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Sample records for administered ptsd scale

  1. Measurement Precision of the Clinician Administered PTSD Scale (CAPS): A RASCH Model Analysis.

    ERIC Educational Resources Information Center

    Betemps, Elizabeth J.; Smith, Richard M.; Baker, Dewleen G.; Rounds-Kugler, Barbara A.

    2003-01-01

    Analyzed the Frequency and Intensity subscales of the Clinician Administered Posttraumatic Stress Disorder Scale (PTSD) separately using a Rasch rating scale model. The Frequency subscale produced measures that encompassed the level of severity found in the sample of 201 veterans. (SLD)

  2. Psychometric properties of a Swedish translation of the Clinician-Administered PTSD Scale--Diagnostic Version.

    PubMed

    Paunović, Nenad; Ost, Lars-Göran

    2005-04-01

    Internal consistency (N = 172) and convergent validity (N = 73) of a Swedish translation of the Clinician-Administered PTSD Scale-Diagnostic Version (CAPS-DX) were evaluated with violence victims with posttraumatic stress disorder (PTSD). The CAPS-DX evidenced a promising internal consistency, and significant correlations (Pearson product-moment) with the PTSD Symptom Scale Self-Report version (PSS-SR) and the Impact of Event Scale-Revised (IES-R). Additionally, each subscale of the CAPS-DX (intrusion, avoidance/numbing, and arousal) was significantly correlated with the corresponding subscales of the PSS-SR and the IES-R. Results of the present study are discussed in the context of internal consistencies and convergent validity coefficients of the CAPS with other PTSD symptom measures in previous studies.

  3. Preliminary Reliability and Validity of the Clinician-Administered PTSD Scale for Schizophrenia

    ERIC Educational Resources Information Center

    Gearon, Jean S.; Bellack, Alan S.; Tenhula, Wendy N.

    2004-01-01

    This study provides preliminary psychometric support for a version of the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS; D. D. Blake et al., 1990) adapted for use with patients with schizophrenia (CAPS-S; J. S. Gearon. S. Thomas-Lohrman, & A. S. Bellack, 2001). Nineteen women with schizophrenia and co-occurring illicit…

  4. The Child PTSD Symptom Scale: Psychometric Properties in Female Adolescent Sexual Assault Survivors

    ERIC Educational Resources Information Center

    Gillihan, Seth J.; Aderka, Idan M.; Conklin, Phoebe H.; Capaldi, Sandra; Foa, Edna B.

    2013-01-01

    Traumatic experiences are common among youths and can lead to posttraumatic stress disorder (PTSD). In order to identify traumatized children who need PTSD treatment, instruments that can accurately and efficiently evaluate pediatric PTSD are needed. One such measure is the Child PTSD Symptom Scale (CPSS), which has been found to be a reliable and…

  5. SCREENING FOR PTSD AMONG INCARCERATED MEN

    PubMed Central

    WOLFF, NANCY; GREGORY CHUGO, M; SHI, JING; HUENING, JESSICA; FRUEH, B. CHRISTOPHER

    2014-01-01

    Trauma exposure is overrepresented in incarcerated male populations and is linked to psychiatric morbidity, particularly posttraumatic stress disorder (PTSD). This study tests the feasibility, reliability, and validity of using computer-administered interviewing (CAI) versus orally administered interviewing (OAI) to screen for PTSD among incarcerated men. A 2 × 2 factorial design was used to randomly assign 592 incarcerated men to screening modality. Findings indicate that computer screening was feasible. Compared with OAI, CAI produced equally reliable screening information on PTSD symptoms, with test–retest intraclass correlations for the PTSD Checklist (PCL) total score ranging from .774 to .817, and the Clinician-Administered PTSD scale and PCL scores were significantly correlated for OAI and CAI. These findings indicate that data on PTSD symptoms can be reliably and validly obtained from CAI technology, increasing the efficiency by which incarcerated populations can be screened for PTSD, and those at risk can be identified for treatment. PMID:25673900

  6. The Child PTSD Symptom Scale: Psychometric Properties in Female Adolescent Sexual Assault Survivors

    PubMed Central

    Gillihan, Seth J.; Aderka, Idan M.; Conklin, Phoebe H.; Capaldi, Sandra; Foa, Edna B.

    2013-01-01

    Traumatic experiences are common among youths and can lead to posttraumatic stress disorder (PTSD). In order to identify traumatized children who need PTSD treatment, instruments that can accurately and efficiently evaluate pediatric PTSD are needed. One such measure is the Child PTSD Symptom Scale (CPSS), which has been found to be a reliable and valid measure of PTSD symptom severity in school-age children exposed to natural disasters (Foa, Johnson, Feeny & Treadwell, 2001). However, the psychometric properties of the CPSS are not known in youths who have experienced other types of trauma. The current study aims to fill this gap by examining the psychometric properties of the interview (CPSS-I) and self-report (CPSS-SR) administrations of the CPSS in a sample of 91 female youths with sexual abuse-related PTSD, a population that is targeted in many treatment studies. Scores on both the CPSS-I and CPSS-SR demonstrated good to excellent internal consistency. One week test-retest reliability assessed for CPSS-SR scores was excellent (r = .86); inter-rater reliability of CPSS-I scores was also excellent (r = .87). Symptom-based diagnostic agreement between the CPSS-SR and CPSS-I was excellent at 85.5%; scores on both the CPSS-SR and CPSS-I also demonstrated good convergent validity (74.5–76.5% agreement) with the PTSD module of The Schedule of Affective Disorders and Schizophrenia for School-Age Children–Revised for DSM-IV (K-SADS; Kaufman, Birmaher, Brent, & Rao, 1997). The strong psychometric properties of the CPSS render it a valuable instrument for PTSD screening as well as for assessing symptom severity. PMID:22867010

  7. The Child PTSD Symptom Scale: psychometric properties in female adolescent sexual assault survivors.

    PubMed

    Gillihan, Seth J; Aderka, Idan M; Conklin, Phoebe H; Capaldi, Sandra; Foa, Edna B

    2013-03-01

    Traumatic experiences are common among youths and can lead to posttraumatic stress disorder (PTSD). In order to identify traumatized children who need PTSD treatment, instruments that can accurately and efficiently evaluate pediatric PTSD are needed. One such measure is the Child PTSD Symptom Scale (CPSS), which has been found to be a reliable and valid measure of PTSD symptom severity in school-age children exposed to natural disasters (Foa, Johnson, Feeny, & Treadwell, 2001). However, the psychometric properties of the CPSS are not known in youths who have experienced other types of trauma. The current study aims to fill this gap by examining the psychometric properties of the interview (CPSS-I) and self-report (CPSS-SR) administrations of the CPSS in a sample of 91 female youths with sexual abuse-related PTSD, a population that is targeted in many treatment studies. Scores on both the CPSS-I and CPSS-SR demonstrated good to excellent internal consistency. One-week test-retest reliability assessed for CPSS-SR scores was excellent (r=.86); interrater reliability of CPSS-I scores was also excellent (r=.87). Symptom-based diagnostic agreement between the CPSS-SR and CPSS-I was excellent at 85.5%; scores on both the CPSS-SR and CPSS-I also demonstrated good convergent validity (74.5-76.5% agreement) with the PTSD module of The Schedule of Affective Disorders and Schizophrenia for School-Age Children--Revised for DSM--IV (K-SADS; Kaufman, Birmaher, Brent, & Rao, 1997). The strong psychometric properties of the CPSS render it a valuable instrument for PTSD screening as well as for assessing symptom severity.

  8. Diagnostic Utility of the Posttraumatic Stress Disorder (PTSD) Checklist for Identifying Full and Partial PTSD in Active-Duty Military.

    PubMed

    Dickstein, Benjamin D; Weathers, Frank W; Angkaw, Abigail C; Nievergelt, Caroline M; Yurgil, Kate; Nash, William P; Baker, Dewleen G; Litz, Brett T

    2015-06-01

    The aim of this study was to determine optimally efficient cutoff scores on the Posttraumatic Stress Disorder Checklist (PCL) for identifying full posttraumatic stress disorder (PTSD) and partial PTSD (P-PTSD) in active-duty Marines and Sailors. Participants were 1,016 Marines and Sailors who were administered the PCL and Clinician-Administered PTSD Scale (CAPS) 3 months after returning from Operations Iraqi and Enduring Freedom. PCL cutoffs were tested against three CAPS-based classifications: full PTSD, stringent P-PTSD, and lenient P-PTSD. A PCL score of 39 was found to be optimally efficient for identifying full PTSD. Scores of 38 and 33 were found to be optimally efficient for identifying stringent and lenient P-PTSD, respectively. Findings suggest that the PCL cutoff that is optimally efficient for detecting PTSD in active-duty Marines and Sailors is substantially lower than the score of 50 commonly used by researchers. In addition, findings provide scores useful for identifying P-PTSD in returning service members.

  9. The Mini-IPIP Scale: psychometric features and relations with PTSD symptoms of Chinese earthquake survivors.

    PubMed

    Li, Zhongquan; Sang, Zhiqin; Wang, Li; Shi, Zhanbiao

    2012-10-01

    The present purpose was to validate the Mini-IPIP scale, a short measure of the five-factor model personality traits, with a sample of Chinese earthquake survivors. A total of 1,563 participants, ages 16 to 85 years, completed the Mini-IPIP scale and a measure of posttraumatic stress disorder (PTSD) symptoms. Confirmatory factor analysis supported the five-factor structure of the Mini-IPIP with adequate values of various fit indices. This scale also showed values of internal consistency, Cronbach's alphas ranged from .79 to .84, and McDonald's omega ranged from .73 to .82 for scores on each subscale. Moreover, the five personality traits measured by the Mini-IPIP and those assessed by other big five measures had comparable patterns of relations with PTSD symptoms. Findings indicated that the Mini-IPIP is an adequate short-form of the Big-Five factors of personality, which is applicable with natural disaster survivors.

  10. Diagnostic accuracy of the Composite International Diagnostic Interview (CIDI 3.0) PTSD module among female Vietnam-era veterans.

