[Subnarcosis, a neglected therapy?].
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Adjustment Disorders↗
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The Trauma Symptom Inventory: factors associated with invalid profiles in a sample of combat veterans with post-traumatic stress disorder.
The assessment of combat-related post-traumatic stress disorder (PTSD) relies upon self-reported symptoms and the need for indicators of valid reporting is critical. The Trauma Symptom Inventory (TSI) is a testing instrument specific to PTSD which includes validity scales. In a pilot study examining the use of the TSI with combat veterans, 50 male veterans diagnosed with PTSD were administered the TSI. Nineteen percent of the profiles were invalid, all but one based on the Atypical Response Scale. Differences between veterans with valid and invalid TSI profiles are examined in terms of demographic and historical factors, TSI profiles, and individual scale items. The model best able to predict invalid profiles included high scores on subscales measuring dissociative experiences and tension reduction behaviors. Implications for the interpretation of TSI validity scales in assessing combat-related PTSD are discussed.
Adult↗
A reevaluation of the use of the MMPI in the assessment of combat-related posttraumatic stress disorder.
This study attempts to validate previously developed, empirically based Minnesota Multiphasic Personality Inventory (MMPI) decision rules (Keane, Malloy, & Fairbank, 1984) to aid in the diagnosis of combat-related posttraumatic stress disorder (PTSD). Four groups of 21 subjects each were identified: PTSD, psychotic, depressed, and chronic pain. A decision rule based on the standard clinical scales resulted in a correct classification rate (PTSD vs. non-PTSD) of 81% across the four-group sample. An empirically derived MMPI PTSD scale resulted in a correct classification rate of 77%. However, 43% of the PTSD subjects were incorrectly classified as non-PTSD by these rules. Independent, blind sorting of the 84 MMPI profiles by two doctoral-level clinical psychologists resulted in "hit rates" similar to the MMPI decision rules. The present results suggest that the previously derived, empirically based MMPI decision rules for PTSD do scarcely better than chance on correct classification of individuals with PTSD. We suggest that the differential diagnosis of PTSD is difficult because of the wide variety of symptoms in common with other diagnostic groups, and hence the variability of PTSD subjects on psychometric measures. We also suggest that the MMPI decision rules of Keane et al. (1984) may have utility in identifying subgroup(s) of combat-related PTSDs.
Chronic Disease↗
Locus of control and combat-related post-traumatic stress disorder: the intervening role of battle intensity, threat appraisal and coping.
The study examined the role of control expectancies in the formation of posttraumatic stress disorder (PTSD) among Israeli soldiers combat stress reactions (battle shock) casualties of the Lebanon War (1982). A random sample of 104 soldiers who fought in the Lebanon War and were identified as combat stress reaction casualties were clinically interviewed and given a battery of self-report questionnaires a year after their participation in combat. In general, the components of Lazarus' stress-illness model were predictive of the severity of PTSD. Greater appraisal of threat, more negative emotions, and more emotion-focused coping were all found to predict a larger number of PTSD symptoms. Path analyses were performed separately for soldiers who reported that they were under high battle intensity and those who were under relatively low battle intensity. For low battle intensity, externals suffered more PTSD than internals. This relationship was due mainly to the indirect effects of locus of control via threat appraisal. These significant relationships were not found when battle intensity was high. The implications of the findings for the study of combat stress reactions and for the stress-illness model are discussed. The relative impact of generalized control expectancies and situational factors are examined for the various components of the model.
Adaptation, Psychological↗
Periodic limb movements of sleep in combat veterans with posttraumatic stress disorder.
Twenty-five veterans suffering from combat-related posttraumatic stress disorder were studied for 1-4 nights with all-night polysomnography. All subjects had sleep complaints. Analysis reveals that nineteen (76%) of the patients were found to have clinically significant periodic limb movements of sleep (PLMs) by the second night of study. PLMs are associated with sleep complaints in normals. For this reason the common assumption that sleep complaints in posttraumatic stress disorder are related only to the psychiatric disorder itself are challenged.
Adult↗
Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder.
