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PubMed2002

Population attributable fractions of psychiatric disorders and behavioral outcomes associated with combat exposure among US men.

OBJECTIVES: This study determined the percentage of adverse outcomes in US men attributable to combat exposure. METHODS: Standardized psychiatric interviews (modified Diagnostic Interview Schedule and Composite International Diagnostic Interview assessments) were administered to a representative national sample of 2583 men aged 18 to 54 in the National Comorbidity Survey part II subsample. RESULTS: Adjusted attributable fraction estimates indicated that the following were significantly attributable to combat exposure: 27.8% of 12-month posttraumatic stress disorder, 7.4% of 12-month major depressive disorder, 8% of 12-month substance abuse disorder, 11.7% of 12-month job loss, 8.9% of current unemployment, 7.8% of current divorce or separation, and 21% of current spouse or partner abuse. CONCLUSIONS: Combat exposure results in substantial morbidity lasting decades and accounts for significant and multifarious forms of dysfunction at the national level.

Adolescent↗
PubMed2005

Relationship of in vivo medial temporal lobe magnetic resonance spectroscopy to documented combat exposure in veterans with chronic posttraumatic stress disorder.

Veterans diagnosed with combat-related posttraumatic stress disorder (PTSD) and comparison subjects underwent single voxel proton magnetic resonance spectroscopy (1H-MRS) of the medial temporal lobe (MTL). PTSD subjects were divided into combat and non-combat groups based on military records. Combat PTSD subjects did not have lower MTL levels of N-acetylaspartate compared with non-combat PTSD subjects.

Behavior Therapy↗
PubMed2002

Prazosin reduces nightmares in combat veterans with posttraumatic stress disorder.

BACKGROUND: Preclinical and clinical observations suggest that the centrally active alpha1-adrenergic antagonist prazosin might alleviate trauma content nightmares and other symptoms in combat veterans with chronic posttraumatic stress disorder (PTSD). METHOD: In this retrospective chart review study, we analyzed data from 59 consecutive combat veterans with previously treatment-resistant chronic PTSD (DSM-IV criteria) and severe intractable trauma content nightmares to whom prazosin had been prescribed. Nightmare severity was quantified using the recurrent distressing dreams item of the Clinician Administered PTSD Scale (CAPS). Change in overall PTSD severity exclusive of nightmares was estimated by assigning a Clinical Global Impressions-Change scale (CGI-C) score based on chart review. RESULTS: Mean +/- SEM recurrent distressing dreams item scores improved significantly (7.0 +/- 0.2 to 3.5 +/- 0.3, p <.0001) in the 36 patients who completed at least 8 weeks of prazosin treatment at their maximum titrated dose. The mean maximum prazosin dose achieved in these 36 patients was 9.6 +/- 0.9 mg/day. Recurrent distressing dreams scores also improved in the total group who filled their prazosin prescriptions (N = 51) (7.1 +/- 0.2 to 4.2 +/- 0.3, p <.0001). In a comparison group of 8 patients who did not fill their prazosin prescriptions but continued in outpatient treatment, there was no significant change in CAPS recurrent distressing dreams score (6.8 +/- 0.5 to 6.7 +/- 0.4). There also was at least some improvement in CGI-C ratings of overall PTSD severity exclusive of nightmares in a substantial majority of patients receiving prazosin, but not in the 8 comparison subjects. There were no serious adverse effects attributable to prazosin. CONCLUSION: These observations suggest that prazosin may relieve symptomatic distress in PTSD, and they provide rationale for placebo-controlled trials of prazosin for PTSD trauma content nightmares and other PTSD symptoms.

Adrenergic alpha-Antagonists↗
PubMed1987

Posttraumatic stress disorder among frontline soldiers with combat stress reaction: the 1982 Israeli experience.