    PubMed

    Kimerling, Rachel; Serpi, Tracey; Weathers, Frank; Kilbourne, Amy M; Kang, Han; Collins, Joseph F; Cypel, Yasmin; Frayne, Susan M; Furey, Joan; Huang, Grant D; Reinhard, Matthew J; Spiro, Avron; Magruder, Kathryn

    2014-04-01

    The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) posttraumatic stress disorder (PTSD) module is widely used in epidemiological studies of PTSD, yet relatively few data attest to the instrument's diagnostic utility. The current study evaluated the diagnostic utility of the CIDI 3.0 PTSD module with U. S. women Vietnam-era veterans. The CIDI and the Clinician-Administered PTSD Scale (CAPS) were independently administered to a stratified sample of 160 women, oversampled for current PTSD. Both lifetime PTSD and recent (past year) PTSD were assessed within a 3-week interval. Forty-five percent of the sample met criteria for a CAPS diagnosis of lifetime PTSD, and 21.9% of the sample met criteria for a CAPS diagnosis of past-year PTSD. Using CAPS as the diagnostic criterion, the CIDI correctly classified 78.8% of cases for lifetime PTSD (κ = .56) and 82.0% of past year PTSD cases (κ = .51). Estimates of diagnostic performance for the CIDI were sensitivity of .61 and specificity of .91 for lifetime PTSD and sensitivity of .71 and specificity of .85 for past-year PTSD. Results suggest that the CIDI has good utility for identifying PTSD, though it is a somewhat conservative indicator of lifetime PTSD as compared to the CAPS. PMID:24740869

  11. The Predictive Validity of the PTSD Checklist in a Nonclinical Sample of Combat-Exposed National Guard Troops

    ERIC Educational Resources Information Center

    Arbisi, Paul A.; Kaler, Matthew E.; Kehle-Forbes, Shannon M.; Erbes, Christopher R.; Polusny, Melissa A.; Thuras, Paul

    2012-01-01

    After returning from an extended combat deployment to Iraq, 348 National Guard soldiers were administered the PTSD Checklist (PCL-M), and the Beck Depression Inventory II (BDI-II) followed, on average, 3 months later by structured diagnostic interviews including the Clinician-Administered PTSD Scale (CAPS) for the "Diagnostic and Statistical…

  12. Therapeutic adherence and competence scales for Developmentally Adapted Cognitive Processing Therapy for adolescents with PTSD

    PubMed Central

    Gutermann, Jana; Schreiber, Franziska; Matulis, Simone; Stangier, Ulrich; Rosner, Rita; Steil, Regina

    2015-01-01

    Background The assessment of therapeutic adherence and competence is often neglected in psychotherapy research, particularly in children and adolescents; however, both variables are crucial for the interpretation of treatment effects. Objective Our aim was to develop, adapt, and pilot two scales to assess therapeutic adherence and competence in a recent innovative program, Developmentally Adapted Cognitive Processing Therapy (D-CPT), for adolescents suffering from posttraumatic stress disorder (PTSD) after childhood abuse. Method Two independent raters assessed 30 randomly selected sessions involving 12 D-CPT patients (age 13–20 years, M age=16.75, 91.67% female) treated by 11 therapists within the pilot phase of a multicenter study. Results Three experts confirmed the relevance and appropriateness of each item. All items and total scores for adherence (intraclass correlation coefficients [ICC]=0.76–1.00) and competence (ICC=0.78–0.98) yielded good to excellent inter-rater reliability. Cronbach's alpha was 0.59 for the adherence scale and 0.96 for the competence scale. Conclusions The scales reliably assess adherence and competence in D-CPT for adolescent PTSD patients. The ratings can be helpful in the interpretation of treatment effects, the assessment of mediator variables, and the identification and training of therapeutic skills that are central to achieving good treatment outcomes. Both adherence and competence will be assessed as possible predictor variables for treatment success in future D-CPT trials. PMID:25791915

  13. The Mini-IPIP Scale: psychometric features and relations with PTSD symptoms of Chinese earthquake survivors.

    PubMed

    Li, Zhongquan; Sang, Zhiqin; Wang, Li; Shi, Zhanbiao

    2012-10-01

    The present purpose was to validate the Mini-IPIP scale, a short measure of the five-factor model personality traits, with a sample of Chinese earthquake survivors. A total of 1,563 participants, ages 16 to 85 years, completed the Mini-IPIP scale and a measure of posttraumatic stress disorder (PTSD) symptoms. Confirmatory factor analysis supported the five-factor structure of the Mini-IPIP with adequate values of various fit indices. This scale also showed values of internal consistency, Cronbach's alphas ranged from .79 to .84, and McDonald's omega ranged from .73 to .82 for scores on each subscale. Moreover, the five personality traits measured by the Mini-IPIP and those assessed by other big five measures had comparable patterns of relations with PTSD symptoms. Findings indicated that the Mini-IPIP is an adequate short-form of the Big-Five factors of personality, which is applicable with natural disaster survivors. PMID:23234106

  14. Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

    PubMed Central

    Lanius, Ruth A.; Frewen, Paul A.; Tursich, Mischa; Jetly, Rakesh; McKinnon, Margaret C.

    2015-01-01

    Background Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD). Objective 1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders. Method Literature relevant to this commentary was reviewed. Results Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed. Conclusions Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms. PMID:25854674

  15. The critical warzone experiences (CWE) scale: initial psychometric properties and association with PTSD, anxiety, and depression.

    PubMed

    Kimbrel, Nathan A; Evans, Lianna D; Patel, Amee B; Wilson, Laura C; Meyer, Eric C; Gulliver, Suzy B; Morissette, Sandra B

    2014-12-30

    The objective of the present research was to develop and evaluate a critical warzone experiences (CWE) scale for use with Iraq/Afghanistan veterans. The psychometric properties of the CWE were evaluated across three independent samples of Iraq/Afghanistan veterans. Despite its brevity (7 items), the CWE exhibited good internal consistency (average α =0.83), good temporal stability (1-year test-retest reliability=0.73), good concurrent validity with lengthier measures of warzone experiences (average r=0.74), and a clear unidimensional factor structure (average factor loading=0.69). Study 2 confirmed the CWE׳s factor structure through confirmatory factor analysis, and structural equation modeling demonstrated a strong association between CWE and post-deployment mental health, β =0.49, p<0.001. Study 3 provided further support for the predictive validity of the CWE by demonstrating that it was associated with PTSD diagnosis, clinician-rated PTSD symptom severity, and global functional impairment in an independent sample of Iraq/Afghanistan veterans (average r=0.59). While replication of these findings in more diverse samples is needed, the preliminary evidence from these studies indicates that the CWE is a brief, reliable, and valid measure of critical warzone experiences among Iraq/Afghanistan war veterans.

  16. Trauma-specific Grey Matter Alterations in PTSD

    PubMed Central

    Meng, Linghui; Jiang, Jing; Jin, Changfeng; Liu, Jia; Zhao, Youjin; Wang, Weina; Li, Kaiming; Gong, Qiyong

    2016-01-01

    Previous studies have demonstrated that patients with posttraumatic stress disorder (PTSD) caused by different types of trauma may show divergence in epidemiology, clinical manifestation and treatment outcome. However, it is still unclear whether this divergence has neuroanatomic correlates in PTSD brains. To elucidate the general and trauma-specific cortical morphometric alterations, we performed a meta-analysis of grey matter (GM) changes in PTSD (N = 246) with different traumas and trauma-exposed controls (TECs, N = 347) using anisotropic effect-size signed differential mapping and its subgroup analysis. Our results revealed general GM reduction (GMR) foci in the prefrontal-limbic-striatal system of PTSD brains when compared with those of TECs. Notably, the GMR patterns were trauma-specific. For PTSD by single-incident traumas, GMR foci were found in bilateral medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, left hippocampus and amygdala; and for PTSD by prolonged traumas in the left insula, striatum, amygdala and middle temporal gyrus. Moreover, Clinician-Administered PTSD Scale scores were found to be negatively associated with the GM changes in bilateral ACC and mPFC. Our study indicates that the GMR patterns of PTSD are associated with specific traumas, suggesting a stratified diagnosis and treatment for PTSD patients. PMID:27651030

  17. Trauma-specific Grey Matter Alterations in PTSD.

    PubMed

    Meng, Linghui; Jiang, Jing; Jin, Changfeng; Liu, Jia; Zhao, Youjin; Wang, Weina; Li, Kaiming; Gong, Qiyong

    2016-01-01

    Previous studies have demonstrated that patients with posttraumatic stress disorder (PTSD) caused by different types of trauma may show divergence in epidemiology, clinical manifestation and treatment outcome. However, it is still unclear whether this divergence has neuroanatomic correlates in PTSD brains. To elucidate the general and trauma-specific cortical morphometric alterations, we performed a meta-analysis of grey matter (GM) changes in PTSD (N = 246) with different traumas and trauma-exposed controls (TECs, N = 347) using anisotropic effect-size signed differential mapping and its subgroup analysis. Our results revealed general GM reduction (GMR) foci in the prefrontal-limbic-striatal system of PTSD brains when compared with those of TECs. Notably, the GMR patterns were trauma-specific. For PTSD by single-incident traumas, GMR foci were found in bilateral medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, left hippocampus and amygdala; and for PTSD by prolonged traumas in the left insula, striatum, amygdala and middle temporal gyrus. Moreover, Clinician-Administered PTSD Scale scores were found to be negatively associated with the GM changes in bilateral ACC and mPFC. Our study indicates that the GMR patterns of PTSD are associated with specific traumas, suggesting a stratified diagnosis and treatment for PTSD patients. PMID:27651030

  18. Validation of a Brief PTSD Scale for Clients with Severe Mental Illnesses

    ERIC Educational Resources Information Center

    O'Hare, Thomas; Shen, Ce; Sherrer, Margaret

    2012-01-01

    Trauma and Posttraumatic Stress Disorder (PTSD) are more common in severe mental illnesses (SMI) clients than in the general population, yet brief screens for detecting probable PTSD in SMI clients are nonexistent. In a two-part study, the authors used correlation analysis and receiver operating characteristics (ROC) analysis to develop and…

  19. PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample.

    PubMed

    Powers, Abigail; Cross, Dorthie; Fani, Negar; Bradley, Bekh

    2015-02-01

    Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients. PMID:25573648

  20. PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample.

    PubMed

    Powers, Abigail; Cross, Dorthie; Fani, Negar; Bradley, Bekh

    2015-02-01

    Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients.

  1. The mediating role of anger in the relationship between PTSD symptoms and impulsivity.

    PubMed

    Contractor, Ateka A; Armour, Cherie; Wang, Xin; Forbes, David; Elhai, Jon D

    2015-03-01

    Research indicates a significant relationship between posttraumatic stress disorder (PTSD) and anger (Olatunji, Ciesielski, & Tolin, 2010; Orth & Wieland, 2006). Individuals may seek urgent coping to deal with the distress of anger, which is a mobilizing and action-oriented emotion (Novaco & Chemtob, 2002); possibly in the form of impulsive actions consistent with impulsivity's association with anger (Milligan & Waller, 2001; Whiteside & Lynam, 2001). This could be 1 of the explanations for the relationship between PTSD and impulsivity (Kotler, Julian, Efront, & Amir, 2001; Ledgerwood & Petry, 2006). The present study assessed the mediating role of anger between PTSD (overall scores and subscales of arousal and negative alterations in mood/cognitions) and impulsivity, using gender as a covariate of impulsivity. The PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Dimensions of Anger Reaction scale-5, and the UPPS Impulsivity Scale were administered to a sample of 244 undergraduate students with a trauma history. Results based on 1000 bootstrapped samples indicated significant direct effects of PTSD (overall and 2 subscales) on anger, of anger on impulsivity, and of PTSD (overall and 2 subscales) on impulsivity. Further, anger significantly mediated the relationship between PTSD (overall and 2 subscales) and impulsivity, consistent with the hypothesized models. Results suggest that impulsivity aims at coping with distressing anger, possibly explaining the presence of substance usage, and other impulsive behaviors in people with PTSD. Further, anger probably serves as a mobilizing and action-oriented emotion coupled with PTSD symptoms. PMID:25793689

  2. PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample

    PubMed Central

    Powers, Abigail; Cross, Dorthie; Fani, Negar; Bradley, Bekh

    2015-01-01

    Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms. The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients. PMID:25573648

  3. PTSD and obesity in younger and older veterans: Results from the mind your heart study.

    PubMed

    Smith, Brian N; Tyzik, Anna L; Neylan, Thomas C; Cohen, Beth E

    2015-10-30

    Posttraumatic stress disorder (PTSD) is increasingly recognized as a relatively common condition that is associated with poor health, including obesity. With a sizable proportion of the population approaching older adulthood, it is important to understand PTSD-health associations in the context of age. Participants were recruited from two Veterans Administration medical centers and included 380 patients age 60 and over and 365 under age 60. PTSD diagnosis was determined by the Clinician Administered PTSD Scale. BMI was trichotomized into normal/under (≤24.9), overweight (25.0-29.9), and obese (≥30.0). Models were run in the total sample, as well as stratified by age group, and adjusted for demographics, depression, antipsychotic medication use, and physical activity. Current PTSD was associated with greater likelihood of overweight and obesity in the total sample, and lifetime PTSD was associated with significantly increased odds of obesity. In the stratified models, current and lifetime PTSD were associated with increased likelihood of overweight and obesity in the older group only. Results suggest that PTSD is associated with risk for overweight and obesity, an effect that may be particularly strong in older adults. These findings support the importance of examining PTSD and potential health correlates across the life course.

