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PubMed1994

Post-traumatic stress disorder: supportive evidence from an eighteenth century natural disaster.

Post-traumatic stress disorder was first recognized as a diagnostic category embracing reactions in response to overwhelming environmental stress 'outside the range of usual human experience' in DSM-III (APA, 1980). Such abnormal stressors are by no means a product of the twentieth century but have featured, sporadically, in all societies from the earliest civilizations. Longitudinal investigations of traumatic stress have rarely gone further back than the nineteenth century, and have been concerned, almost exclusively, with adverse effects following railway accidents and military combat. The present study, utilizing a mid-eighteenth century medical source, presents an analysis of the impact of a natural disaster on members of a peasant family trapped in an avalanche in the Italian Alps in 1755.

Disasters↗

PubMed1986

A cross-validation of the Keane and Penk MMPI scales as measures of post-traumatic stress disorder.

The scores of DSM-III-diagnosed post-traumatic stress disorder (PTSD) patients (N = 116), psychiatric patients who did not meet the criteria, and normals (N = 19) on the Keane, Malloy, and Fairbank (1984) PTSD and Penk Combat scales for the MMPI were compared. The Keane scale discriminated PTSD-positive patients from normals at a substantial level of accuracy (omega 2 = .23; mean hit rate = 80.5%) and PTSD-positive from PTSD-negative patients at a more modest level (omega 2 = .09; mean hit rate = 64%). The scores of the PTSD-positive and PTSD-negative patients were considerably lower than those of Keane et al.'s (1984) samples, which suggests that local norms may be needed to facilitate their interpretation. The Penk Combat Intensity scale, which was correlated highly with the Keane scale, differentiated the PTSD-positive patients from both the normals and the PTSD-negative patients, but with less differentiating power (omega 2'S = .07 and .08). The Penk Combat Exposure scale did not separate the groups.

Combat Disorders↗

PubMed2006

The D2 dopamine receptor (DRD2) gene is associated with co-morbid depression, anxiety and social dysfunction in untreated veterans with post-traumatic stress disorder.

OBJECTIVE: To identify clusters of patients with post-traumatic stress disorder (PTSD) according to symptom profile and to examine the association of the A1 allele of the D2 dopamine receptor (DRD2) gene with these clusters. METHOD: Fifty-seven untreated Caucasian Vietnam veterans with PTSD were administered the General Health Questionnaire-28 (GHQ) and the Mississippi Scale for combat-related PTSD. DRD2 allelic status was determined by PCR. RESULTS: Subjects with the DRD2 Al allele compared to those without this allele had significantly higher scores on GHQ 2 (anxiety/insomnia), GHQ 3 (social dysfunction) and GHQ 4 (depression). Cluster analysis of the GHQ data identified two primary groups. A high psychopathology cluster (cluster 3), featured by high co-morbid levels of somatic concerns, anxiety/insomnia, social dysfunction and depression, and a low psychopathology cluster (cluster 1), manifested by the reverse pattern. Scores in each of the four GHQ groups were significantly higher in cluster 3 than cluster 1, as was Mississippi Scale PTSD score. DRD2 A1 allele veterans compared to those without this allele were significantly more likely to be found in the high than the low psychopathology cluster group. CONCLUSIONS: DRD2 variants are associated with severe co-morbid psychopathology in PTSD subjects.

Alleles↗

PubMed2002

Neuropsychological processes in post-traumatic stress disorder.

The unique constellation of symptoms that constitute post-traumatic stress disorder (PTSD) may reflect persistent alterations in attention and memory that are fundamental to this disorder. This article reviews the literature on the neuropsychology of PTSD and its relevance to phenomenological, clinical, and biological aspects of this disorder. It addresses the nature and magnitude of the neuropsychological alterations in PTSD and the extent to which they involve the processing of trauma-related or neutral stimuli. This article summarizes the types of deficits in attention and memory that have been found in a broad range of trauma survivors with PTSD and explores the extent to which the deficits may be risk factors for or consequences of trauma and PTSD. The implications of these findings for the course and pathophysiology of PTSD are also discussed.

Brain↗

PubMed2002

Characterizing the effects of sertraline in post-traumatic stress disorder.

BACKGROUND: Sertraline has a proved efficacy in post-traumatic stress disorder (PTSD), but it is unknown which symptoms respond or in what sequence this occurs. Such information might be useful clinically and heuristically. METHOD: The study examined the effects of sertraline on the individual symptoms of PTSD. It also examined whether early changes in anger explained drug-induced change in other symptoms over time. Mixed models analysis was applied to datasets from two 12-week placebo-controlled trials of sertraline. A validated self-rating scale (DTS) was used to assess treatment efficacy. RESULTS: Sertraline was superior to placebo on 15 of 17 symptoms, especially in the numbing and hyperarousal clusters. A strong effect was found on anger from week 1, which partly explained the subsequent effects of sertraline on other symptoms, some of which began to show significantly greater response to drug than to placebo at week 6 (emotional upset at reminders, anhedonia, detachment, numbness, hypervigilance) and week 10 (avoidance of activities, foreshortened future). CONCLUSIONS: Sertraline exercises a broad spectrum effect in PTSD. Effects are more apparent on the psychological rather than somatic symptoms of PTSD, with an early modulation of anger and, perhaps, other affects, preceding improvement in other symptoms.

