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PubMed1999

Rapid eye movement sleep changes during the adaptation night in combat veterans with posttraumatic stress disorder.

BACKGROUND: Hyperarousal in posttraumatic stress disorder (PTSD) is manifested during sleep as well as waking. Elevated rapid eye movement sleep (REMS) phasic activity, likely signifying central nervous system alerting, has been identified in PTSD. The authors reasoned that PTSD compared to control subjects would show particularly increased REMS phasic activity on the first night of polysomnography, with adaptation to a novel environment. METHODS: First-night polysomnograms of 17 veterans with PTSD were compared with those of 11 control subjects. Sleep was also studied in subsets of both groups over two nights. RESULTS: On the first night, the PTSD subjects had a higher density of rapid eye movements in the first REMS period. This measure was increased on the first compared to the second night, but there was no interaction effect between night and group. CONCLUSIONS: REMS changes are again demonstrated in veterans with PTSD. Introduction to a novel environment activated a REMS phasic process, but not differentially in PTSD compared to control subjects.

Adaptation, Physiological↗
PubMed1999

Symptom structure and psychiatric comorbidity of combat-related post-traumatic stress disorder.

The placement of the diagnostic category of post-traumatic stress disorder (PTSD) among anxiety disorders reflects the recognition that anxiety is a predominant reaction to trauma. Indeed, the symptoms of PTSD overlap considerably with those of other anxiety disorders. The nosological criteria render PTSD as quite a heterogeneous diagnosis. Two individuals with no common symptoms can be diagnosed as having PTSD. In this report we provide information on the phenomenology and psychiatric comorbidity in a sample of 33 patients with combat-related PTSD. The finding of clinical heterogeneity in subjects with combat-related PTSD and the therapy implications are discussed.

Adult↗
PubMed1999

Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder.

BACKGROUND: Psychotic symptoms may be present in up to 40% of patients with combat-related posttraumatic stress disorder (PTSD). In this study, we hypothesized that severity of psychotic symptoms would also reflect severity of PTSD symptoms in patients with well-defined psychotic features. METHODS: Forty-five Vietnam combat veterans with PTSD but without a primary psychotic disorder diagnosis underwent a Structured Clinical Interview for DSM-III-R with Psychotic Screen, and the Clinician Administered PTSD Scale (CAPS). Patients identified as having psychotic features (PTSD-P), (n = 22) also received the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale (HDRS). RESULTS: There was a significant positive correlation between the CAPS and PANSS global ratings (p < .001) and the HDRS and PANSS (p < .03) in the PTSD-P patients. Many CAPS and PANSS subscales also demonstrated significant intercorrelations; however, the CAPS-B subscale (reexperiencing) and the PANSS positive symptom scale were not correlated, suggesting that psychotic features may not necessarily be influenced or accounted for by more severe reexperiencing symptoms. Fifteen (68%) of the PTSD-P patients had major depression (MDD). Both CAPS and PANSS ratings were significantly higher in the PTSD-P patients with comorbid MDD. CONCLUSIONS: As postulated, patients with more severe psychosis ratings are likely to have more severe PTSD disease burden if psychotic features are present. This study further documents the occurrence of psychotic features in PTSD that are not necessarily due to a primary psychotic disorder, suggesting that this may be a distinct subtype; however, a significant interaction likely exists between PTSD, depression, and psychotic features.

Behavioral Symptoms↗
PubMed1997

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans.

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.

Chronic Disease↗
PubMed2003

Hazardous alcohol use and treatment outcome in male combat veterans with posttraumatic stress disorder.

The relationship between alcohol problems and posttraumatic stress disorder (PTSD) remains unclear. Six hundred and eight combat veterans diagnosed with PTSD were assessed for PTSD symptoms and alcohol problems prior to group cognitive-behavioral treatment. They were reassessed 3 and 9 months after treatment. Participants were classified into low-risk and hazardous drinkers at each time point. Drinking status at intake did not predict PTSD symptoms at intake or follow-up. However, drinking status was associated with PTSD symptoms when both were assessed at follow-up. PTSD arousal symptoms were the only symptom cluster to differentiate drinking groups.

Alcoholism↗
PubMed2003

Comorbid alcohol addiction increases aggression level in soldiers with combat-related post-traumatic stress disorder.

The aim of this study was to compare aggressive behavior in soldiers with combat-related post-traumatic stress disorder (PTSD), PTSD comorbid with alcohol addiction and alcohol addiction only. Three groups of male combat experienced soldiers with PTSD (n=43), PTSD comorbid with alcohol addiction (n=41) and alcohol addiction (n=39) were compared by Aggression rating scale A-87. PTSD was diagnosed according to DSM-IV criteria and Watson's PTSD rating scale. Alcohol addiction was diagnosed according to DSM-IV criteria and CAGE Questionnaire. Combat-experienced soldiers with alcohol addiction as well as soldiers with combat-related PTSD comorbid with alcohol addiction have a high level of verbal latent aggression (VLA), (F=26.65; P<0.001), physically latent aggression (PLA), (F=37.86; P<0.001), indirect aggression (INA), (F=56.94; P<0.001), verbal manifest aggression (VMA), (F=18.35; P<0.001), and physically manifest aggression (PMA), (F=43.22; P<0.001), vs. soldiers with combat-related PTSD without comorbid conditions. Alcohol addiction is a severe factor in increasing aggression levels in soldiers with PTSD.