  4. Brief treatment for PTSD: A non-inferiority trial.

    PubMed

    Sloan, Denise M; Marx, Brian P; Resick, Patricia A

    2016-05-01

    Prior studies have identified several psychosocial treatment approaches as effective for posttraumatic stress disorder (PTSD). Unfortunately, a substantial minority of individuals who receive these treatments drop out prematurely. Moreover, a considerable number of individuals in need of PTSD treatment do not present for treatment due to time constraints and other barriers to care. Thus, there is a need to develop alternative evidence-based PTSD treatments that have lower treatment dropout rates and address current barriers to receiving care. One recently developed PTSD treatment that has demonstrated efficacy and potentially meets these criteria is Written Exposure Therapy (WET), a 5-session treatment protocol that promotes recovery through writing about the trauma event as well as one's thoughts and feelings about it without any assigned homework. In an ongoing randomized controlled trial (RCT) we are investigating whether WET is equally efficacious as Cognitive Processing Therapy (CPT), a treatment that typically requires more therapist training and more therapy sessions. The study sample consists of 126 adults diagnosed with PTSD who are randomly assigned to either WET (n=63) or CPT (n=63). Participants are assessed prior to treatment and 6-, 12-, 24-, 36-, and 60-weeks after the first treatment session. The primary outcome measure is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Given the prevalence of PTSD and the aforementioned limitations of currently available first-line PTSD treatments, the identification of a brief, efficacious treatment that is associated with reduced patient dropout would represent a significant public health development. PMID:27080931

  5. Longitudinal assessment of dissociation in Holocaust survivors with and without PTSD and nonexposed aged Jewish adults.

    PubMed

    Labinsky, Ellen; Blair, William; Yehuda, Rachel

    2006-07-01

    The trajectory of posttraumatic stress disorder (PTSD) and PTSD-related symptoms in relation to aging is not well understood. We previously observed higher levels of dissociation as measured by the Dissociative Experiences Scale (DES) among older Holocaust survivors with, compared to those without, PTSD, though scores on the DES in Holocaust survivors were markedly lower than those that had been reported for younger cohorts. We undertook a longitudinal evaluation of dissociation in Holocaust survivors. Twenty-six Holocaust survivors with current PTSD, 30 Holocaust survivors without current PTSD, and 19 nonexposed were evaluated at the initial evaluation and subsequently 8.11 years later. Repeated measures analysis of variance (ANOVA) on the DES scores from these times demonstrated a significant main effect for time and a significant group by time interaction, reflecting a marked decline in Holocaust survivors, particularly those with PTSD. Controlling for age obliterated the effect of time, but not the group by time interaction. A similar pattern was shown with The Clinician Administered PTSD Scale (CAPS) scores. Different symptoms related to PTSD show different trajectories of change with age, with dissociation appearing to be less prominent with age.

  6. Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders.

    PubMed

    Jobe-Shields, Lisa; Flanagan, Julianne C; Killeen, Therese; Back, Sudie E

    2015-11-01

    Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur and affect a substantial proportion of military Veterans. Although the impact of parental PTSD and SUD on child development is well-documented, little is known about the influence of family composition on PTSD/SUD symptom severity. The present study investigated children in the home as an independent risk factor for symptom severity in a sample of treatment-seeking Veterans (N = 94; 92% male) with comorbid PTSD/SUD. Twenty-seven percent of the sample had minor children (age 18 or younger) living in the home. Veterans with children in the home evidenced significantly higher PTSD symptomatology as measured by the Clinical Administered PTSD Scale (CAPS; M = 82.65 vs. M = 72.17; t = -2.18; p < .05), and reported using marijuana more frequently than Veterans without children in the home (34% vs. 13% of past 60 days; t = -2.35, p < .05). In a multivariate model, having children in the home accounted for unique variance (ΔR(2) = .07) in PTSD severity after accounting for a range of covariates; however, having children in the home did not account for unique variance in substance use. Directions for future research as well as potential clinical implications for parents seeking treatment for PTSD/SUD are discussed.

  7. Childhood trauma, PTSD, and psychosis: Findings from a highly traumatized, minority sample☆

    PubMed Central

    Powers, Abigail; Fani, Negar; Cross, Dorthie; Ressler, Kerry J.; Bradley, Bekh

    2016-01-01

    Trauma, especially early life trauma, is a risk factor for the development of both posttraumatic stress disorder and psychosis. The goal of the present study was to determine specific associations between exposure to childhood abuse, PTSD symptoms, and current psychotic disorder. Subjects were recruited from a public, urban hospital (N = 328, >90% African American). Psychotic disorders were measured using the MINI International Neuropsychiatric Interview, PTSD was measured using the Clinician Administered PTSD Scale, child abuse was measured with the Childhood Trauma Questionnaire, and lifetime trauma exposure was measured with the Traumatic Events Inventory. Logistic regression analyses showed that both child abuse and current PTSD were statistically significant predictors of psychotic disorder beyond the effects of lifetime trauma load. When PTSD symptom clusters were examined, avoidance and numbing symptoms showed unique association with psychotic disorder independent of demographic variables and trauma exposure. Using bootstrapping techniques, we found a full indirect effect of PTSD on the association between child abuse and, suggesting a particularly important role of PTSD symptoms in relation to psychotic disorder in the presence of early life trauma. Because this is a cross-sectional study, continued research is needed to determine causality of such models. Identifying co-occurring psychosis and PTSD, particularly in populations with high levels of trauma exposure, is critical and will likely aid in more successful treatment interventions. PMID:27371800

  8. Childhood trauma, PTSD, and psychosis: Findings from a highly traumatized, minority sample.

    PubMed

    Powers, Abigail; Fani, Negar; Cross, Dorthie; Ressler, Kerry J; Bradley, Bekh

    2016-08-01

    Trauma, especially early life trauma, is a risk factor for the development of both posttraumatic stress disorder and psychosis. The goal of the present study was to determine specific associations between exposure to childhood abuse, PTSD symptoms, and current psychotic disorder. Subjects were recruited from a public, urban hospital (N=328, >90% African American). Psychotic disorders were measured using the MINI International Neuropsychiatric Interview, PTSD was measured using the Clinician Administered PTSD Scale, child abuse was measured with the Childhood Trauma Questionnaire, and lifetime trauma exposure was measured with the Traumatic Events Inventory. Logistic regression analyses showed that both child abuse and current PTSD were statistically significant predictors of psychotic disorder beyond the effects of lifetime trauma load. When PTSD symptom clusters were examined, avoidance and numbing symptoms showed unique association with psychotic disorder independent of demographic variables and trauma exposure. Using bootstrapping techniques, we found a full indirect effect of PTSD on the association between child abuse and, suggesting a particularly important role of PTSD symptoms in relation to psychotic disorder in the presence of early life trauma. Because this is a cross-sectional study, continued research is needed to determine causality of such models. Identifying co-occurring psychosis and PTSD, particularly in populations with high levels of trauma exposure, is critical and will likely aid in more successful treatment interventions. PMID:27371800

  9. Self-Compassion as a Prospective Predictor of PTSD Symptom Severity Among Trauma-Exposed U.S. Iraq and Afghanistan War Veterans

    PubMed Central

    Hiraoka, Regina; Meyer, Eric C.; Kimbrel, Nathan A.; DeBeer, Bryann B.; Gulliver, Suzy Bird; Morissette, Sandra B.

    2016-01-01

    U. S. combat veterans of the Iraq and Afghanistan wars have elevated rates of posttraumatic stress disorder (PTSD) compared to the general population. Self-compassion, characterized by self-kindness, a sense of common humanity when faced with suffering, and mindful awareness of suffering, is a potentially modifiable factor implicated in the development and maintenance of PTSD. We examined the concurrent and prospective relationship between self-compassion and PTSD symptom severity after accounting for level of combat exposure and baseline PTSD severity. Participants at baseline assessment were 115 Iraq and Afghanistan war veterans exposed to 1 or more traumatic events during deployment (n = 101 at follow-up). PTSD symptoms were assessed using the Clinician Administered PTSD Scale for DSM-IV at baseline and 12 months. Self-compassion and combat exposure were assessed at baseline via self-report. Self-compassion was associated with baseline PTSD symptoms after accounting for combat exposure (β = −.59; p < .001; ΔR2 = .34; f2 = .67; large effect) and predicted 12-month PTSD symptom severity after accounting for combat exposure and baseline PTSD severity (β = −.24; p = .008; ΔR2 = .03; f2 = .08; small effect). Findings suggest that interventions that increase self-compassion may be beneficial for treating chronic PTSD symptoms among some Iraq and Afghanistan war veterans. PMID:25808565

  10. Self-Compassion as a prospective predictor of PTSD symptom severity among trauma-exposed U.S. Iraq and Afghanistan war veterans.

    PubMed

    Hiraoka, Regina; Meyer, Eric C; Kimbrel, Nathan A; DeBeer, Bryann B; Gulliver, Suzy Bird; Morissette, Sandra B

    2015-04-01

    U.S. combat veterans of the Iraq and Afghanistan wars have elevated rates of posttraumatic stress disorder (PTSD) compared to the general population. Self-compassion, characterized by self-kindness, a sense of common humanity when faced with suffering, and mindful awareness of suffering, is a potentially modifiable factor implicated in the development and maintenance of PTSD. We examined the concurrent and prospective relationship between self-compassion and PTSD symptom severity after accounting for level of combat exposure and baseline PTSD severity in 115 Iraq and Afghanistan war veterans exposed to 1 or more traumatic events during deployment. PTSD symptoms were assessed using the Clinician Administered PTSD Scale for DSM-IV (CAPS-IV) at baseline and 12 months (n =101). Self-compassion and combat exposure were assessed at baseline via self-report. Self-compassion was associated with baseline PTSD symptoms after accounting for combat exposure (β = -.59; p < .001; ΔR(2) = .34; f(2) = .67; large effect) and predicted 12-month PTSD symptom severity after accounting for combat exposure and baseline PTSD severity (β = -.24; p = .008; ΔR(2) = .03; f(2) = .08; small effect). Findings suggest that interventions that increase self-compassion may be beneficial for treating chronic PTSD symptoms among some Iraq and Afghanistan war veterans.

  11. Online self-administered training of PTSD treatment providers in cognitive-behavioral intervention skills: results of a randomized controlled trial.

    PubMed

    Ruzek, Josef I; Rosen, Raymond C; Garvert, Donn W; Smith, Lauren D; Sears, Katharine C; Marceau, Lisa; Harty, Brian; Stoddard, Anne M

    2014-12-01

    Despite potential advantages in scalability and efficiency of web-based training for trauma providers, few controlled trials of feasibility and effectiveness of web-based mental health training have been performed. Our study compared web-based training in 3 intervention skills (motivation enhancement [ME], goal setting [GS], behavioral task assignment [BTA]) with web-based training plus telephone consultation, and a no-training control. The primary outcome measures included objective measures of skills acquisition (standardized patient assessments). Results showed significant differences among the training conditions. The overall tests of differences among the groups were statistically significant for ME and BTA skills (p < .001 and p = .005, respectively), but not for GS (p = .245). The web training plus consultation group improved in ME skills by 0.35 units compared to 0.12 units in the web only group (p < .001) and no change in the control group (p = .001). For BTA skills, the web training plus consultation improved by 0.27 units compared to 0.17 units in the web only group (p = .175) and no change in the control group (p = .004). Overall, these findings support the use of web-based dissemination for large-scale training programs for trauma providers in health care delivery systems. Further studies are needed to clarify the specific role of consultation as an adjunct to web-based training. PMID:25522731

  12. Predicting parenting behaviors from Antisocial Practices content scale scores of the MMPI-2 administered during pregnancy.

