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PubMed1980

Management of violent patients in a psychiatry walk-in clinic.

The authors discuss a systems approach for managing violent psychiatric outpatients. Multiple care-giving and brief, as needed visits within an outpatient walk-in clinic setting can provide empathic care for those violent patients who become too threatened by the intimacy of individual therapy, and who often reject treatment. The walk-in clinic can provide the violent patient and his therapist sufficient "distance" from each other, so that excessive transference and countertransference reactions--which can lead to acting out and violence--are diluted. Case vignettes illustrate how the walk-in clinic can treat violent patients falling under a variety of diagnoses, and prepare them for eventual acceptance of more traditional therapies. This approach may assist community clinics who are increasingly involved in the treatment of violent patients.

Adult↗
PubMed2006

Platelet serotonin in combat related posttraumatic stress disorder with psychotic symptoms.

BACKGROUND: Combat-related posttraumatic stress disorder (PTSD) is severe form of PTSD, frequently associated with psychotic symptoms. Platelet serotonin (5-hydroxytryptamine, 5-HT) was used as a peripheral 5-HT marker to identify particular symptoms in PTSD. METHODS: Platelet 5-HT was determined fluorimetrically in 67 war veterans with combat related PTSD, 36 combat exposed veterans who did not develop PTSD, 35 veterans with PTSD complicated with psychotic features. PTSD diagnosis of current and chronic PTSD, and clinical symptoms of PTSD and psychoses were assessed according to DSM-IV criteria, using the Clinician Administrated PTSD Scale, and Positive and Negative Syndrome Scale (PANSS). RESULTS: Platelet 5-HT concentration was significantly higher in veterans with psychotic PTSD than in veterans with non-psychotic PTSD, veterans without PTSD, or in control subjects. Platelet 5-HT was significantly positively correlated with the positive symptoms in PANSS subscale, and with the symptoms of delusions within PANSS positive subscale. LIMITATIONS: The results were obtained on peripheral 5-HT marker, i.e. platelet 5-HT concentration. CONCLUSIONS: Since the delusions are the core psychotic symptoms occurring in our psychotic PTSD patients, the result of the increased platelet 5-HT concentration, associated with delusions, indicate that platelet 5-HT might be used as a trait marker of psychotic symptoms in PTSD, but not as a state marker for PTSD.

Adult↗
PubMed1993

A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder.

Eighteen chronic post-traumatic stress disorder (PTSD+) combat veterans were administered nalmefene, a non-FDA approved oral opiate antagonist, based on the hypothesis that emotional numbing is an opiate-mediated phenomenon. Eight veterans showed a favorable response with a marked decrease of emotional numbing and other symptoms of PTSD, including startle response, nightmares, flashbacks, intrusive thoughts, rage and vulnerability. Veterans who responded favorably to the drug demonstrated a waxing and a waning of positive and negative PTSD symptoms with a general improvement in all these symptoms at higher nalmefene dosages. Case descriptions highlight some of the many changes veterans experienced on nalmefene dosage increases.

Adult↗
PubMed2002

Neuropsychological findings in combat-related posttraumatic stress disorder.

Previous research investigating whether combat-related Posttraumatic Stress Disorder (PTSD) is associated with impaired neuropsychological functioning has yielded inconsistent findings. The present study addressed many methodological limitations of previous research. Neuropsychological measures of intellectual ability, learning, memory, attention, visuospatial ability, executive functioning, language, and psychomotor speed were compared in four groups of early middle-aged community dwelling veterans. The four demographically comparable groups were: (a) those with current PTSD symptoms (n=80); (b) those with a prior history of PTSD but not currently experiencing active PTSD symptoms (n=80); (c) a non-PTSD psychiatrically matched control group (n=80); and (d) a normal control group (n=80). Results indicated that the four groups did not statistically differ on the neuropsychological measures and that veterans with PTSD perform similarly to demographically matched controls. Results further suggested that the cognitive difficulties previously linked to PTSD may actually have been secondary to preexisting individual differences or other clinical conditions coexisting with PTSD.