Adolescent↗

PubMed2004

Post-traumatic stress disorder in UK police officers.

Prevalence rates for post-traumatic stress disorder (PTSD) in police officers may be six or more times the prevalence rates for the community. Once established, is PTSD in police officers more severe than PTSD in civilians? This small study looks at the symptom frequencies in established cases of PTSD in 31 police officers and 72 civilians and compares the two. No significant differences were found, although there was a tendency for higher use of alcohol and to try not to think about the trauma. Police officers had more experiences of reliving the trauma or acting as if the trauma were recurring but, again, not to a significant degree.

Adult↗

PubMed1997

Post-traumatic stress disorder symptoms and the Clapham rail accident.

BACKGROUND: Post-traumatic stress disorder is a well recognised condition which can have long-term consequences. A rail accident to commuter trains in south London provided an opportunity, within the context of a Psychological Therapies Service, to study the prevalence and associations of the condition in a follow-up study. METHOD: Postal questionnaires were completed by 187 survivors (52% response rate) 10 to 22 months after the accident, and their symptoms were compared with a commuter control group. RESULTS: The accident group scored significantly higher on the Impact of Events scale (IES) than the control group. Severity of physical injury was significantly associated with high IES scores. Thirty per cent of those moderately or severely injured showed high levels of intrusion or avoidance symptoms (sub-scores of 20 or more). Thirty per cent of those nearest the accident focus had high sub-scores, associated variables being the accident experience of risk of death, feeling trapped and seeing death. For those less directly involved the proportions with symptoms were similar to those of controls. CONCLUSIONS: It is recommended that disaster services should provide for long-term psychological effects, particularly for those survivors who are injured, who experience risk of death, feeling trapped or who witness death.

Accidents↗

PubMed2003

Paroxetine in the treatment of post-traumatic stress disorder: pooled analysis of placebo-controlled studies.

Post-traumatic stress disorder (PTSD) is increasingly understood to be a medical disorder characterised by particular psychobiological dysfunctions that respond to specific treatments. Paroxetine is a selective serotonin re-uptake inhibitor that has been found effective in the treatment of major depression as well as a range of anxiety disorders. This paper reviews data on the use of paroxetine for the treatment of adult PTSD. There have been three 12-week, placebo-controlled studies of paroxetine in PTSD. As these followed a partly similar design, a pooled analysis of the studies is possible and is reported here. Paroxetine is effective in the short-term treatment of PTSD, resulting in significantly better response and remission rates than placebo, improving sleep disturbance and reducing each of the symptom clusters of PTSD, as well as the disability associated with this condition. The medication is effective in both male and female PTSD patients and whether or not there are comorbid disorders such as depression.

Administration, Oral↗

PubMed2001

Translating the psychobiology of post-traumatic stress disorder into clinically useful analogy.

Psychological theorizing about post-traumatic stress disorder (PTSD) has developed considerably since early behavioural formulations (Brewin, Dalgleish, & Joseph, 1996; Mowrer, 1960) and there have been parallel developments in biological understanding (Yehuda, 1998). However clinical practice has not been affected by the new psychobiology. It is suggested that it is possible to translate this new understanding into a clinically useful analogy that will help circumvent the difficulties of forming a therapeutic alliance with trauma victims which have been reported (Pitman et al., 1991; Scott & Stradling, 1997).

Amygdala↗

PubMed2004

Post-traumatic stress disorder: considerations for dentistry.

A dental patient with post-traumatic stress disorder (PTSD) may present with greater dental and behavioral challenges than most dental patients. The background review of PTSD's initiating factors, diagnostic criteria, and medical management should help practitioners better understand and manage these challenges. Many of the challenges the clinician may encounter and managing recommendations are described. A case report of a PTSD patient complaining of constant bilateral tooth pain of the maxillary and mandibular bicuspids and molars is presented. Recommended techniques for identifying the tooth pain source and contributing factors are provided. The primary contributing factor for the patient's tooth pain was determined to be his severe tooth clenching activity. A maxillary acrylic appliance provided some pain reduction and a subsequent mandibular soft occlusal appliance worn opposing the maxillary appliance provided additional relief.

Bruxism↗

PubMed1990

Post traumatic stress disorder: an eclectic approach.

A number of victims of post traumatic stress disorder, apart from the rest of their symptom constellation, suffer flashbacks. These flashbacks occur during the waking state and frequently are very disabling. From among this group of patients, we have identified a few who demonstrate epileptiform discharge emanating from temporal lobe foci. We have postulated that indeed the flashbacks might represent an amalgam of abnormal neuronal firing along with the expression of a dynamically charged event. Eight cases are documented which illustrate this pattern. In all eight cases, the flashbacks were completely controlled through the use of anticonvulsant medication (carbamazepine and one case of valproate). Other symptoms were treated more traditionally. A modification to a conventional psychotherapeutic approach is introduced which does not merely foster abreaction but also introduces a process of desensitization to the highly charged events. The sessions during which the patient relives the precipitant to the syndrome are audiotaped. Following the experience of working through in therapy, the patient is encouraged to replay the tape(s) repeatedly over several months to facilitate flooding/desensitization. The two case summaries which are presented illustrate the integration of pharmacotherapeutic intervention, a focal short-term dynamic approach, and a behavioral model.