One year after the 1982 Lebanon War, the authors assessed the prevalence, type, and severity of posttraumatic stress disorder in a large representative sample of Israeli soldiers who had been treated for combat stress reactions. Comparisons were made with a group of soldiers who had fought in the same battles but had not been treated for this reaction. A dramatically higher percentage of soldiers with combat stress reaction (59%) than of soldiers without combat stress reaction (16%) developed posttraumatic stress disorder. Age was significantly associated with posttraumatic stress disorder. The authors discuss the differential quality of posttraumatic stress disorder among both groups as well as the factors facilitating recovery.

Adolescent↗
PubMed1991

Combat stress reaction and changes in military medical profile.

This study examines changes in the military medical profile following participation in war. Two groups of Israeli soldiers who participated in the 1982 Lebanon War were studied: 360 soldiers who were treated for immediate combat stress disorder during the war, and a matched control group of 310 soldiers who participated in the same war and were not identified as combat stress reaction casualties. Significant lowering of the profile after the war was noted for both groups. These changes were much stronger for combat stress reaction casualties. The differences between the groups were especially pronounced with regard to the addition of the psychiatric impairment category to the military medical profile. No background characteristics differentiated between combat stress reaction casualties who lowered their profile and those who did not. The implications of the findings for further research and for military mental health policy are discussed.

Combat Disorders↗
PubMed1996

Cognitive processing in post-traumatic stress disorder.

Recent research has suggested an abnormal attentional bias to threat in anxiety disorders. We have assessed the processing of thoughts of trauma, panic attacks, general fear and positive affect in a cohort of 15 war veterans with post-traumatic stress disorder (PTSD) and an age- and sex-matched normal control group. Subjects with PTSD showed delayed processing of self-referential sentences when the themes of the sentences were traumatic experiences or positive affect, compared with controls. However, they were more efficient than control subjects in the processing of sentences describing situations of panic attacks and general fear. It would therefore appear that in patients with PTSD, cognitive processing is hindered by personally relevant themes of past traumatic experiences, whereas it may be facilitated by information related to general threat or internal body sensations of panic.

Adult↗
PubMed2006

Gulf War-related trauma and psychological distress of Kuwaiti children and their mothers.

The participants were 111 Kuwaiti boys and girls and 59 mothers assessed in 1993 and 2003 to determine exposure to war-related trauma during the Iraqi occupation and subsequent psychological distress. Children were classified into four groups based on what happened to their fathers during the occupation: killed, missing, arrested, or unharmed. The results indicate that the group whose fathers were arrested had the highest level of posttraumatic stress symptoms and the highest level of depression and anxiety in 2003. In 1993, the highest levels of depression for children and their mothers were observed in those whose fathers-husbands were killed or missing relative to controls. Long-term effects of war-related trauma in children may be influenced by the war experience of their fathers.

Age Factors↗
PubMed2001

GABA(A) receptor beta 3 subunit gene and psychiatric morbidity in a post-traumatic stress disorder population.

GABAergic systems have been implicated in the pathogenesis of anxiety, depression and insomnia. These symptoms are part of the core and comorbid psychiatric disturbances in post-traumatic stress disorder (PTSD). In a sample of Caucasian male PTSD patients, dinucleotide repeat polymorphisms of the GABA(A) receptor beta 3 subunit gene were compared to scores on the General Health Questionnaire-28 (GHQ). As the major allele at this gene locus (GABRB3) was G1, the alleles were divided into G1 and non-G1 groups. On the total score of the GHQ, which comprises the somatic symptoms, anxiety/insomnia, social dysfunction and depression subscales, patients with the G1 non-G1 genotype had a significantly higher score when compared to either the G1G1 genotype (alpha=0.01) or the non-G1 non-G1 genotype (alpha=0.05). No significant difference was found between the G1G1 and non-G1 non-G1 genotypes. When the G1 non-G1 heterozygotes were compared to the combined G1G1 and non-G1 non-G1 homozygotes, a significantly higher total GHQ score was found in the heterozygotes (P=0.002). These observations suggest a heterosis effect. Further analysis of GHQ subscale scores showed that heterozygotes compared to the combined homozygotes had higher scores on the somatic symptoms (P=0.006), anxiety/insomnia (P=0.003), social dysfunction (P=0.054) and depression (P=0.004) subscales. In conclusion, the present study indicates that in a population of PTSD patients, heterozygosity of the GABRB3 major (G1) allele confers higher levels of somatic symptoms, anxiety/insomnia, social dysfunction and depression than found in homozygosity.