Adult↗
PubMed1996

Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: findings and clinical implications.

Several clinical studies suggest that individuals with posttraumatic stress disorder (PTSD) experience neuroendocrine system alterations, resulting in significantly lower plasma cortisol. To test this hypothesis, morning serum cortisol was compared among a national sample of Vietnam "theater" veterans (n = 2,490) and a sample of Vietnam "era" veterans (n = 1,972) without service in Vietnam. Analysis of covariance was used to compare cortisol concentrations after adjusting for 9 covariates (education, income, race, age, smoking status, alcohol use, illicit drug use, medication use, and body mass index). Adjusted cortisol was lower among theater veterans with current PTSD but not era or theater veterans with lifetime PTSD. Among theater veterans, cortisol was inversely related to combat exposure, with veterans exposed to heavy combat having the lowest concentrations. Analysis of plasma cortisol, together with other clinical data, may be instrumental in the future diagnosis and treatment of stress disorders.

Adult↗
PubMed1986

Which Vietnam veterans develop posttraumatic stress disorders?

Fifty Vietnam combat veterans diagnosed PTSD were compared with 50 controls, who were also combat veterans. The two groups were evaluated with a structured interview, and assessments were made of childhood and family histories, immediate preservice experiences, combat experiences, and postdischarge experiences. The two groups differed significantly in the intensity of their combat experiences and their perceptions of their homecoming experiences. Neither early history nor immediate preservice factors differentiated the two groups.

Adaptation, Psychological↗
PubMed1996

Personality scales as predictors of older combat veterans with posttraumatic stress disorder.

The sparse literature on Posttraumatic Stress Disorder among older combat veterans has not explored individual personality styles. 120 older combat veterans who were treatment-seeking in medical and psychiatric outpatient clinics, were assessed whether two personality styles (identified in other research as potentially reflective of PTSD) added to the problems of PTSD beyond the information associated with the stressors of combat and aging. Analyses indicated that the personality style, Sensitivity, was significantly related to PTSD beyond these other factors.

Aged↗
PubMed2000

Interactive psychoeducational group therapy in the treatment of authority problems in combat-related posttraumatic stress disorder.

The use of Interactive Psychoeducational Group Therapy to ameliorate authority problems of veterans with combat-related posttraumatic stress disorder is described. Despite the common occurrence of authority problems in this population, and the degree of damage they have caused in family, work, and legal domains, they are rarely specifically targeted by treatment interventions. A conceptual framework linking psychological trauma with distortions in authority relations is presented, followed by the format, procedures, and case examples of this form of group therapy. By uncovering the distorted beliefs associated with traumatic schemas as they emerge in the group interaction, the group therapist can first help the clients question their assumptions about authority, and then explore more adaptive behaviors. The need to examine in greater detail the causes and impact of authority problems among clients with posttraumatic stress disorder is emphasized.

Adult↗
PubMed2001

Dissociative flashbacks after right frontal injury in a vietnam veteran with combat-related posttraumatic stress disorder.

A Vietnam veteran with a combat-related posttraumatic stress disorder developed recurrent dissociative flashbacks (related to the atrocities of a specific war incident) several months after suffering a traumatic brain injury. CT disclosed a small lesion in the right dorsolateral prefrontal cortex. SPECT demonstrated more extensive functional changes in prefrontal and anterior paralimbic brain regions, mainly in the right hemisphere. This case further implicates the provocative effect of physical stimuli (brain damage) in reawakening old dormant memories and the preferential role of the right hemisphere for the storage of traumatic memories.

Brain Mapping↗
PubMed2004

Olanzapine versus fluphenazine in an open trial in patients with psychotic combat-related post-traumatic stress disorder.

