial validity. Numbing Scale scores discriminated levels of psychopathology within the veteran population. PTSD outreach center veterans' sum scores and item scores on the Numbing Scale were more similar to responses of anxiety disorder patients than to major depressive disorder patients. Overall, the findings strongly support the clinical application of the Numbing Scale.

Adult↗