    PubMed

    Bosquet, M; Egeland, B

    2000-02-01

    This article examines the relation between scores on the Antisocial Practices (ASP) content scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and parenting behaviors in a sample of low-income women. During pregnancy, 141 women were administered the MMPI-2 and then placed into 1 of 3 groups: an antisocial, nonclinical, or clinical control group. When their children were 13 and 24 months old, antisocial mothers were observed to be less understanding and more hostile and harsh in their parenting styles than mothers in the other groups. The nonclinical and clinical control groups did not differ on any measures. Other MMPI-2 measures of antisocial behavior were not predictive of harsh parenting styles. These findings support the predictive and construct validity of the ASP content scale of the MMPI-2.

  13. Combat PTSD and Implicit Behavioral Tendencies for Positive Affective Stimuli: A Brief Report

    PubMed Central

    Clausen, Ashley N.; Youngren, Westley; Sisante, Jason-Flor V.; Billinger, Sandra A.; Taylor, Charles; Aupperle, Robin L.

    2016-01-01

    Background: Prior cognitive research in posttraumatic stress disorder (PTSD) has focused on automatic responses to negative affective stimuli, including attentional facilitation or disengagement and avoidance action tendencies. More recent research suggests PTSD may also relate to differences in reward processing, which has lead to theories of PTSD relating to approach-avoidance imbalances. The current pilot study assessed how combat-PTSD symptoms relate to automatic behavioral tendencies to both positive and negative affective stimuli. Method: Twenty male combat veterans completed the approach-avoidance task (AAT), Clinician Administered PTSD Scale, Beck Depression Inventory-II, and State-Trait Anger Expression Inventory-II. During the AAT, subjects pulled (approach) or pushed (avoid) a joystick in response to neutral, happy, disgust, and angry faces based on border color. Bias scores were calculated for each emotion type (avoid-approach response latency differences). Main and interaction effects for psychological symptom severity and emotion type on bias score were assessed using linear mixed models. Results: There was a significant interaction between PTSD symptoms and emotion type, driven primarily by worse symptoms relating to a greater bias to avoid happy faces. Post hoc tests revealed that veterans with worse PTSD symptoms were slower to approach as well as quicker to avoid happy faces. Neither depressive nor anger symptoms related to avoid or approach tendencies of emotional stimuli. Conclusion: Posttraumatic stress disorder severity was associated with a bias for avoiding positive affective stimuli. These results provide further evidence that PTSD may relate to aberrant processing of positively valenced, or rewarding stimuli. Implicit responses to rewarding stimuli could be an important factor in PTSD pathology and treatment. Specifically, these findings have implications for recent endeavors in using computer-based interventions to influence automatic

  14. ApoE2 Exaggerates PTSD-Related Behavioral, Cognitive, and Neuroendocrine Alterations.

    PubMed

    Johnson, Lance A; Zuloaga, Damian G; Bidiman, Erin; Marzulla, Tessa; Weber, Sydney; Wahbeh, Helane; Raber, Jacob

    2015-09-01

    Apolipoprotein E (apoE) is an essential component of lipoprotein particles in both the brain and periphery, and exists in three isoforms in the human population: E2, E3, and E4. ApoE has numerous, well-established roles in neurobiology. Most notably, E4 is associated with earlier onset and increased risk of Alzheimer's disease (AD). Although possession of E2 is protective in the context of AD, E2 appears to confer an increased incidence and severity of posttraumatic stress disorder (PTSD). However, the biological processes underlying this link remain unclear. In this study, we began to elucidate these associations by examining the effects of apoE on PTSD severity in combat veterans, and on PTSD-like behavior in mice with human apoE. In a group of 92 veterans with PTSD, we observed significantly higher Clinician-Administered PTSD Scale and PTSD Checklist scores in E2+ individuals, as well as alterations in salivary cortisol levels. Furthermore, we measured behavioral and biological outcomes in mice expressing human apoE after a single stressful event as well as following a period of chronic variable stress, a model of combat-related trauma. Mice with E2 showed impairments in fear extinction, and behavioral, cognitive, and neuroendocrine alterations following trauma. To the best of our knowledge, these data constitute the first translational demonstration of PTSD severity in men and PTSD-like symptoms in mice with E2, and point to apoE as a novel biomarker of susceptibility, and potential therapeutic target, for PTSD.

  15. A pilot randomized placebo-controlled trial of adjunctive aripiprazole for chronic PTSD in US military Veterans resistant to antidepressant treatment.

    PubMed

    Naylor, Jennifer C; Kilts, Jason D; Bradford, Daniel W; Strauss, Jennifer L; Capehart, Bruce P; Szabo, Steven T; Smith, Karen D; Dunn, Charlotte E; Conner, Kathryn M; Davidson, Jonathan R T; Wagner, Henry Ryan; Hamer, Robert M; Marx, Christine E

    2015-05-01

    Many individuals with post-traumatic stress disorder (PTSD) experience persistent symptoms despite pharmacological treatment with antidepressants. Several open-label monotherapy and adjunctive studies have suggested that aripiprazole (a second-generation antipsychotic) may have clinical utility in PTSD. However, there have been no randomized placebo-controlled trials of aripiprazole use for PTSD. We thus conducted a pilot randomized controlled trial of adjunctive aripiprazole versus placebo among Veterans with chronic PTSD serving in the US military since 11 September 2001 to assess the feasibility, safety, tolerability, and therapeutic potential of aripiprazole. Sixteen Veterans were randomized, and 14 completed at least 4 weeks of the study; 12 completed the entire 8-week trial. Outcome measures included the Clinician-Administered PTSD Scale (CAPS), PTSD Checklist, Beck Depression Inventory, Second Edition, and Positive and Negative Syndrome Scale scores. Aripiprazole was well-tolerated in this cohort, and improvements in CAPS, PTSD Checklist, Beck Depression Inventory, Second Edition, and Positive and Negative Syndrome Scale scores were as hypothesized. Although CAPS change scores did not reach statistical significance, aripiprazole outperformed placebo by 9 points on the CAPS in the last observation carried forward analysis compared with the placebo group (n = 7 per group), and by 20 points in the group randomized to aripiprazole that completed the entire study (n = 5) compared with the placebo group (n = 7). Results suggest promise for aripiprazole as an adjunctive strategy for the treatment of PTSD.

  16. Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial.

    PubMed

    Speroff, Theodore; Sinnott, Patricia L; Marx, Brian; Owen, Richard R; Jackson, James C; Greevy, Robert; Sayer, Nina; Murdoch, Maureen; Shane, Andrea C; Smith, Jeffrey; Alvarez, JoAnn; Nwosu, Samuel K; Keane, Terence; Weathers, Frank; Schnurr, Paula P; Friedman, Matthew J

    2012-12-01

    Posttraumatic stress disorder (PTSD) is one of the fastest growing compensated medical conditions. The present study compared usual disability examiner practices for PTSD with a standardized assessment that incorporates evidence-based assessments. The design was a multicenter, cluster randomized, parallel-group study involving 33 clinical examiners and 384 veterans at 6 Veterans Affairs medical centers. The standardized group incorporated the Clinician Administered PTSD Scale and the World Health Organization Disability Assessment Schedule-II into their assessment interview. The main outcome measures were completeness and accuracy of PTSD diagnosis and completeness of functional assessment. The standardized assessments were 85% complete for diagnosis compared to 30% for nonstandardized assessments (p < .001), and, for functional impairment, 76% versus 3% (p < .001). The findings demonstrate that the quality of PTSD disability examination would be improved by using evidence-based assessment.

  17. A pilot examination of the use of narrative therapy with individuals diagnosed with PTSD.

    PubMed

    Erbes, Christopher R; Stillman, John R; Wieling, Elizabeth; Bera, Walter; Leskela, Jennie

    2014-12-01

    Narrative therapy is a postmodern, collaborative therapy approach based on the elaboration of personal narratives for lived experiences. Many aspects of narrative therapy suggest it may have great potential for helping people who are negatively affected by traumatic experiences, including those diagnosed with posttraumatic stress disorder (PTSD). The potential notwithstanding, narrative therapy is relatively untested in any population, and has yet to receive empirical support for treatment among survivors of trauma. A pilot investigation of the use of narrative therapy with 14 veterans with a diagnosis of PTSD (11 treatment completers) is described. Participants completed structured diagnostic interviews and self-report assessments of symptoms prior to and following 11 to 12 sessions of narrative therapy. After treatment, 3 of 11 treatment completers no longer met criteria for PTSD and 7 of 11 had clinically significant decreases in PTSD symptoms as measured by the Clinician Administered PTSD Scale. Pre- to posttreatment effect sizes on outcomes ranged from 0.57 to 0.88. These preliminary results, in conjunction with low rates of treatment dropout (21.4%) and a high level of reported satisfaction with the treatment, suggest that further study of narrative therapy is warranted as a potential alternative to existing treatments for PTSD. PMID:25385702

  18. The impact of endorsing Spitzer's proposed criteria for PTSD in the forthcoming DSM-V on male and female Veterans.

    PubMed

    Miller, Lyndsey N; Chard, Kathleen M; Schumm, Jeremiah A; O'Brien, Carol

    2011-06-01

    This study explored differences between Spitzer's proposed model of posttraumatic stress disorder (PTSD) and the current DSM-IV diagnostic classification scheme in 353 Veterans. The majority of Veterans (89%) diagnosed with PTSD as specified in the DSM-IV also met Spitzer's proposed criteria. Veterans who met both DSM-IV and Spitzer's proposed criteria had significantly higher Clinician Administered PTSD Scale severity scores than Veterans only meeting DSM-IV criteria. Logistic regression indicated that being African American and having no comorbid diagnosis of major depressive disorder or history of a substance use disorder were found to predict those Veterans who met current, but not proposed criteria. These findings have important implications regarding proposed changes to the diagnostic classification criteria for PTSD in the forthcoming DSM-V.

  19. The Computer-Assisted Hypnosis Scale: Standardization and Norming of a Computer-Administered Measure of Hypnotic Ability.

    ERIC Educational Resources Information Center

    Grant, Carolyn D.; Nash, Michael R.

    1995-01-01

    In a counterbalanced, within subjects, repeated measures design, 130 undergraduates were administered the Computer-Assisted Hypnosis Scale (CAHS) and the Stanford Hypnotic Susceptibility Scale and were hypnotized. The CAHS was shown to be a psychometrically sound instrument for measuring hypnotic ability. (SLD)

  20. Rape survivors' trauma-related beliefs before and after Cognitive processing therapy: associations with PTSD and depression symptoms.

    PubMed

    Iverson, Katherine M; King, Matthew W; Cunningham, Katherine C; Resick, Patricia A

    2015-03-01

    This study examined whether cognitive distortions (i.e., assimilated and overaccommodated thoughts) and realistic (i.e., accommodated) thoughts assessed from impact statements written 5-10 years after completing cognitive processing therapy (CPT) accurately predicted posttreatment maintenance or decline in treatment gains during the same period. The sample included 50 women diagnosed with posttraumatic stress disorder (PTSD) secondary to rape who participated in a randomized clinical trial of CPT for PTSD. Cognitions were assessed via coding and analyses of participants' written impact statements at three time points: beginning of treatment, end of treatment, and at 5-10 years follow-up. Primary mental health outcomes were symptoms of PTSD (Clinician-Administered PTSD Scale) and depression (Beck Depression Inventory). Changes in trauma-related beliefs between the end of treatment and long-term follow-up were associated with concomitant changes in PTSD and depression symptoms (effect sizes ranging from r = .35-.54). Declines in accommodated thinking and increases in overaccommodated thinking were associated with elevations in symptomatology. Improvement in accommodated thinking and declines in overaccommodated thinking were associated with lower PTSD and depression symptoms during this same time period. Findings provided support for the role of changes in accommodated and overaccommodated thinking being associated with level of PTSD and depression many years after participating in CPT.

