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PubMed1982

Vietnam veterans. Their problems continue.

From August 5, 1964, the onset of the Vietnam War, until the official ending of the war, May 7, 1975, the Vietnam War tore at the fabric of American society. That tear has not yet been mended. Our nation as a whole has opposed thoughtful reflection about the Vietnam War, and our veterans continue to suffer its consequences. This article summarizes some of the national and psychological problems caused by the war. Special characteristics of the Vietnam War that contributed to these problems are discussed, and post-traumatic stress disorder is reviewed.

Combat Disorders↗
PubMed1995

Post-traumatic stress disorder. Does it exist?

Facing the inevitable, psychiatry formally acquired PTSD as a diagnostic entity in 1980. It then discovered that PTSD had a bevy of nasty laylegal relatives (e.g., disability and personal injury claims). In response, psychiatrists have been continuously trying to refine PTSD criteria. There have even been cogent arguments that psychiatrists should take their own forensic medicine and formally address legally relevant behavior in the DSM. In the meantime, prosecutors, defense attorneys, and adjudicators sometimes stretch and pull the DSM-III-R PTSD diagnosis beyond justifiable limits to try to fit square pegs of psychiatric testimony into round holes of legal rules. Ultimately, however, lawyers cannot be blamed for misusing the PTSD diagnosis because only clinicians can make it. Causal diagnosticians may fail to apply the requisite symptomatic criteria or do so only superficially. In their haste to eliminate bogus stress claims, clinicians should not throw out the baby (authentic PTSD) with the bathwater (idiosyncratic "stress" disorders and careless PTSD diagnoses).

Arousal↗
PubMedDate not supplied

Alteration of corticothalamic perfusion ratios during a PTSD flashback.

We performed a single photon emission computed tomography (SPECT) study of patients with posttraumatic stress disorder (PTSD) by measuring changes in regional cerebral blood flow (rCBF) during provocation by combat stimuli. A single patient experienced an actual flashback following exposure to combat sounds, exhibiting tearfulness, diaphoresis, tachypnea, and severe agitation. Results from his SPECT study demonstrated a dramatically altered ratio of cortical to subcortical perfusion during the flashback but not during the control scan. This altered pattern, which showed a peak of activity in the thalamus, was not consistent with global rCBF changes induced by hyperventilation. The perfusion pattern during the patient's control scan was qualitatively indistinguishable from any of the SPECT scans obtained for the other patients. This single case suggests a possible role for corticothalamic dysfunction in flashbacks.

Acoustic Stimulation↗
PubMed2005

Prevalence of psychotic comorbidity in combat-related post-traumatic stress disorder.

OBJECTIVE: We explored the prevalence of comorbidity of psychotic symptoms among Croatian war veterans with combat-related post-traumatic stress disorder (PTSD) and the psychotic features among these patients, as well as the association between psychotic symptoms and personality disorders. METHODS: The study included 680 men who had experienced combat stress and had diagnoses of PTSD confirmed before examination. They were compared with a group of 289 soldiers with combat experience under regular medical examination, who were still in active military service. The groups were matched in duration of combat experience, time elapsed between combat experience and the study, age, marital status, and education. Statistical analyses were performed using the t test and chi2 test. RESULTS: The study showed that 15% of war veterans had current chronic PTSD and 45% had PTSD with one or more comorbid diagnoses. Psychotic disorders with PTSD were confirmed for 17% of those patients and major depressive disorder with psychotic features for 15%. Depression and psychotic symptoms were more often found among patients without personality disorders. Also, we found that 9% of the war veterans who were still in active military service had some psychiatric disorders. CONCLUSIONS: Many patients demonstrated psychotic symptoms different from flashbacks and dissociative symptoms. Those psychotic symptoms are an integral part of PTSD and have a symbolic relation to the trauma.

Adult↗
PubMed1984

Factor-analytic support for DSM-III's post-traumatic stress disorder for Vietnam veterans.

Found substantial support for DSM-III's criteria for Post-Traumatic Stress using 405 Vietnam combat veterans. The results also suggested that some additional symptoms such as depression and anger be included as major signs, especially when one is dealing with Vietnam veterans. A comparison of symptom intensity was made between Vietnam veterans and non-Vietnam veterans. The results of the second study showed that Vietnam veterans attested to experiencing significantly greater intensities of DSM-III criteria behaviors than did non-Vietnam veterans. However, no significant differences were found for symptoms related to depression.

