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PubMed2000

An investigation of the impact of posttraumatic stress disorder on physical health.

In a large sample of Gulf War veterans (N = 2301) we examined the relations between PTSD symptoms assessed immediately upon returning from the Gulf War and self-reported health problems assessed 18-24 months later. PTSD symptomatology was predictive of self-reported health problems over time for both men and women veterans, even after the effects of combat exposure were removed from the analysis. Female veterans reported significantly more health problems than male veterans, however, there was no interactive effect of gender and PTSD on health problems. These findings provide further support for the theory that psychological response to stressors impacts health outcome.

Adult↗
PubMedDate not supplied

[Clinical, pathophysiological and morphological features of closed craniocerebral trauma in combatants].

We studied clinicodynamic features of neuropsychic disorders resultant from a combat craniocerebral trauma (CCT) in patients of Nizhny Novgorod Regional Neurological Hospital for War Veterans (n = 420). The patients were divided into three groups: with mild, moderate and severe traumas. All the patients were examined clinically and clinicophysiologically (electroencephalography, computer tomography, electrocardiography, ultrasound and X-ray investigations). Experimental-psychological tests and questionnaire survey were alsom conducted. 200 patients had been followed up for 3-7 years. Impairment of brain stem structures and vascular factor play a key role in development of psychopathological disorders of primary asthenic and neurosis-like spectrum. Local lesion of the brain in severe CCT leads to predominant manifestations of the psychoorganic syndrome in milder symptoms of poststress disorders.

Adult↗
PubMed1996

Complex posttraumatic stress disorder: an exploratory investigation of PTSD and DES NOS among Dutch war veterans.

The recently developed concept Disorder of Extreme Stress Not Otherwise Specified (DES NOS) or complex posttraumatic stress disorder (complex PTSD) is designed to encompass long-standing symptoms not present in PTSD. An exploratory investigation of PTSD and DES NOS was performed with the Structured Clinical Interview for PTSD and for DES NOS in a small sample of Dutch war veterans with combat experience. Both PTSD and DES NOS symptoms were frequently reported. About 67% of the veterans met criteria for PTSD and 38% met criteria for DES NOS. DES NOS appeared to be associated with PTSD. Several DES NOS subcategories proved more important than others for distinguishing "simple" PTSD from complex PTSD.

Aged↗
PubMed1999

D-fenfluramine challenge in posttraumatic stress disorder.

BACKGROUND: Much progress has been made in understanding the role of catecholamines in the pathophysiology of posttraumatic stress disorder (PTSD). Recent research has broadened the scope of neuroregulation of PTSD to include serotonin. METHODS: We used the serotonin-releasing agent and reuptake inhibitor, d-fenfluramine, to assess the integrity of the serotonin-mediated prolactin release in 8 men with combat-induced PTSD and 8 healthy men. RESULTS: The veterans with PTSD had a significantly lower prolactin response to d-fenfluramine as compared to healthy control subjects. The prolactin response to d-fenfluramine was inversely correlated with the patient's level of PTSD symptomatology and measures of aggression. CONCLUSIONS: This study demonstrates a central serotonin dysfunction, as reflected in a lower prolactin response to d-fenfluramine, in patients with PTSD.

Analysis of Variance↗
PubMed1998

Psychological benefits and liabilities of traumatic exposure in the war zone.

Data from the National Vietnam Veterans Readjustment Study on 1,198 Vietnam theater veterans were used to examine the psychological benefits and liabilities of traumatic exposure in the war zone. Psychological benefits and liabilities were found to be largely independent of one another and to be related positively to the dose of traumatic exposure. Additionally, there was a curvilinear trend in the form of an inverted U, such that psychological benefits, most notably solidarity with others, were stronger at intermediate compared to high and low levels of exposure. Psychological benefits counteracted and psychological liabilities passed through the effects of traumatic exposure on posttraumatic stress disorder (PTSD). The psychological benefit of self-improvement moderated the effects of the psychological liability of self-impoverishment on PTSD.