Alleles↗
PubMed1993

Psychotherapy for Vietnam-related Posttraumatic Stress Disorder.

There are a wide range of psychotherapeutic treatments for Vietnam-related Posttraumatic Stress Disorder. This paper reviews some of the more commonly used interventions which are the behavioral, psychodynamic, family, and group therapies. Commonalities among these diverse treatments are shown to involve reconfronting trauma stimuli and the attempt to reintegrate traumatic experiences into ongoing personality functioning. It is shown that there are virtually no methodologically sound, empirically based studies that compare two or more treatments within a given study. Experimentally controlled, comparative studies are needed to advance our knowledge of effective treatments of this disorder.

Combat Disorders↗
PubMed2003

Reduced hippocampal volume in alcohol and substance naïve Vietnam combat veterans with posttraumatic stress disorder.

OBJECTIVE: This pilot study was undertaken to exclude the effects of alcohol and other substances on brain morphology in posttraumatic stress disorder. BACKGROUND: Posttraumatic stress disorder and alcohol use are among the conditions associated with decreased hippocampal volume. The possible confounding contribution of alcohol and other substances of abuse to decreased hippocampal volume in posttraumatic stress disorder has not been previously explored directly. METHOD: In this pilot study, magnetic resonance imaging scans of 4 substance naive subjects with combat-related posttraumatic stress disorder and of 4 controls were quantified. RESULTS: Bilateral hippocampal volumes were significantly smaller in posttraumatic stress disorder subjects. No significant differences were found between posttraumatic stress disorder subjects and the comparison group for total brain, gray and white matter, and ventricular volumes. CONCLUSIONS: These findings suggest that posttraumatic stress disorder in the absence of alcohol and other substance abuse may be associated with reduced hippocampal volume. The significance of reduced hippocampal volume in posttraumatic stress disorder is discussed.

Atrophy↗
PubMed2006

Remission from pathological gambling among Hispanics and Native Americans.

This community survey studied remission from pathological gambling (PG) among American Indian (AI) and Hispanic American (HA) veterans. Remission was defined as having a lifetime diagnosis of PG, but no gambling symptoms in the last year. Sample consisted of 1624 AI and Hispanic veterans. Instruments included demographic data, the computer-based algorithmic Quick Diagnostic Interview Schedule Symptom, and three symptom checklists, one each for substance related problems (MAST/AD), anxiety and depressive symptoms (BSI-57), and combat-related post-trauma symptoms (PCL/M). Remission was associated with absence of a current Axis 1 diagnosis, especially absence of a current post-traumatic stress disorder.

Adult↗
PubMed1994

[Psychiatric morbidity following psychic trauma of combat origin].

Psychiatric morbidity following trauma of combat origin was studied in 60 Israeli veterans who applied for treatment 4-6 years after the war in Lebanon. Diagnostic tools were structured interviews for psychiatric disorders. In all subjects multiple psychiatric disorders had been diagnosed, most of which developed following the traumatic experience. Post-traumatic stress disorder (PTSD) was the most prevalent condition (100%-ever; 87%-present). Comorbidity included major depression with a very high prevalence (95%-ever; 50%-present) and anxiety disorders: phobic disorder, obsessive-compulsive disorder, panic attacks and generalized anxiety (prevalence range 12-25%-ever and 8-18%-present). The prevalence of minor affective disorders (specifically alcoholism or drug abuse) was considerably less. These findings suggest a possible link between PTSD and depressive and anxiety disorders, beyond a mere sharing of common symptoms. They also support the diagnostic validity of PTSD as an independent nosologic category. In addition, the lack of specific pharmacotherapy for PTSD on the one hand and the high prevalence of depressive and anxiety comorbidity on the other, support a special focus on antidepressive and anxiolytic medication for PTSD.

Anxiety Disorders↗