  1. Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD

    PubMed Central

    Markowitz, John C.; Petkova, Eva; Neria, Yuval; Van Meter, Page E.; Zhao, Yihong; Hembree, Elizabeth; Lovell, Karina; Biyanova, Tatyana; Marshall, Randall D.

    2015-01-01

    Background Exposure to trauma reminders has been considered imperative in psychotherapy for posttraumatic stress disorder (PTSD). No treatment benefits all patients, however. We tested Interpersonal Psychotherapy, which has demonstrated antidepressant efficacy and showed promise in pilot PTSD research, as a non-exposure-based, non-cognitive behavioral PTSD treatment. Methods A randomized, fourteen-week trial compared Interpersonal Psychotherapy; Prolonged Exposure, an exposure-based exemplar; and Relaxation Therapy, an active control psychotherapy. Subjects were 110 unmedicated patients having DSM-IV chronic PTSD and Clinician-Administered PTSD Scale (CAPS) score >50. Randomization stratified for comorbid major depression. We hypothesized Interpersonal Psychotherapy would be no more than minimally inferior (CAPS difference <12.5 points) to Prolonged Exposure. Results All therapies had large within-group pre/post effect sizes (d=1.32–1.88). Response rates (>30% CAPS improvement) were: Interpersonal Psychotherapy 63%, Prolonged Exposure 47%, Relaxation Therapy 38% (n.s.). Interpersonal psychotherapy and Prolonged Exposure CAPS outcome differed by 5.5 points (n.s.); the null hypothesis of more than minimal Interpersonal Psychotherapy inferiority was rejected (p=0.035). Patients with comorbid major depression dropped out from Prolonged Exposure nine times more than non-depressed Prolonged Exposure patients. Interpersonal Psychotherapy and Prolonged Exposure improved quality of life and social functioning more than Relaxation Therapy. Conclusions This first controlled study of individual Interpersonal Psychotherapy for PTSD demonstrated non-inferiority to the “gold standard” PTSD treatment. Interpersonal Psychotherapy had (non-significantly) lower attrition and higher response rates than Prolonged Exposure. Contradicting a widespread clinical belief, PTSD treatment may not require cognitive behavioral exposure to trauma reminders. Moreover, as differential

  2. Measuring Sensory Reactivity in Autism Spectrum Disorder: Application and Simplification of a Clinician-Administered Sensory Observation Scale

    ERIC Educational Resources Information Center

    Tavassoli, Teresa; Bellesheim, Katherine; Siper, Paige M.; Wang, A. Ting; Halpern, Danielle; Gorenstein, Michelle; Grodberg, David; Kolevzon, Alexander; Buxbaum, Joseph D.

    2016-01-01

    Sensory reactivity is a new DSM-5 criterion for autism spectrum disorder (ASD). The current study aims to validate a clinician-administered sensory observation in ASD, the Sensory Processing Scale Assessment (SPS). The SPS and the Short Sensory Profile (SSP) parent-report were used to measure sensory reactivity in children with ASD (n = 35) and…

  3. The (de)construction of a psychiatric diagnosis: PTSD among former guerrilla and paramilitary soldiers in Colombia.

    PubMed

    de la Espriella, R; Pingel, E Sweetnam; Falla, J V

    2010-01-01

    The demobilisation of guerrillas and paramilitaries in Colombia, also known as irregular armed groups, has raised the question among mental health professionals as to whether ex-combatants who have had repeated exposure to stressful events might meet the requirements for posttraumatic stress disorder (PTSD). Upon arrival at a psychiatric clinic in Bogotá, 76 patients were evaluated by a group of mental health professionals with experience in this diagnosis. Contrary to clinicians' expectations, there was a conspicuous lack of PTSD among this population. Subsequently, the clinical team administered the Clinician Administered PTSD Scale with 21 of these patients; PTSD was found in 57% of the men. The authors consider various arguments that might explain this discrepancy. Differences between the clinical presentation of PTSD among the ex-combatants and the classic descriptions contained in the DSM-IV-TR may be explained by organisational characteristics of the irregular armed groups. Further research is necessary which focuses on the mental health of populations in the context of political violence, such as those encountered in Colombia. PMID:20401817

  4. Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders

    PubMed Central

    Wabnitz, Pascal; Gast, Ursula; Catani, Claudia

    2013-01-01

    Background The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. Methods Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. Results Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. Conclusion Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients. PMID:24298325

  5. A cross-lagged analysis of the relationship between symptoms of PTSD and retrospective reports of exposure.

    PubMed

    Bolton, Elisa E; Gray, Matthew J; Litz, Brett T

    2006-01-01

    As part of a larger longitudinal investigation, 522 U.S. peacekeepers who served in Somalia were administered a comprehensive psychosocial questionnaire. The questionnaire included the PTSD Checklist [PCL; Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, November). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX], the Mississippi Scale [Keane, T. M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi Scale for combat-related posttraumatic stress disorder: three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56, 85-90], the War-Zone Exposure Scale [WZES; Litz, B. T., Orsillo, S. M, Freidman, M., Ehlich, P., & Batres, A. (1997). Posttraumatic stress disorder associated with peacekeeping duty in Somalia for US military personnel. American Journal of Psychiatry, 154(2), 178-184], and the Other Stressors Associated with Peacekeeping Scale [Litz, B. T., King, L. A., King, D. W., Orsillo, S. M., & Friedman, M. J. (1997). Warriors as peacekeepers: features of the Somalia experience and PTSD. Journal of Consulting and Clinical Psychology, 65, 1001-1010]. These measures were administered approximately 15 weeks postdeployment and roughly a year and a half later. Using a cross-lagged panel design, PTSD symptom severity was associated with increases in reports of exposure at Time 2. However, this finding was modest and was not specific to the recall of traumatic events. PMID:16530379

  6. Responding to the need for sleep among survivors of interpersonal violence: A randomized controlled trial of a cognitive-behavioral insomnia intervention followed by PTSD treatment.

    PubMed

    Pigeon, Wilfred R; Heffner, Kathi L; Crean, Hugh; Gallegos, Autumn M; Walsh, Patrick; Seehuus, Martin; Cerulli, Catherine

    2015-11-01

    Sleep disturbance is a common feature of posttraumatic stress disorder (PTSD), but is not a focus of standard PTSD treatments. Psychological trauma exposure is associated with considerable physical and mental health morbidity, possibly due to the alterations in neuroendocrine function and inflammation observed in trauma exposed individuals. Although PTSD treatments are efficacious, they are associated with high drop-out rates in clinical trials and clinical practice. Finally, individuals with PTSD stemming from exposure to interpersonal violence represent an especially under-treated population with significant sleep disturbance. Community-based participatory research was utilized to design and prepare a clinical trial that randomizes recent survivors of interpersonal violence who have PTSD, depression, and insomnia to receive either: (1) Cognitive Behavioral Therapy for Insomnia (CBTi) followed by Cognitive Processing Therapy (CPT) for trauma, or (2) attention control followed by CPT. Outcome measures include subjective and objective measures of sleep, clinician-administered PTSD and depression scales, inflammatory cytokines, and salivary cortisol. Assessments are conducted at baseline, following the sleep or control intervention, and again following CPT. The design allows for: (1) the first test of a sleep intervention in this population; (2) the comparison of sequenced CBTi and CPT to attention control followed by CPT, and (3) assessing the roles of neuroendocrine function, inflammatory processes, and objective sleep markers in mediating treatment outcomes. The study's overarching hypothesis is that treating insomnia will produce reduction in insomnia, PTSD, and depression severity, allowing patients to more fully engage in, and derive optimal benefits from, cognitive processing therapy.

  7. Dimensions of trauma associated with posttraumatic stress disorder (PTSD) caseness, severity and functional impairment: a study of Bosnian refugees resettled in Australia.

    PubMed

    Momartin, S; Silove, D; Manicavasagar, V; Steel, Z

    2003-09-01

    Refugee survivors of inter-ethnic warfare vary greatly in the extent and range of their trauma experiences. Discerning which experiences are most salient to generating and perpetuating disorders such as posttraumatic stress disorder (PTSD) is critical to the mounting rational strategies for targeted psychosocial interventions. In a sample of Bosnian Muslim refugees (n=126) drawn from a community centre and supplemented by a snowball sampling method, PTSD status and associated disability were measured using the clinician-administered PTSD Scale (CAPS) for DSM-IV. A principal components analysis (PCA) based on a pool of trauma items yielded four coherent trauma dimensions: Human Rights Violations, Threat to Life, Traumatic Loss and Dispossession and Eviction. A cluster analysis identified three subgroupings according to extent of trauma exposure. There were no differences in PTSD risk for the group most exposed to human rights violations (internment in concentration camps, torture) compared to the general war-exposed group. Logistic regression analysis using the dimensions derived from the PCA indicated that Threat to Life alone of the four trauma factors predicted PTSD status, a finding that supports the DSM-IV definition of a trauma. Both Threat to Life and Traumatic Loss contributed to symptom severity and disability associated with PTSD. It may be that human rights violations pose a more general threat to the survivor's future psychosocial adaptation in areas of functioning that extend beyond the confines of PTSD.

  8. Alterations in White Matter Microstructure as Vulnerability Factors and Acquired Signs of Traffic Accident-Induced PTSD

    PubMed Central

    Ding, Weina; Wan, Jieqing; Zhuang, Zhiguo; Zhang, Yong; Liu, Yijun

    2013-01-01

    It remains unclear whether white matter (WM) changes found in post-traumatic stress disorder (PTSD) patients are stress-induced or precursors for vulnerability. The current study aimed to identify susceptibility factors relating to the development of PTSD and to examine the ability of these factors to predict the course of longitudinal PTSD. Sixty two victims who had experienced traffic accidents underwent diffusion tensor imaging using a 3.0T MRI system within 2 days after their accidents. Of these, 21 were diagnosed with PTSD at 1 or 6 months using the Clinician-Administered Ptsd Scale (CAPS). Then, 11 trauma-exposed victims with PTSD underwent the second MRI scan. Compared with the victims without PTSD, the victims with PTSD showed decreased fractional anisotropy (FA) in WM of the anterior cingulate cortex, ventromedial prefrontal cortex (vmPFC), temporal lobes and midbrain, and increased mean diffusivity (MD) in the vmPFC within 2 days after the traumatic event. Importantly, decreased FA of the vmPFC in the acute phase predicted greater future CAPS scores. In addition, we found decreased FA in the insula in the follow-up scan in the victims with PTSD, which correlated with the decreased FA of the vmPFC in their baseline scan. These results suggested that the WM might have changed within 2 days after the traumatic event in the individuals who would later develop PTSD. Furthermore, decreased FA of the vmPFC could be a possible vulnerability marker predicting future development of PTSD and may provide an outcome prediction of the acquired signs. PMID:24349515

  9. Screening for PTSD among Somali adolescent refugees: psychometric properties of the UCLA PTSD Index.

    PubMed

    Ellis, B Heidi; Lhewa, Dechen; Charney, Meredith; Cabral, Howard

    2006-08-01

    This study presents the psychometric properties for the UCLA Posttraumatic Stress Disorder Index among a sample of Somali adolescents. Data were derived from a sample of English-speaking Somali adolescent refugees between the ages of 12 and 19 years (n=76). The UCLA PTSD Index showed good reliability (Cronbach's alpha=.85). Convergent validity was assessed through bivariate correlations with the Depression Self Rating Scale (r=.72, p<.001) and the War Trauma Screening Scale (r=59, p<.001). Results suggest that the UCLA PTSD Index may be a reliable and valid screening tool for PTSD symptoms for use with Somali adolescent refugees. PMID:16929510

  10. Creative arts program as an intervention for PTSD: a randomized clinical trial with motor vehicle accident survivors

    PubMed Central

    Wang, Xiuling; Lan, Chao; Chen, Juwu; Wang, Wenying; Zhang, Hua; Li, Li

    2015-01-01

    The aim of this study is to determine whether the creative arts program (HA) is effective in preventing the onset of Posttraumatic stress disorder (PTSD). PTSD develops in 10-20% of motor vehicle accident survivors (MVAs). MVAs in the initial months after the accident were randomly assigned to receive 8-week HA intervention (n = 26) or wait the list (WL, n = 26). The arts program consisted of writing and drawing. PTSD severity was assessed at 2, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale, CAPS) and self-report instrument (Impact of Event Scale-Revised, IES-R). Secondary outcomes were post-traumatic growth (PTG), depression and anxiety symptoms. Repeated measures analysis of variance indicated that both HA and WL group exhibited a significant effect of time (P < 0.01) on CAPS, but no significant group differences over time. There were no group differences on depression or anxiety over time. Pessimists did not benefit more from attending the HA than they did from attending the WL. Our results fail to support the hypothesis that the creative arts program is effect in avoiding MVA-related PTSD symptoms. But it only seems to be a short-term, rather than a long-term effect. PMID:26550298

  11. Creative arts program as an intervention for PTSD: a randomized clinical trial with motor vehicle accident survivors.