Adaptation, Psychological↗
PubMedDate not supplied

'Low intensity' war and mental trauma in Nicaragua: a study in a rural community.

'Low intensity' warfare, with its key psychological element, aimed to terrorize the rural population of Nicaragua during the 1980s. A survey of ex-refugees still living in the war zone revealed 62% of men and 91% of women as 'cases' of psychological disturbance on the General Health Questionnaire. Somatization was central to the subjective experience and communication of the distress caused by the Contra war. Sustained sleep disturbance, hyperalertness and other anxiety-based symptomatology and poor concentration were very common and were exacerbated by war-related cues. 25% of men and 50% of women merited a diagnosis of posttraumatic stress disorder. Some distress reflected unresolved grief states. The longer term mental and social costs of terrorization have been insufficiently documented in the Third World.

Adolescent↗
PubMedDate not supplied

Military TBI during the Iraq and Afghanistan wars.

Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Lessons learned from the sports concussion and civilian mild TBI literature are useful. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.

Afghanistan↗
PubMed1998

Hospital utilization and personality characteristics of veterans with psychiatric problems.

OBJECTIVE: The relationship between hospital utilization and psychometric, demographic, and diagnostic data was examined among veterans with psychiatric problems. METHODS: Data were obtained from the records of 500 psychiatric inpatients admitted to a Veterans Affairs medical center between 1984 and 1987 and followed for four years. All patients completed the Minnesota Multiphasic Personality Inventory, the California Personality Inventory, the Millon Clinical Multiaxial Inventory, and the Psychological Inventory of Personality and Symptoms. Stepwise linear regression analysis was used to predict the number and length of inpatient stays, and Cox and logistic regression analyses predicted rehospitalization. RESULTS: Higher rates of psychiatric hospital utilization were found among patients who were unmarried, who had disabilities connected with their military service, who had lower levels of adaptive functioning, and who were diagnosed as having posttraumatic stress disorder, drug or alcohol use disorder, or passive-aggressive or antisocial personality disorder. Higher utilization was also found among those whom psychometric data characterized as less responsible and more compulsive. The data also predicted the length of subsequent medical hospitalization and identified patients who stayed out of the hospital longer and who were not rehospitalized. CONCLUSIONS: Hospital utilization was found to be a function of psychiatric diagnosis, marital status, and various personality factors. Factors relating to social disadvantage also played a role. Axis I diagnoses, particularly substance use disorders, were as important as, if not more important than, axis II diagnoses in predicting utilization.

Adult↗
PubMed2004

PTSD and coping resources among survivors of a kamikaze attack: the role of character strength.

33 survivors of the U.S.S. Emmons (M age=79.7 yr., SD=2.3), which was sunk by kamikaze attacks during World War II, were given an adapted form of the Posttraumatic Stress Disorder Checklist-Civilian and a set of questions regarding 8 coping resources they may have used during the war. Participants were categorized into three groups: those who served on the Emmons at any given time during World War II (Any Service), those who experienced combat while aboard the Emmons or another ship during World War II (Any Combat), and those who were serving on board the Emmons when it was sunk during the battle for Okinawa island (Okinawa). Analyses using a one-tailed Spearman rank-order correlation indicated that scores on only one coping resource, Character Strength, were significantly correlated with lower symptoms of PTSD for all three groups (Any Service: r(s) = -.46, p<.01; Any Combat: r(s)= -.47, p<.01; Okinawa: r(s)=-.45, p<.05). The findings suggest that, for the survivors of the Emmons, psychological qualities, not social influences, were associated with a lower risk for developing PTSD.

Adaptation, Psychological↗
PubMed2006

A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder.