Abreaction↗

PubMed1993

Undiagnosed post-traumatic stress disorder following motor vehicle accidents.

OBJECTIVES: To determine the pattern of emergence of post-traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability. DESIGN: A longitudinal study of motor vehicle accident victims one month and 18 months after the accident. SUBJECTS: Twenty-four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved. MAIN OUTCOME MEASURES: Post-traumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile. RESULTS: Eighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work-related dysfunction equal to that associated with severe physical handicap. CONCLUSION: The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents.

Accidents, Traffic↗

PubMedDate not supplied

[Post-traumatic stress disorder and substance use disorder: treatment intervention].

There is an increasing interest to find efficacious treatments for patients with post-traumatic stress disorder (PTSD) and comorbid substance use disorder (SUD). Therefore, in this paper the studies published on the psychological and pharmacological treatment for the management of comorbid PTSD and SUD will be discussed, as these are highly prevalent and shown in part I. The few studies published to date suggest that patients benefit most form an integrated treatment approach for the comorbid disorders. Psychological treatments based on cognitive behavioural strategies appear to be useful for patients with PTSD and comorbid SUD disorder. Medications such as SSRIs and particularly sertraline that efficacious for PTSD, seem to be as well for this dual disorder. In addition, pharmacological options, among them quetiapine or bupropion have shown promising results in preliminary studies.

Humans↗

PubMed1997

Media triggers of post-traumatic stress disorder 50 years after the Second World War.

Post-traumatic stress disorder (PTSD) may present many years after the original trauma. Case studies of two elderly patients are described. Both had experienced life-threatening combat situations and witnessed intense suffering during the Second World War. Marked distress was triggered by the media commemorating the fiftieth anniversary of the end of the war. PTSD patients often avoid talking of their traumatic experiences because of associated distress. Without taking a military and trauma history from elderly patients the diagnosis is likely to be missed.

Aged↗

PubMed1992

The use of image habituation training with post-traumatic stress disorders.

An exposure treatment for patients suffering from post-traumatic stress disorder (PTSD) is described. Image habituation training (IHT) involves the patient in generating verbal descriptions of the traumatic event and recording these onto an audiotape. After the initial training session with the therapist, homework sessions of self-directed exposure in which the patient visualised the described event in response to listening to the audiotape were carried out. Of ten consecutive patients who received this treatment, six improved considerably after ten homework sessions, two showed moderate improvements, and two showed minimal improvement on a range of outcome measures. There were significant decreases in anxiety between and within homework sessions, suggesting that habituation did occur and was responsible for improvement. Treatment gains were maintained at six-month follow-up.

Adaptation, Psychological↗

PubMed1997

Response characteristics to antidepressants and placebo in post-traumatic stress disorder.

Characteristic response patterns are described for two antidepressant drugs and placebo in post-traumatic stress disorder. Early onset and steady improvement occurred on a global rating scale for both drugs and placebo in those who ultimately met responder criteria at the end of treatment. In certain cases, the magnitude of global response was greater for drug than for placebo. At weeks 2 or 4, the Clinical Global Impressions score for fluoxetine but not for amitriptyline, served as a good predictor of eventual response. In a review of numerous completed placebo-controlled trials, antidepressants were superior to placebo in seven out of eight comparisons using the Clinical Global Impressions, although specific effects on post-traumatic stress disorder scales were more variable. Drug response rates are similar for combat and civilian trauma samples, but placebo response rates may be higher in the latter. Effect sizes suggested a moderate-to-good effect for drug therapy.

Antidepressive Agents↗

PubMed1992

Prevalence of post-traumatic stress disorder in patients with chronic idiopathic facial pain.

34 patients with chronic idiopathic orofacial pain were assessed by a structured clinical interview for diagnosis of mental disorders according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R). Five (15%) had a history of post traumatic stress disorder (PTSD) which coincided with the pain onset. The majority of these PTSD sufferers also had a personality disorder. The implications of these findings in the diagnosis and management of post-traumatic chronic TMJ pain syndromes is discussed.

Adult↗

PubMed2006

[Post-traumatic stress disorder in a patient with recurrent ICD shocks. The role of RF ablation].

In patients with frequent ICD discharges an acute stress disorder (ASD), and afterwards a post-traumatic stress disorder (PTSD) is commonly observed. We present a case of a 53-year-old patient with ASD and PTSD in whom RF ablation of VT was performed. After the successful procedure the symptoms of PTSD were significantly diminished. We conclude that in patients with PTSD after ICD discharges RF ablation should be performed as soon as possible.

Adaptation, Psychological↗