    PubMed

    Wang, Xiuling; Lan, Chao; Chen, Juwu; Wang, Wenying; Zhang, Hua; Li, Li

    2015-01-01

    The aim of this study is to determine whether the creative arts program (HA) is effective in preventing the onset of Posttraumatic stress disorder (PTSD). PTSD develops in 10-20% of motor vehicle accident survivors (MVAs). MVAs in the initial months after the accident were randomly assigned to receive 8-week HA intervention (n = 26) or wait the list (WL, n = 26). The arts program consisted of writing and drawing. PTSD severity was assessed at 2, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale, CAPS) and self-report instrument (Impact of Event Scale-Revised, IES-R). Secondary outcomes were post-traumatic growth (PTG), depression and anxiety symptoms. Repeated measures analysis of variance indicated that both HA and WL group exhibited a significant effect of time (P < 0.01) on CAPS, but no significant group differences over time. There were no group differences on depression or anxiety over time. Pessimists did not benefit more from attending the HA than they did from attending the WL. Our results fail to support the hypothesis that the creative arts program is effect in avoiding MVA-related PTSD symptoms. But it only seems to be a short-term, rather than a long-term effect. PMID:26550298

  12. Changes in PTSD and Depression during Prolonged Exposure and Client-Centered Therapy for PTSD in Adolescents

    PubMed Central

    McLean, Carmen P.; Su, Yi-Jen; Carpenter, Joseph K.; Foa, Edna B.

    2015-01-01

    Objective Depressive symptoms are common among individuals with posttraumatic stress disorder (PTSD). Prolonged exposure therapy (PE) for PTSD has been found to alleviate both PTSD and depressive symptoms, but relatively little is known about the pattern of PTSD and depressive symptom change during treatment. This study aimed to investigate the relationship between changes in PTSD and depression during PE for adolescent (PE-A) and client-centered Therapy (CCT). The moderating role of PE-A vs. CCT and the possible differences across symptom clusters of PTSD were also examined. Method Participants were 61 female adolescents with sexual assault-related PTSD randomized to PE-A (n = 31) or CCT (n = 30). Participants completed the Beck Depression Inventory and the Child PTSD Symptom Scale at pre-, mid-, and post-treatment, and before each treatment session. Results Multilevel mediation analysis indicated a reciprocal but asymmetrical relationship between changes in PTSD and depression during treatment in the overall sample. Moderated mediation analysis showed that the reciprocal relation was observed only during PE-A. Reductions in PTSD led to reductions in depression to a greater extent (48.7%, 95% CI [30.2, 67.2]) than vice versa (22.0% [10.6, 33.4]). For participants receiving CCT, reduction in PTSD led to reductions in depression (31.6% [11.8, 51.4]) but not vice versa (7.4% [−7.1, 21.9]). The reciprocal relationship between PTSD and depression was also observed across different symptoms clusters of PTSD. Conclusions Our findings suggest that changes in PTSD led to changes in depressive symptoms to a greater extent than vice versa across PE-A and CCT. PMID:25751238

  13. Properties of the patient administered questionnaires: new scales measuring physical and psychological symptoms of hip and knee disorders.

    PubMed

    Mancuso, Carol A; Ranawat, Amar S; Meftah, Morteza; Koob, Trevor W; Ranawat, Chitranjan S

    2012-04-01

    The Patient Administered Questionnaires (PAQ) incorporate physical and psychological symptoms into one scale and permit more comprehensive self-reports for hip and knee disorders. We tested the psychometric properties of the PAQ-Hip and PAQ-Knee. Correlations between baseline PAQ-Hip and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were .39 to .72 (n = 102), .39 to .69 for score change (n = 68 post-total hip arthroplasty), and most κ values > .60 (n = 50). Correlations between baseline PAQ-Knee and WOMAC were .35 to .64 (n = 100), .62 to .79 for score change (n = 43 post-total knee arthroplasty), and most κ values >.60 (n = 51). For both scales, effect sizes were higher than for the WOMAC, and there was modest correlation between physical and psychological questions, indicating these concepts are not completely interchangeable. Thus, the PAQ scales have strong psychometric properties and are unique compared with existing scales by including physical and psychological symptoms.

  14. National Center for PTSD

    MedlinePlus

    ... Z) Hepatitis HIV Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research ( ... VHA Forms & Publications Quality & Safety Quality of Care Ethics VA/DOD Clinical Practice Guidelines Hospital Quality Data ...

  15. How Is PTSD Measured?

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  16. Suicide and PTSD

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  17. [Posttraumatic stress disorder (PTSD)].

    PubMed

    Martényi, Ferenc

    2004-11-14

    The diagnosis of posttraumatic stress disorder (PTSD) has been introduced in 1980. The diagnosis, as construct raises several political, moral, legal, and compensation issues. PTSD is considered as a multisystemic dysregulation, involving the hypothalamic- pituitary - adrenal axis, adrenergic hypersensibility, and serotonergic dysfunction. The prevalence of PTSD is 1-9% in the general population, but substantially higher among victims of traumatic events: 19-70%. Placebo controlled studies provide a body of evidence concerning efficacy of selective serotonin reuptake inhibitors in the treatment of PTSD both in the acute and maintenance treatments. Studies with balanced male-female ratio suggest no gender-related differences in the clinical response, furthermore both civilians and veterans improved significantly for selective serotonin reuptake inhibitor treatment. PMID:16106902

  18. The effectiveness of VR exposure therapy for PTSD in returning warfighters.

    PubMed

    Miyahira, Sarah D; Folen, Raymond A; Hoffman, Hunter G; Garcia-Palacios, Azucena; Spira, James L; Kawasaki, Michelle

    2012-01-01

    In the decade following the attack on the World Trade Center, over 2.3 million American military personnel were deployed to Iraq and Afghanistan. Lengthy tours of duty and multiple re-deployments were characteristic of these operations. Research findings demonstrate that prolonged exposure to combat increases the risk of developing posttraumatic stress disorder (PTSD). The current study was a randomized controlled clinical trial designed to assess the effectiveness of a novel intervention to treat combat-related PTSD in returning Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) warfighters. A cognitive behavior treatment approach augmented with virtual reality exposure therapy (VRE) was developed, and administered for 10 treatment sessions over 5 weeks. Comparisons with a control group receiving minimal attention (MA) for 5 weeks revealed that the VRE group had significant reductions in the avoidance/numbing symptoms on the Clinician Administered PTSD Scale (CAPS). The VRE group also had significant reductions in guilt at post-treatment compared to the control group. PMID:22954842

  19. Development and reliability of a Telephone-Administered Perceived Racism Scale (TPRS): a tool for epidemiological use.

    PubMed

    Vines, A I; McNeilly, M D; Stevens, J; Hertz-Picciotto, I; Baird, M; Baird, D D

    2001-01-01

    The conceptualization of perceived racism as a chronic stressor is relatively new to epidemiology. The Telephone-Administered Perceived Racism Scale (TPRS) captures the complexity of racism within five scales: Experience of Racism (by Blacks as a group and by the respondent), Emotional Responses, Behavioral Responses, Concern for Child(ren), and Past Experiences of Racism. The TPRS was developed for employed Black women. Exploratory factor analyses and tests of internal consistency were completed with 476 Black women, aged 36-53. Factor analyses on their responses to racism yielded five factors: passive emotions, active emotions, passive behaviors, internal active behaviors, and external active behaviors. Alpha reliability values ranged from 0.75 to 0.80 for the active and passive emotions subscales, from 0.59 to 0.69 for the passive behaviors subscale, and greater than 0.76 for both active behaviors subscales. Alpha reliabilities were 0.82, 0.90, 0.88, and 0.82 for Past Experiences, Concern for Child(ren), Experience of Racism--Personal, and Experience of Racism--Group, respectively. Another 30 Black women were queried for test-retest reliability, with values ranging from 0.61 to 0.82. The TPRS was found to be reliable and should serve as a useful epidemiological tool in the examination of the effects of perceived racism on Black women's health.

  20. Endocannabinoid concentrations in hair are associated with PTSD symptom severity.

    PubMed

    Wilker, Sarah; Pfeiffer, Anett; Elbert, Thomas; Ovuga, Emilio; Karabatsiakis, Alexander; Krumbholz, Aniko; Thieme, Detlef; Schelling, Gustav; Kolassa, Iris-Tatjana

    2016-05-01

    The endocannabinoid system has been implicated in the regulation of the stress response, fear memory formation, and inflammatory processes. Posttraumatic stress disorder (PTSD) can result from exposure to extreme stress and is characterized by strong, associative memories for the traumatic events experienced. Furthermore, an elevated physical disease risk has been observed in PTSD, likely to be mediated by inflammatory processes. Therefore, altered endocannabinoid regulation can be expected in individuals with PTSD. However, attempts to assess PTSD-associated differences in the endocannabinoid system from human blood samples have provided inconsistent results, possibly due to fluctuating levels of endocannabinoids. In hair, these neuromodulators are accumulated over time and thus give access to a more stable and reliable assessment. We therefore investigated PTSD-associated differences in hair concentrations of endocannabinoids (N-acyl-ethanolamides palmitoylethanolamide [PEA], oleoylethanolamide [OEA] and stearoylethanolamide [SEA]) in 38 rebel war survivors from Northern Uganda suffering from PTSD and N=38 healthy rebel war survivors without current and lifetime PTSD. PTSD diagnosis and symptom severity were assessed in structured clinical interviews employing the Posttraumatic Diagnostic Scale (PDS). A significant group difference was observed for OEA, with PTSD patients showing reduced hair concentrations. Regression analyses further revealed strong negative relationships between all investigated N-acyl-ethanolamides and symptom severity of PTSD. The observed reductions in endocannabinoids might account for the increased inflammatory state as well as for the failure to extinguish fear memories observed in PTSD. Our findings add to the accumulating evidence suggesting the endocannabinoid system as a target for pharmacological enhancement of exposure-based psychotherapy for PTSD. PMID:26923850