BACKGROUND: Excessive brain responsiveness to norepinephrine appears to contribute to post-traumatic stress disorder (PTSD), particularly at night. Prazosin, a brain active alpha-1 adrenergic receptor antagonist, significantly reduced trauma nightmares and sleep disturbance in 10 Vietnam War combat veterans in a previous placebo-controlled crossover study. The current parallel group trial in a larger sample of veterans evaluated prazosin effects on trauma nightmares, sleep quality, global clinical status, dream characteristics, and comorbid depression. METHODS: Forty veterans (mean age 56 +/- 9) with chronic PTSD and distressing trauma nightmares and sleep disturbance were randomized to evening prazosin (13.3 +/- 3 mg/day) or placebo for 8 weeks. RESULTS: In the evaluable sample (n = 34), primary outcome measures demonstrated that prazosin was significantly superior to placebo for reducing trauma nightmares and improving sleep quality and global clinical status with large effect sizes. Prazosin shifted dream characteristics from those typical of trauma-related nightmares toward those typical of normal dreams. Blood pressure changes from baseline to end study did not differ significantly between prazosin and placebo. CONCLUSIONS: Prazosin is an effective and well-tolerated treatment for trauma nightmares, sleep disturbance and global clinical status in veterans with chronic PTSD.

Adrenergic alpha-Antagonists↗
PubMed2006

Examining the uniqueness of frequency and intensity symptom ratings in posttraumatic stress disorder assessment.

Data from two studies are presented, investigating the relative effectiveness of posttraumatic stress disorder (PTSD) symptom frequency and intensity rating dimensions, in assessing overall PTSD severity and diagnosis. We assessed frequency and intensity ratings using 1) the Modified PTSD Symptom Scale with 298 trauma-exposed college students, and 2) the Clinician-Administered PTSD Scale with 130 combat-exposed military veterans. Results demonstrated little empirical justification for separating frequency and intensity ratings when measuring PTSD. Large overlaps in variance were evidenced between the dimensions (suggesting construct redundancy), with little meaningful contribution to diagnosing PTSD using one dimension over the other. Implications for future PTSD clinical and research assessment are discussed, including the potential to decrease administration time for these commonly used PTSD measures, given their time-consuming nature.

Adolescent↗
PubMed1991

Characterization of depression in war-related posttraumatic stress disorder.

OBJECTIVE: Many patients with posttraumatic stress disorder (PTSD) have symptoms of depression, but operationalized psychological constructs related to depression have not been used extensively in characterizing affective symptoms of PTSD. The authors' objective is to better characterize the affective component of PTSD. METHOD: The subjects were 45 male psychiatric inpatients at a Veterans Administration medical center; 28 met DSM-III-R criteria for PTSD and 17 met Research Diagnostic Criteria (RDC) for major depressive disorder. All of the subjects with PTSD were Vietnam veterans. The 21-item Hamilton Rating Scale for Depression was used to assess state measures of symptom severity, and the Depressive Experiences Questionnaire was used to measure dimensions of dependency, self-criticism, and self-efficacy. RESULTS: The mean total Hamilton scale score of the patients with PTSD was nonsignificantly higher than that of the patients with major depressive disorder; patients with PTSD had higher scores on almost all individual Hamilton symptoms, particularly insomnia, somatic anxiety, and diurnal variation. Patients with PTSD had significantly higher scores on the self-criticism scale but not on the dependency and self-efficacy scales of the Depressive Experiences Questionnaire. The scores of patients with PTSD on the dependency and self-criticism scales were negatively correlated. No significant differences between patients with PTSD with and without concurrent major depressive disorder were observed. CONCLUSIONS: Characterization of such depressive dimensions of PTSD as dependency and self-criticism may have important clinical implications.

Adult↗
PubMed1996

Increased pituitary activation following metyrapone administration in post-traumatic stress disorder.