Combat Disorders↗
PubMed2003

Ambulatory monitoring and physical health report in Vietnam veterans with and without chronic posttraumatic stress disorder.

This study investigated the associations among PTSD, ambulatory cardiovascular monitoring, and physical health self-reports in 117 male Vietnam combat veterans (61 with PTSD and 56 without PTSD). PTSD was associated with health symptoms and number of current health conditions beyond the influence of several covariates. PTSD was associated with greater systolic blood pressure variability, and an elevated percentage of heart rate and systolic blood pressure readings above baseline. Higher mean heart rate and an elevated percentage of heart rate above baseline were associated with physical health symptoms. None of the ambulatory monitoring variables mediated the association between PTSD and physical health outcomes. Findings suggest that the interrelationships among ambulatory autonomic responses, PTSD, and physical health deserve more research attention.

Blood Pressure↗
PubMed1984

Post-Traumatic Stress Disorder and substance abuse in Vietnam combat veterans: treatment problems, strategies and recommendations.

Post-Traumatic Stress Disorder (PTSD) rarely presents as a discrete diagnostic entity. Frequently, PTSD is accompanied by substance abuse, somatoform, and/or affective disorders. This article focuses on the interplay of PTSD and substance abuse in Vietnam combat veterans. PTSD symptoms, assessment and diagnostic difficulties, treatment strategies and recommendations are discussed. The role of substance abuse should be determined before initiating treatment. Substance abuse may suppress, exacerbate or perpetuate PTSD symptoms. Substance-free combat veterans, veterans who use substances to self-medicate PTSD symptoms, and chronic substance abusers can be differentiated. Treatment goals and strategies differ for each group. Case histories, intake procedures and treatment recommendations conclude this article. To conform with APA guidelines (1983) for non-sexist language and to avoid ambiguity of reference, it should be stated that all of the information in this paper came from or relates to male Vietnam combat veterans. It is truly unfortunate that so little is known about the role of females in the Vietnam conflict. The authors, who are themselves Vietnam veterans, have interviewed or treated more than 2,000 combat veterans and their families and have found that 80% of the veterans seen have had alcohol related problems. The information in this paper is largely drawn from the authors' personal experiences, that of co-professionals with whom they have worked, and from the direct experiences of patients who have been treated by the authors.

Adult↗
PubMed1996

Interpersonal and self-reported hostility among combat veterans with and without posttraumatic stress disorder.

The present study investigated self-reported and interpersonal hostility in 70 Vietnam combat veterans with and without posttraumatic stress disorder (PTSD) and 60 comparison community volunteer subjects. Veterans were 50 help-seeking, male Vietnam combat veterans with PTSD and 20 non-help-seeking male combat veterans without PTSD. Vietnam veterans with PTSD not only reported more hostility than non-PTSD veterans and healthy community volunteers, but also reacted behaviorally with more hostility during an interpersonal interaction. Compared to veterans without PTSD, veterans with PTSD reported significantly higher levels of hostility and demonstrated significantly greater non-verbal expressions of hostility during an interpersonal task. These results suggest that the level of hostility in PTSD combat veterans may be high as compared to comparison groups. The implications of these results and possible research directions are presented.

Case-Control Studies↗
PubMed1995

Clinical characteristics of delayed and immediate-onset combat-induced post-traumatic stress disorder.

The aim of the current study is to examine the clinical characteristics of war-related disturbances among veterans with delayed and immediate-onset post-traumatic stress disorder (PTSD). One hundred twenty-five veterans who sought help for war-related disturbances, 8 years after the 1982 Lebanon War, filled out the PTSD Inventory, Impact of Event Scale, and SCL-90. Their scores were compared with those of 370 treated combat stress reaction casualties who filled out the questionnaires a year after the same war. Findings indicate that veterans from the delayed-helpseeking group suffer from a higher rate (92 vs. 59%) and a greater intensity of PTSD, more intrusive tendencies, and more severe general psychiatric symptomatology than those of the immediate-helpseeking group. These findings indicate that a fair number of combatants still seek help for war-related disturbances almost a decade after the war. The complex relationship between delayed-helpseeking and delayed-onset PTSD is discussed.

Adult↗