Posttraumatic stress disorder (PTSD) is a difficult condition to treat, and existing studies show considerable variability in outcome. Investigations of factors that influence outcome have the potential to inform alternate treatment approaches to maximize benefits gained from interventions for the disorder. Because PTSD is commonly associated with comorbidity, it is important to investigate the influence of comorbidity on symptom change after treatment. This article examines pretreatment and 9-month follow-up data for 134 Australian Vietnam veterans who attended a treatment program for combat-related PTSD. A series of analyses were conducted to investigate the influence of the comorbid factors of anxiety, depression, anger, and alcohol use on PTSD symptom change after treatment. Analyses identified anger, alcohol, and depression as significant predictors of symptom change over time, independent of the effect of initial PTSD severity. Further analyses indicated that anger at intake was the most potent predictor of symptom change. Further investigations of anger as an influence on symptom change after treatment of combat-related PTSD is recommended.
Alcohol-Related Disorders↗
Combat-related, chronic posttraumatic stress disorder: implications for group-therapy intervention.
The patient with combat-related chronic Posttraumatic Stress Disorder suffers from a wide spectrum of maladaptive behaviors. This paper delineates the work that has been done with such a population in group therapy. The plan that is proposed takes into account three interrelated sets of factors: factors important for creating an effective working relation; curative factors; and particular themes. Each of these factors is analyzed in the light of the particularities of group work with such a population. Each of the points discussed is based upon the relevant literature, upon the experience of the therapist, and illustrated with examples.
Adaptation, Psychological↗
Psychiatric symptoms and health service utilization in rural and urban combat veterans with posttraumatic stress disorder.
This study investigated differences in rural/urban mental health and service use in veterans with combat-related posttraumatic stress disorder (PTSD). Data were obtained from 48 urban and 52 rural residing combat veterans diagnosed with PTSD at a Veterans Affairs Medical Center's outpatient PTSD clinic. Rural and urban groups were compared on health service utilization indices (PTSD, primary and specialty care clinic visits), the Minnesota Multiphasic Personality Inventory-2, the Mississippi Combat PTSD Scale, the Beck Depression Inventory, and the Dissociative Experiences Scale. Results indicated a lack of substantive differences between rural and urban combat PTSD patients. The sole difference involved higher dissociation scores among rural patients. Rural combat PTSD patients therefore seem to have similar mental health needs compared with their urban counterparts, with important service delivery implications.
Combat Disorders↗
Quetiapine treatment in an open trial in combat-related post-traumatic stress disorder with psychotic features.
Patients with combat-related post-traumatic stress disorder (PTSD) with psychotic features frequently fail to respond to antidepressants. Previous research has shown that these patients improve significantly after monotherapy with two atypical antipsychotics, olanzapine and risperidone. This study investigated the clinical outcome of another atypical antipsychotic, quetiapine, in war veterans with combat-related PTSD with psychotic features. Male war veterans (n=53) with DSM-IV-diagnosed PTSD with psychotic symptoms completed 8 wk of in-patient treatment with quetiapine (25-400 mg/d). The reductions in the total and subscale scores on the Clinician-Administered PTSD Scale (CAPS), and the increase in the Clinical Global Impression - Improvement Scale (CGI-I) were the primary outcome measures, and reductions in the Positive and Negative Syndrome Scale (PANSS) were the secondary outcome measures. The CGI - Severity of Illness scale (CGI-S) was used to assess the global clinical improvement. Drug-Induced Extrapyramidal Symptoms scale recorded adverse effects. Two, 6 and 8 wk treatment with quetiapine significantly reduced total and the subscales scores on the CAPS, PANSS, and CGI-S scales, in patients with psychotic PTSD. The results indicate that 8 wk of monotherapy with quetiapine reduced the majority of the psychotic and PTSD symptoms in the patients. Our present and previous data suggest that treatment-resistant psychotic PTSD patients may improve after taking atypical antipsychotics.
Adolescent↗
Treatment for combat-related posttraumatic stress disorder: two-year follow-up.