Our previous findings have demonstrated that individuals with post-traumatic stress disorder (PTSD) show lower basal cortisol levels, a larger number of lymphocyte glucocorticoid receptors, and an enhanced suppression of cortisol following the administration of dexamethasone compared to normals and patients with major depression. We have previously suggested that these alterations reflect an enhanced negative feedback inhibition of the hypothalamic-pituitary-adrenal (HPA) axis in PTSD. However, in the absence of direct knowledge of pituitary capability in this disorder, it has been equally likely that the alterations observed reflected either pituitary or adrenal insufficiency. In the present study, we examined ACTH release from the pituitary gland in PTSD following the administration of metyrapone. Metyrapone resulted in a significantly greater increase of ACTH and 11-deoxycortisol in combat veterans with PTSD (n = 11) compared with normal male volunteers (n = 8). When seen in the context of other abnormalities observed in PTSD, the present demonstration of increased pituitary activity in the absence of negative feedback provides unequivocal support for the hypothesis of enhanced negative feedback.

Adrenocorticotropic Hormone↗
PubMed2003

Genetics of posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder marked by behavioral, physiologic, and hormonal alterations. PTSD is disabling and commonly follows a chronic course. The etiology of PTSD is unknown, although exposure to a traumatic event constitutes a necessary, but not sufficient, factor. A twin study of Vietnam veterans has shown significant genetic contribution to PTSD. The fact that PTSD's underlying genotypic vulnerability is only expressed following trauma exposure limits the usefulness of family-based linkage approaches. In contrast to the other major psychiatric disorders, large studies for the search of underlying genes have not been described in PTSD to date. Complementary approaches for locating involved genes include association-based studies employing case-control or parental genotypes for transmission dysequilibrium analysis and quantitative trait loci studies in animal models. Identification of susceptibility genes will increase our understanding of traumatic stress disorders and help to elucidate their molecular basis. The current review provides an up-to-date outline of progress in the field of PTSD.

Animals↗
PubMed1987

Folie à famille: shared paranoid disorder in a Vietnam veteran and his family.

Reports of folie à famille are rare; this may be the first reported case involving a Vietnam veteran. Expression of his paranoid schizophrenia involved delusions and hallucinations relating to Vietnam, and his wife and children shared his paranoia. Typical of folie à famille were the dominant family member, the threat of violence, and the family's social isolation, frequent crises, and stable membership. Although the veteran's intrusive recollections of his Vietnam experience were typical of posttraumatic stress disorder, he acted on rather than avoided them. Treatment focused on the entire family, partly to minimize future problems in the children.

Adolescent↗
PubMed1982

Alcoholism in black Vietnam veterans: symptoms of posttraumatic stress disorder.

A definitive diagnosis of a posttraumatic stress disorder in black Vietnam veterans can be made when recognition is given, not only to the stressors of war but to racism. An aftermath of the war for black veterans has been an alarming increase in alcoholism, believed to be an attempt to reduce feeling of inadequacy, pessimism, and uncontrollable rage.Two cases are described that are illustrative of the posttraumatic stress disorder and alcoholism in black Vietnam veterans. A brief discussion of salient issues that are crucial to diagnosis and treatment is presented.

Adult↗
PubMed2003

Risk factors for course of posttraumatic stress disorder among Vietnam veterans: a 14-year follow-up of American Legionnaires.

Risk factors affecting the course of posttraumatic stress disorder (PTSD) are poorly understood. As part of a larger study on characterizing exposure to herbicides in Vietnam, the authors investigated this issue in a random sample of 1,377 American Legionnaires who had served in Southeast Asia during the Vietnam War and were followed over a 14-year period. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression symptoms at Time 1, and more anger at Time 1 predicted a more chronic course. Community involvement at Time 1 was protective and associated with decreased risk at Time 2. Discomfort in disclosing Vietnam experiences was associated with an increased risk for developing PTSD but did not predict its course. Combat exposure predicted PTSD course more strongly than any other risk factor. Findings suggest recovery from PTSD is significantly influenced by perceived social support.

Adult↗
PubMed1985

Do Vietnam veterans suffer from toxic neurasthenia?

This paper evaluates the claim that Vietnam veterans with psychiatric disorders are suffering from toxic neurasthenia--a neurasthenic syndrome caused by exposure to pesticides while serving in Vietnam.

2,4,5-Trichlorophenoxyacetic Acid↗