RATIONALE: Combat-related post-traumatic stress disorder (PTSD) is often complicated with other psychiatric comorbidities, and is refractory to treatment. OBJECTIVE: The aim of an open, comparative 6-week study was to compare olanzapine and fluphenazine, as a monotherapy, for treating psychotic combat-related PTSD. METHOD: Fifty-five male war veterans with psychotic PTSD (DSM-IV criteria) were treated for 6 weeks with olanzapine (n=28) or fluphenazine (n=27) in a 5-10 mg/day dose range, once or twice daily. Patients were evaluated at baseline, and after 3 and 6 weeks of treatment, using Watson's PTSD scale, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity Scale (CGI-S), Clinical Global Impression Improvement Scale (CGI-I), Patient Global Impression Improvement Scale (PGI-I) and Drug Induced Extra-Pyramidal Symptoms Scale (DIEPSS). RESULTS: At baseline, patient's data (age, duration of combat experience and scores in all measurement instruments) did not differ. After 3 and 6 weeks of treatment, olanzapine was significantly more efficacious than fluphenazine in reducing symptoms in PANSS (negative, general psychopathology subscale, supplementary items), Watson's PTSD (avoidance, increased arousal) subscales, CGI-S, CGI-I, and PGI-I scale. Both treatments affected similarly the symptoms listed in PANSS positive and Watson's trauma re-experiencing subscales. Fluphenazine induced more extrapyramidal symptoms. Prolongation of the treatment for 3 additional weeks did not affect the efficacy of either drug. CONCLUSIONS: Our data indicate that both fluphenazine and olanzapine were effective for particular symptom profile in psychotic combat-related PTSD. Olanzapine was better than fluphenazine in reducing most of the psychotic and PTSD symptoms, and was better tolerated in psychotic PTSD patients.

Adult↗
PubMed1990

Selective processing of threat cues in posttraumatic stress disorder.

Vietnam combat veterans with (n = 15) and without (n = 15) posttraumatic stress disorder (PTSD) performed a modified Stroop task in which they named the colors of neutral words (e.g., INPUT), positive words (e.g., LOVE), obsessive-compulsive disorder (OCD) words (e.g., GERMS), and PTSD words (e.g., BODYBAGS). In contrast to normal controls, PTSD patients took significantly longer to color-name PTSD words than to color-name neutral, OCD, and positive words. Because Stroop interference reflects involuntary semantic activation, it may provide a quantitative measure of intrusive cognitive activity--the hallmark symptom of PTSD.

Adult↗
PubMed2002

Anger and combat-related posttraumatic stress disorder.

We examined whether combat-related PTSD was differentially associated with particular dimensions of anger on two multi-index, psychometric instruments and whether the proportion of variation in PTSD scores explained by anger was significantly greater than that by demographic and exposure variables. We also examined the reliability and validity of a subset of Mississippi Scale items as an anger measure. Participants were 143 Vietnam combat veterans. Anger accounted for over 40% of the variance in Mississippi PTSD scores (minus the anger items) above that associated with age, education, and combat exposure. Veterans with structured-interview-diagnosed PTSD were significantly differentiated from those without PTSD on all anger indices. The results point to anger treatment as a high priority for combat-related PTSD.

Anger↗
PubMedDate not supplied

The structure of posttraumatic stress disorder symptoms in combat veterans: a confirmatory factor analysis of the impact of event scale.

There has been controversy over the most appropriate way to define symptom clusters for posttraumatic stress disorder (PTSD). We tested the factor structure of the Impact of Event Scale (IES) in a sample of 195 male combat veterans with chronic PTSD by using confirmatory factor analysis. The two-factor model including Intrusion (i.e., unwanted memories of the event) and Avoidance (i.e., attempts to avoid reminders and numbing of emotional responsiveness) deviated significantly from good fit. However, a four-factor model, including Intrusion and Effortful Avoidance subscales, as well as Sleep Disturbance and Emotional Numbing subscales, fit significantly better. Correlations with other PTSD measures are explored and implications for the conceptualization of PTSD are discussed.

Aged↗