  1. The Suitability of the EPQ-R Short Scale for Counselling Brunei Student Teachers when Administered in English and Malay Languages

    ERIC Educational Resources Information Center

    Mundia, Lawrence; Abu Bakar, Hj Abu Zahari Bin

    2010-01-01

    The study investigated the psychometric properties of the Eysenck Personality Questionnaire-Revised (EPQ-R) Short Scale administered to two groups of Brunei trainee teachers of both genders taking psychology courses in English (117 students) and Malay (106 students). The extraversion scale had the most problematic items. Both administrations…

  2. Immune function in PTSD.

    PubMed

    Altemus, Margaret; Dhabhar, Firdaus S; Yang, Ruirong

    2006-07-01

    Disturbed regulation of both the hypothalamic-pituitary-adrenal (HPA) axis and sympathoadrenomedullary system in posttraumatic stress disorder (PTSD) suggests that immune function, which is modulated by these systems, may also be dysregulated. Two dermatologic, in vivo measures of immune function, delayed-type hypersensitivity (DTH) and skin barrier function recovery, were examined in female subjects with PTSD and compared to measures in healthy female comparison subjects. In addition, at the time of DTH test placement, circulating numbers of lymphocyte subtypes were assessed. In separate studies, the effects of acute psychological stress on DTH and skin barrier function recovery were examined in healthy volunteer subjects. Both DTH and barrier function recovery were enhanced in women with PTSD. These findings contrast with the effects of acute stress in healthy control subjects, which was associated with suppression of DTH responses and skin barrier function recovery. There was no difference between subjects with PTSD and healthy control subjects in proportions of circulating lymphocyte subsets or in expression of the lymphocyte markers CD62, CD25, and CD45RO/CD45RA. These results suggest that cell-mediated immune function is enhanced in individuals with PTSD, a condition that imposes chronic physiologic and mental stress on sufferers. These findings contrast with suppression of DTH and skin barrier function recovery in healthy volunteers in response to acute psychological stress.

  3. The impact of intolerance of emotional distress and uncertainty on veterans with co-occurring PTSD and substance use disorders.

    PubMed

    Banducci, Anne N; Bujarski, Sarah J; Bonn-Miller, Marcel O; Patel, Amee; Connolly, Kevin M

    2016-06-01

    The risk of developing a substance use disorder (SUD) is significantly higher among veterans with posttraumatic stress disorder (PTSD). Veterans with this co-occurrence have poorer outcomes than singly diagnosed veterans, which may be related to two risk factors: intolerance uncertainty (IU) and low tolerance of emotional distress (TED). We hypothesized low TED and high IU would independently and interactively relate to heightened PTSD symptomatology and trauma-cue elicited SUD cravings. A sample of 70 veterans (M age=50; 95% men; 65% Black) with co-occurring PTSD-SUD was recruited. The Posttraumatic Stress Disorder Checklist (PCL), Craving Questionnaire, Distress Tolerance Scale, and Intolerance of Uncertainty Scale were administered. In general, low TED and high IU were significantly correlated with the PCL total and subscale scores. When examined within regression models, low TED was associated with elevated PCL scores and trauma-cue elicited SUD cravings; IU was not. However, there was a significant interaction between IU and TED; veterans with elevated IU and low TED had higher PCL Total, Hyperarousal, and Intrusions scores. This highlights the importance of assessing TED and IU among veterans with co-occurring PTSD-SUD, as these risk factors may not only be prognostic indicators of outcomes, but also treatment targets. PMID:27004450

  4. Multi-site randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders

    PubMed Central

    Hien, Denise A.; Wells, Elizabeth A.; Jiang, Huiping; Suarez-Morales, Lourdes; Campbell, Aimee N. C.; Cohen, Lisa R.; Miele, Gloria M.; Killeen, Therese; Brigham, Gregory S.; Zhang, Yulei; Hansen, Cheri; Hodgkins, Candace; Hatch-Maillette, Mary; Brown, Chanda; Kulaga, Agatha; Kristman-Valente, Allison; Chu, Melissa; Sage, Robert; Robinson, James A.; Liu, David; Nunes, Edward V.

    2009-01-01

    We compared the effectiveness of Seeking Safety (SS), an integrated cognitive behavioral treatment for substance use disorder (SUD) and post-traumatic stress disorder (PTSD), to an active comparison health education group (Women’s Health Education [WHE]) within NIDA’s Clinical Trials Network. We randomized 353 women to receive 12 sessions of SS (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment at post-treatment and 3-, 6-, and 12-months post-treatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self Report (PSS-SR), and substance use (self-reported abstinence in the prior 7 days and days per week of any substance use). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively), but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline, when 46% of participants were abstinent. Study results do not favor SS over WHE as an adjunct to SUD treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. PMID:19634955

  5. A Randomized, Double-blind Evaluation of D-cycloserine or Alprazolam Combined with Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder (PTSD) in Iraq and Afghanistan War Veterans

    PubMed Central

    Rothbaum, Barbara Olasov; Price, Matthew; Jovanovic, Tanja; Norrholm, Seth D.; Gerardi, Maryrose; Dunlop, Boadie; Davis, Michael; Bradley, Bekh; Duncan, Erica; Rizzo, Albert “Skip”; Ressler, Kerry J.

    2014-01-01

    Objective To determine the effectiveness of Virtual Reality Exposure (VRE) augmented with D-cycloserine (50mg) or alprazolam (0.25mg), compared to placebo, in reducing PTSD due to military trauma in Iraq and Afghanistan. Method A double-blind, placebo-controlled randomized clinical trial comparing augmentation methods for VRE for subjects (n= 156) with PTSD was conducted. Results PTSD symptoms significantly improved from pre- to post-treatment over the 6-session VRE treatment (p<.001) across all conditions and were maintained at 3, 6, and 12 months follow-up. There were no overall differences between the D-cycloserine group on symptoms at any time-point. The alprazolam and placebo conditions significantly differed on the post-treatment Clinician Administered PTSD scale (p = .006) and the 3-month post-treatment PTSD diagnosis, such that the alprazolam group showed greater rates of PTSD (79.2% alprazolam vs. 47.8% placebo). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only (p<.005). At post-treatment, the D-cycloserine group was the lowest on cortisol reactivity (p<.05) and startle response during VR scenes (p<.05). Conclusions A small number of VRE sessions were associated with reduced PTSD diagnosis and symptoms in Iraq/Afghanistan veterans, although there was no control condition for the VRE. Overall, there was no advantage of D-cycloserine on PTSD symptoms in primary analyses. In secondary analyses, benzodiazepine use during treatment may impair recovery, and D-cycloserine may enhance VRE in patients who demonstrate within-session learning. D-cycloserine augmentation treatment in PTSD patients may reduce cortisol and startle reactivity compared to the alprazolam and placebo treatment, consistent with the animal literature. PMID:24743802

  6. Oxytocin improves compassion toward women among patients with PTSD.

    PubMed

    Palgi, Sharon; Klein, Ehud; Shamay-Tsoory, Simone G

    2016-02-01

    Although impairments in social skills, including empathic abilities, are common in post-traumatic stress disorder (PTSD), the ability to feel compassion-a pro-social behavior that is based on empathy and drives us to help others-has never been assessed among these patients. The first aim of this study was to examine whether patients with PTSD suffer from deficits in compassion and to examine the association between the clusters of PTSD symptoms and these deficits. Furthermore, given that intranasal oxytocin (OT) has been suggested to possibly modulate social behaviors, the second aim of this study was to investigate whether intranasal OT may enhance compassion in these patients. Using a randomized, double-blind, placebo-controlled crossover design, we administered 24 IU of OT and placebo at a one-week interval to 32 patients with PTSD and to 30 matched healthy control participants. The results indicate that patients with PTSD exhibit deficits in compassion and that the numbing cluster emerged as the key predictor of those deficits. Moreover, the results indicate that a single intranasal dose of OT enhances compassion toward women (but not towards men), both in patients with PTSD and in controls. These results offer support for recent suggestions that intranasal OT may potentially be an effective pharmacological intervention for patients with PTSD.

  7. Oxytocin improves compassion toward women among patients with PTSD.

    PubMed

    Palgi, Sharon; Klein, Ehud; Shamay-Tsoory, Simone G

    2016-02-01

    Although impairments in social skills, including empathic abilities, are common in post-traumatic stress disorder (PTSD), the ability to feel compassion-a pro-social behavior that is based on empathy and drives us to help others-has never been assessed among these patients. The first aim of this study was to examine whether patients with PTSD suffer from deficits in compassion and to examine the association between the clusters of PTSD symptoms and these deficits. Furthermore, given that intranasal oxytocin (OT) has been suggested to possibly modulate social behaviors, the second aim of this study was to investigate whether intranasal OT may enhance compassion in these patients. Using a randomized, double-blind, placebo-controlled crossover design, we administered 24 IU of OT and placebo at a one-week interval to 32 patients with PTSD and to 30 matched healthy control participants. The results indicate that patients with PTSD exhibit deficits in compassion and that the numbing cluster emerged as the key predictor of those deficits. Moreover, the results indicate that a single intranasal dose of OT enhances compassion toward women (but not towards men), both in patients with PTSD and in controls. These results offer support for recent suggestions that intranasal OT may potentially be an effective pharmacological intervention for patients with PTSD. PMID:26671007

  8. Social anxiety, depression, and PTSD in Vietnam veterans.

    PubMed

    Hofmann, Stefan G; Litz, Brett T; Weathers, Frank W

    2003-01-01

    Many Vietnam veterans with PTSD report a high level of social anxiety and avoidance. Many traumatized individuals also suffer from symptoms of depression, which is often associated with significant problems in social functioning. In order to explore the relationship between social anxiety, depression, and PTSD, we recruited a group of Vietnam veterans with PTSD (n = 27), veterans with other mental disorders (n = 20), and veterans with no mental disorders (n = 35). Participants were administered diagnostic interviews and some of the most commonly used social anxiety instruments. Although the groups did not differ in their rates of social phobia, veterans with PTSD scored highest in most social anxiety measures. Veterans with PTSD were also more likely to be clinically depressed than veterans without PTSD at the time of the assessment. When controlling for the level of depression, the three groups no longer differed in any of the social anxiety measures. Furthermore, level of depression was the best predictor for group membership. These findings suggest that social anxiety in Vietnam combat veterans with PTSD is closely associated with mood disturbance, social withdrawal, and isolation associated with depression.