This study reports on outcomes 2 years following completion of specialist veteran posttraumatic stress disorder (PTSD) treatment programs in 2,223 (reduced to 1,508 at 24 months) consecutive admissions. Self-report measures of PTSD, anxiety, depression, anger, alcohol use, and general functioning were obtained at admission, 6, 12, and 24 months after admission. Significant improvements were demonstrated at 6 months, with smaller gains continuing through to 24-month assessment. Within subject effect sizes of around 0.8 were obtained for PTSD and around 0.5 for anxiety and depression. Although lack of a control group limits the extent to which improvements can be attributed to the treatment program, the data suggest that specialized treatment programs for combat-related PTSD continue to be of value.
Alcohol Drinking↗
[The "war neurosis"-- an early model of a pluridimensional outlined trauma-theory in psychiatry].
The war neurosis, mainly observed during the first World War, caused a lively debate on its origin and etiology. In psychiatric history this debate is often portrayed in a somewhat simplifying manner. Namely Oppenheim was considered as the leading exponent of the organic etiology of traumatic neurosis, while others, with growing interest in psychodynamic theories, were thought to favor exclusively psychogenesis of this condition. However, only discussing matters in this way would be too simple. Rather, the controversy was much more differentiated and led to important insights: First, it turned out to be impossible to explain any psychopathological syndrome exclusively in terms of neuropathological, i. e. structural alterations, in particular, a syndrome presenting with a sudden onset of dissociative and conversion symptoms. Secondly, the psychiatric theory of hysteria of Charcot and Freud was developed and extended further. And, last, the etiology of war neurosis was recognized to be multifactorial. Thus, the discourse on this issue was not one-dimensional and favoring a single explanation for a complex disorder, but revealed "pluridimensional" features. Subsequently psychotherapy, for the first time, was widely introduced into clinical practice with a clear indication and well-defined methodological approach. In summary, war neuroses can be addressed as an early model of traumatic stress disorder, such as acute stress disorder or post-traumatic stress disorder.
Combat Disorders↗
The interaction of posttraumatic stress disorder and depression among older combat veterans.
The question whether depression is related to trauma as part of posttraumatic stress disorder (PTSD) itself or whether it represents autonomous symptoms occurring separately (from PTSD) has not been answered. We addressed two issues: (a) What is the relationship between PTSD and depression as measured by continuous measures on outcomes? and (b) By removing depression components from the PTSD diagnosis, what is the impact on standard outcomes? Older veterans from World War II or Korea were interviewed and given self-report measures on PTSD and depression. The CAPS-1 and the MMPI-D were used as the continuous measures for PTSD and depression. The outcome measures were health status, overall adjustment, social support, and physiological status. Results showed that depression influenced health status and social support: PTSD did not contribute to the equation. The CAPS-1 also was further divided into CAPS-PTSD and CAPS-D (depression) based on item content. For adjustment and health status, PTSD asserted a greater influence; for social support and heart rate, depression was the greater influence. Discussion addressed the fact that depression is an important consideration in the expression of PTSD.
Adaptation, Psychological↗
Psychotic symptoms in combat-related posttraumatic stress disorder.
BACKGROUND: Posttraumatic stress disorder (PTSD) is known often to be comorbid with other anxiety, mood, and substance use disorders. Psychotic symptoms have also been noted in PTSD and have been reported to be more common in Hispanic veterans. However, the occurrence of psychotic symptoms, including the degree to which they are accounted for by comorbid disorders, have received limited systematic investigation. Our study objectives were to assess psychotic symptoms according to DSM-III-R criteria in patients with a primary diagnosis of combat-related PTSD and determine the associations of those symptoms with psychiatric comorbidity and ethnicity. METHOD: Fifty-three male combat veterans consecutively admitted to a PTSD rehabilitation unit were assessed for psychotic symptoms and Axis I disorders. Ninety-one percent were Vietnam veterans; 72% were white, 17% were Hispanic, and 11% were black. Associations between psychotic symptoms and comorbid depression, substance use disorders, and minority status were compared by chi-square analyses; associations between psychotic symptoms and both PTSD and dissociative symptom severity were compared by t test analysis. RESULTS: Forty percent of patients reported a psychotic symptom or symptoms in the preceding 6 months. These symptoms featured auditory hallucinations in all but 1 case. The psychotic symptoms typically reflected combat-themes and guilt, were nonbizarre, and were not usually associated with formal thought disorder or flat or inappropriate affect. Psychotic symptoms were significantly associated with current major depression (p < .02), but not with alcohol or drug abuse or with self-rated PTSD and dissociation severity. Psychotic symptoms and current major depression were more common in minority (black and Hispanic) than white veterans (p < .002). CONCLUSION: Psychotic symptoms can be a feature of combat-related PTSD and appear to be associated with major depression. The association with minority status may be a function of comorbidity.