Adult↗
PubMed1987

Five psychosocial variables related to the existence of post-traumatic stress disorder symptoms.

Sixty Vietnam veterans from a midwestern VA Medical Center were surveyed to determine the relationship between symptoms of Post-Traumatic Stress Disorder (PTSD) and five psychosocial variables: Intensity of combat experienced in Vietnam, current subjective impact of the previously experienced stress of Vietnam experiences, current level of life stress, extent and nature of social support available to the veteran during the first year of return from Vietnam, and pre-service psychosocial functioning. A stepwise discriminant function analysis revealed that combat intensity, current impact of the previously experienced events in Vietnam, and current level of life stress correctly classified 75% of the total cases. These findings were supported by other lines of analyses, including tests of correlation and stepwise regression analysis. Current levels of life stress, especially disruption in interpersonal relationships, also were associated significantly with PTSD symptoms. These findings are consistent with previous reports on the etiology and correlates of PTSD symptoms and suggest the existence of a quantifiable constellation of symptoms associated with psychological sequelae of severely stressful trauma.

Adult↗
PubMed2000

Hispanic ethnicity and risk for combat-related posttraumatic stress disorder.

Hispanic veterans are said to exhibit higher risk of developing posttraumatic stress disorder (PTSD) than veterans of other racial/ethnic backgrounds. This prediction is based largely on findings from the National Vietnam Veterans Readjustment Study (NVVRS; R. A. Kulka et al., 1990a, 1990b). This article first summarizes the findings of the NVVRS with regard to race/ethnicity and PTSD, and then it makes a careful assessment of both the external and the internal validity of these findings. Conceptual issues are addressed and, where possible, further analyses of the NVVRS data set are conducted to identify factors that account for ethnic differences in rates of the disorder. Possible mediators of the effects of Hispanic ethnicity on vulnerability to PTSD are identified, including psychosocial factors (racial/ethnic discrimination and alienation) and sociocultural influences (stoicism and normalization of stress, alexithymia, and fatalism). Areas in which future research is needed are indicated.

Confounding Factors, Epidemiologic↗
PubMed1985

Posttraumatic stress disorder: a thirty-year delay in a World War II veteran.

Some clinicians doubt the validity of a diagnosis of delayed posttraumatic stress disorder for Vietnam veterans. Precombat psychopathology, drug abuse, factitious symptoms, and malingering in pursuit of disability compensation are cited as alternative explanations for the syndrome. The authors discuss the case of a much decorated World War II veteran whose symptoms of posttraumatic stress disorder first occurred more than 30 years after combat. They consider the alternative explanations for his symptoms to be inadequate.

Combat Disorders↗
PubMed2005

Clinical presentations and treatment outcomes of peacekeeper veterans with PTSD: preliminary findings.

OBJECTIVE: Despite evidence of potential psychiatric sequelae following peacekeeping operations, no data have appeared on treatment outcome for this population. This study examined intake and treatment outcome data for a group of peacekeepers with posttraumatic stress disorder (PTSD). METHOD: Participants were 63 Australian Vietnam veterans and 66 Australian peacekeepers attending specialized PTSD treatment units. Measures of PTSD, depression, anxiety, alcohol use, and anger were obtained at intake and 3-month follow-up. RESULTS: PTSD scores were more severe for peacekeepers than Vietnam veterans at intake, primarily in reexperiencing symptoms. In terms of comorbidity, only anger was higher among peacekeepers. No differences were apparent in treatment outcome. Initial anger predicted change in PTSD severity for peacekeepers. CONCLUSIONS: The finding of differences between peacekeepers and Vietnam veterans in anger and reexperiencing symptoms, in addition to the attenuating role of anger on treatment outcome, suggests that modification to standard PTSD treatment models may be warranted for peacekeepers.

Adult↗
PubMed1986

Use of a metaphor in the treatment of combat-induced posttraumatic stress disorder.

In this case of posttraumatic stress disorder, instead of interpretation, we used a metaphor that was indirectly yet concretely related to the patient's trauma. It subsequently became a symbol for other crucial events and situations in the patient's life. Mann's original approach to this type of patient had to be modified since the traumatic experience was not only too painful and isolated but also untouchable. The use of metaphor was thus a viable, indirect approach. Matching the metaphor to the therapeutic situation of patients with severe trauma, makes successful treatment possible where other approaches are excessively painful or almost impossible. The use of metaphor offers a solution to the therapeutic dilemma of too much resistance to brief therapy versus dependency-inducing long-term therapy for the patient suffering from posttraumatic stress disorder.

Adult↗
PubMed1987

Combat stress reactions, post traumatic stress disorder and somatic complaints among Israeli soldiers.

This study examined the effect of combat stress on somatic health in a sample of 804 Israeli soldiers. Three groups of subjects were assessed: combatants who did not participate in the Lebanon War, combatants who fought and suffered from combat stress reactions, and combatants who participated in the Lebanon War but did not sustain psychiatric injury. One year following the war subjects were asked to report somatic complaints and were screened for post-traumatic stress disorder. Results indicated that participation in combat per se did not have pathogenic effects. However, combat stress reactions and post-traumatic stress disorder were found to be associated with somatic complaints. The practical and theoretical implications of these findings are discussed.

Adult↗