Adult↗
Another case of self-cutting after combat stress.
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Adult↗
Gun use, attitudes toward violence, and aggression among combat veterans with chronic posttraumatic stress disorder.
Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) have been frequently reported to exhibit high levels of aggression and violent behavior. In this study, gun collection and use habits, attitudes toward violence, and self-reported levels of aggression were compared between veterans with chronic PTSD and non-PTSD veterans with equivalent histories of alcohol and substance abuse. PTSD patients reported different attitudes toward violent crime, higher levels of self-reported aggression, and a significantly higher incidence of potentially dangerous firearm-related behaviors than comparison subjects.
Adult↗
Meanings of combat and the development of posttraumatic stress disorder.
The authors use the concept of "meanings of combat" to explain combat veterans' different reactions to war experiences, particularly the development of a posttraumatic stress disorder after combat. The authors present four case reports to illustrate some of the different meanings of combat and the ways such meanings relate to stress disorder and soldiers' adaptation before, during, and after combat.
Adaptation, Psychological↗
Self-reported symptoms of social anxiety in a sample of combat veterans with posttraumatic stress disorder.
The relationship between posttraumatic stress disorder (PTSD) and self-reported levels of social anxiety among combat veterans was assessed using the Social Phobia and Anxiety inventory (SPAI). Participants were 45 veterans with combat-related PTSD assessed using a multimeasure assessment package. The veterans reported a high level of social anxiety and agoraphobia-like symptoms. Agoraphobia scores were predicted by PTSD severity and elevated by Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales of acute distress and psychopathology. Social phobia scores were predicted by severity of depression. The relationship between social anxiety, depression, and PTSD is discussed. Implications for the assessment and treatment of PTSD are also discussed.
Agoraphobia↗
Subtle neurologic compromise as a vulnerability factor for combat-related posttraumatic stress disorder: results of a twin study.
CONTEXT: Previous studies have demonstrated subtle neurologic dysfunction in chronic posttraumatic stress disorder (PTSD) manifest as increased neurologic soft signs (NSSs). The origin of this dysfunction is undetermined. OBJECTIVE: To resolve competing origins of increased NSSs in PTSD, namely, preexisting vulnerability factor vs acquired PTSD sign. DESIGN: Case-control study of identical twins. SETTING: A Veterans Affairs and academic medical center (ambulatory). PARTICIPANTS: A convenience sample of male Vietnam veteran twins with (n = 25) and without (n = 24) PTSD and their combat-unexposed identical (monozygotic) co-twins. INTERVENTIONS: Neurologic examination for 45 NSSs. MAIN OUTCOME MEASURE: Average scores for 45 NSSs, each scored on an ordinal scale from 0 to 3, masked to diagnosis and combat exposure status. RESULTS: There was a significant between-pair main effect of PTSD diagnosis (as determined in the combat-exposed twin) on average NSS score in the absence of a significant combat exposure main effect or diagnosis x exposure interaction. Combat veterans with PTSD had significantly higher NSS scores than combat veterans without PTSD. The "high-risk," unexposed co-twins of the former also had significantly higher NSS scores than the "low-risk," unexposed co-twins of the latter. This result could not be explained by age, number of potentially traumatic lifetime noncombat events, alcoholism, or the presence of a comorbid affective or anxiety disorder. The average NSS score in unexposed co-twins was not significantly associated with combat severity in combat-exposed twins. CONCLUSIONS: These results replicate previous findings of increased NSSs in Vietnam combat veterans with PTSD. Furthermore, results from their combat-unexposed identical co-twins support the conclusion that subtle neurologic dysfunction in PTSD is not acquired along with the trauma or PTSD but rather represents an antecedent familial vulnerability factor for developing chronic PTSD on exposure to a traumatic event.
Ambulatory Care↗