  9. Malingering and PTSD: Detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST)

    PubMed Central

    2013-01-01

    Background Malingering is prevalent in PTSD, especially in delayed-onset PTSD. Despite the attempts to detect it, indicators, tools and methods to accurately detect malingering need extensive scientific and clinical research. Therefore, this study was designed to validate a tool that can detect malingering of war-related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST). Methods In this blind clinical diagnosis study, one hundred and twenty veterans referred to War Related PTSD Diagnosis Committee in Iran in 2011 were enrolled. In the first step, the clients received Psychiatry diagnosis and were divided into two groups based on the DSM-IV-TR, and in the second step, the participants completed M-FAST. Results The t-test score within two groups by M-FAST Scale showed a significant difference (t = 14.058, P < 0.0001), and 92% of malingering war-related PTSD participants scored more than 6 and %87 of PTSD group scored less than 6 in M-FAST Scale. Conclusions M-FAST showed a significant difference between war-related PTSD and malingering participants. The ≥6 score cutoff was suggested by M-FAST to detect malingering of war-related PTSD. PMID:23714274

  10. Role Preferences of People with Multiple Sclerosis: Image-Revised, Computerized Self-Administered Version of the Control Preference Scale

    PubMed Central

    Solari, Alessandra; Giordano, Andrea; Kasper, Jurgen; Drulovic, Jelena; van Nunen, An; Vahter, Liina; Viala, Frederique; Pietrolongo, Erika; Pugliatti, Maura; Antozzi, Carlo; Radice, Davide; Köpke, Sascha; Heesen, Christoph

    2013-01-01

    Background The Control Preference Scale (CPS) is the most frequently used measure of patients’ preferred roles in treatment decisions. We revised the original CPS and developed a new computerized patient self-administered version (eCPS). We used the eCPS to assess role preferences, and their determinants, in Italian and German people with multiple sclerosis (MS). Methods New cartoons were produced, based on MS health professional and patient input/feedback and previous findings, and pilot tested on 26 Italian and German MS patients. eCPS acceptability and reliability (weighted kappa statistic, wK) in comparison to the original tool, was determined in 92 MS patients who received both CPS versions in random order. Results The new cartoons were well accepted and easily interpreted by patients, who reported they based their choices mainly on the text and considered the images of secondary importance. eCPS reliability was moderate (wK 0.53, 95% confidence interval [CI] 0.40–0.65) and similar to the test-retest reliability of face-to-face administration assessed in a previous publication (wK 0.65, 95% CI 0.45–0.81). Higher education (odds ratio [OR] 3.74, 95% CI 1.00–14.05) and German nationality (OR 10.30, 95% CI 3.10–34.15) were associated with preference for an active role in the logistic model. Conclusions The newly devised eCPS was well received and considered easy to use by MS patients. Reliability was in line with that of the original version. Role preference appears affected by cultural characteristics and (borderline statistical significance) education. PMID:23823627

  11. Bullying and PTSD Symptoms

    ERIC Educational Resources Information Center

    Idsoe, Thormod; Dyregrov, Atle; Idsoe, Ella Cosmovici

    2012-01-01

    PTSD symptoms related to school bullying have rarely been investigated, and never in national samples. We used data from a national survey to investigate this among students from grades 8 and 9 (n = 963). The prevalence estimates of exposure to bullying were within the range of earlier research findings. Multinomial logistic regression showed that…

  12. Responding to the need for sleep among survivors of interpersonal violence: A randomized controlled trial of a cognitive-behavioral insomnia intervention followed by PTSD treatment.

    PubMed

    Pigeon, Wilfred R; Heffner, Kathi L; Crean, Hugh; Gallegos, Autumn M; Walsh, Patrick; Seehuus, Martin; Cerulli, Catherine

    2015-11-01

    Sleep disturbance is a common feature of posttraumatic stress disorder (PTSD), but is not a focus of standard PTSD treatments. Psychological trauma exposure is associated with considerable physical and mental health morbidity, possibly due to the alterations in neuroendocrine function and inflammation observed in trauma exposed individuals. Although PTSD treatments are efficacious, they are associated with high drop-out rates in clinical trials and clinical practice. Finally, individuals with PTSD stemming from exposure to interpersonal violence represent an especially under-treated population with significant sleep disturbance. Community-based participatory research was utilized to design and prepare a clinical trial that randomizes recent survivors of interpersonal violence who have PTSD, depression, and insomnia to receive either: (1) Cognitive Behavioral Therapy for Insomnia (CBTi) followed by Cognitive Processing Therapy (CPT) for trauma, or (2) attention control followed by CPT. Outcome measures include subjective and objective measures of sleep, clinician-administered PTSD and depression scales, inflammatory cytokines, and salivary cortisol. Assessments are conducted at baseline, following the sleep or control intervention, and again following CPT. The design allows for: (1) the first test of a sleep intervention in this population; (2) the comparison of sequenced CBTi and CPT to attention control followed by CPT, and (3) assessing the roles of neuroendocrine function, inflammatory processes, and objective sleep markers in mediating treatment outcomes. The study's overarching hypothesis is that treating insomnia will produce reduction in insomnia, PTSD, and depression severity, allowing patients to more fully engage in, and derive optimal benefits from, cognitive processing therapy. PMID:26343743

  13. The use of the trauma symptom inventory in the assessment of PTSD symptoms.

    PubMed

    McDevitt-Murphy, Meghan E; Weathers, Frank W; Adkins, Jennifer W

    2005-02-01

    This study examined the Trauma Symptom Inventory (TSI; Briere, 1995) in a sample of 62 trauma-exposed community residents (80% Caucasian, 89% women), including 16 who had posttraumatic stress disorder (PTSD). PTSD and non-PTSD groups differed on seven TSI clinical scales and one validity scale, with effect sizes (r) ranging from 0.26 to 0.53. The largest effect sizes and best diagnostic utility were found for the Defensive Avoidance and Anxious Arousal scales. Diagnostic utility analyses suggest that TSI subscales in isolation are not superior to existing measures of PTSD. A logistic regression using the five most discriminating TSI scales produced a correct classification rate of 85.5%. TSI scales also demonstrated good convergent validity with other measures of PTSD. Overall, the results provide preliminary support for the use of the TSI in the assessment of PTSD. PMID:16281197

  14. The 10-year Course of PTSD in Borderline Patients and Axis II Comparison Subjects

    PubMed Central

    Zanarini, Mary C.; Hörz, Susanne; Frankenburg, Frances R.; Weingeroff, Jolie; Reich, D. Bradford; Fitzmaurice, Garrett

    2011-01-01

    Objective The first objective is to detail the prevalence of PTSD over a decade of follow-up for those in both study groups. The second is to determine time-to-remission, recurrence, and new onset of PTSD and the third is to assess the relationship between sexual adversity and the likelihood of remission and recurrence of PTSD. Method The SCID I was administered to 290 borderline inpatients and 72 axis II comparison subjects during their index admission and re-administered at five contiguous two-year follow-up periods. Results The prevalence of PTSD declined significantly over time for patients with BPD (61%). Over 85% of borderline patients meeting criteria for PTSD at baseline experienced a remission by the time of the 10-year follow-up. Recurrences (40%) and new onsets (27%) were less common. A childhood history of sexual abuse significantly decreased the likelihood of remission from PTSD and an adult history of sexual assault significantly increased the likelihood of a recurrence of PTSD. Conclusion Taken together, the results of this study suggest that PTSD is not a chronic disorder for the majority of borderline patients. They also suggest a strong relationship between sexual adversity and the course of PTSD among patients with BPD. PMID:21564040

  15. PTSD After Severe Vehicular Crashes

    PubMed Central

    Ryb, Gabriel E.; Dischinger, Patricia C.; Read, Kathleen M.; Kufera, Joseph A.

    2009-01-01

    Purpose: To describe predictors of PTSD after motor vehicle crashes (MVC). Methods: MVC patients were interviewed during their hospitalization and at 6 and 12 months post-injury. Interviews included information about behavioral factors, circumstances around the crash, recovery and PTSD screening. PTSD was defined as the development of 3 or more of 7 PTSD symptoms. Association of risk factors with PTSD development at 6 and 12 months was analyzed using contingency tables. Multiple regression models were built for the prediction of PTSD. Results: 367 and 317 patients completed the 6 and 12 month interviews respecively. PTSD developed in 27.5 % (n=101) and 24.3 % (n=77) of the population at 6 and 12 months repectively. PTSD occurred more frequently among females, those with a previous history of depression, violent injury, or other traumatic events, and those whose crashes involved a fatality. Those who were culpable for the crash, age<30, and sustained brain injuries were less likely to develop PTSD at 6 months. Occupant position, education, marital status, alcohol problems, injury severity, heart rate, and blood alcohol + status did not show any significant association with PTSD. In the multiple logistic regression, female gender, history of depression, culpabilty, prior violent injury, and a fatality in the crash were associated with PTSD at 6 months. Only prior violent injury, and a death in same crash were predictors at one year. Conclusion: PTSD occurs frequently after MVCs. Female gender, prior violent injury, death of another occupant and history of depression are associated with PTSD development. PMID:20184843

  16. A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social–Emotional Processing

    PubMed Central

    King, Anthony P.; Block, Stefanie R.; Sripada, Rebecca K.; Rauch, Sheila A. M.; Porter, Katherine E.; Favorite, Todd K.; Giardino, Nicholas; Liberzon, Israel

    2016-01-01

    Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social–emotional threat related to symptom reduction. PMID:27703434

  17. Assessing Treatment-Resistant Posttraumatic Stress Disorder: The Emory Treatment Resistance Interview for PTSD (E-TRIP)

    PubMed Central

    Dunlop, Boadie W.; Kaye, Joanna L.; Youngner, Cole; Rothbaum, Barbara

    2014-01-01

    Patients with posttraumatic stress disorder (PTSD) who fail to respond to established treatments are at risk for chronic disability and distress. Although treatment-resistant PTSD (TR-PTSD) is a common clinical problem, there is currently no standard method for evaluating previous treatment outcomes. Development of a tool that could quantify the degree of resistance to previously provided treatments would inform research in patients with PTSD. We conducted a systematic review of PTSD treatment trials to identify medication and psychotherapy interventions proven to be efficacious for PTSD. We then developed a semi-structured clinician interview called the Emory Treatment Resistance Interview for PTSD (E-TRIP). The E-TRIP includes clinician-administered questions to assess the adequacy and benefit derived from past treatment trials. For each adequately delivered treatment to which the patient failed to respond, a score is assigned depending on the strength of evidence supporting the treatment’s efficacy. The E-TRIP provides a comprehensive assessment of prior PTSD treatments that should prove valuable for researchers studying TR-PTSD and evaluating the efficacy of new treatments for patients with PTSD. The E-TRIP is not intended to guide treatment; rather, the tool quantifies the level of treatment resistance in patients with PTSD in order to standardize TR-PTSD in the research domain. PMID:25494488

  18. Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD.

    PubMed

    Rash, Carla J; Coffey, Scott F; Baschnagel, Joseph S; Drobes, David J; Saladin, Michael E

    2008-08-01

    Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale-Revised (IES-R) in a sample of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.

  19. Comparison of Adding Treatment of PTSD During and After Shelter Stay to Standard Care in Residents of Battered Women's Shelters: Results of a Randomized Clinical Trial.

    PubMed

    Johnson, Dawn M; Johnson, Nicole L; Perez, Sara K; Palmieri, Patrick A; Zlotnick, Caron

    2016-08-01

    This study explored the acceptability, feasibility, and initial efficacy of an expanded version of a PTSD treatment developed for residents of battered women's shelters, Helping to Overcome PTSD through Empowerment (HOPE) in women who received standard shelter services (SSSs). A Phase I randomized clinical trial comparing HOPE + SSSs (n = 30) to SSSs (n = 30) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (Blake et al., 1995) and the Revised Conflict Tactic Scales (Straus, Hamby, Boney-McCoy, & Sugarman, ). Participants were followed at 1-week, and 3- and 6-months posttreatment. Only 2 women dropped out of HOPE + SSS treatment. Latent growth curve analyses found significant treatment effects for PTSD from intimate partner violence (IPV) (β = -.007, p = .021), but not for future IPV (β = .002, p = .709) across follow-up points. Significant effects were also found for secondary outcomes of depression severity (β = -.006, p = .052), empowerment (β = .155, p = .022), and resource gain (β = .158, p = .036). Additionally, more women in HOPE + SSSs were employed at 3- and 6-month follow-up compared to those in SSSs only. Results showed the acceptability and feasibility of adding IPV-related treatment to standard services. They also suggested that HOPE may be a promising treatment for residents of battered women's shelters. Further research with a larger sample, utilizing more diverse shelter settings and a more rigorous control condition, is needed to confirm these findings. PMID:27459503

  20. Comparison of Adding Treatment of PTSD During and After Shelter Stay to Standard Care in Residents of Battered Women’s Shelters: Results of a Randomized Clinical Trial

    PubMed Central

    Johnson, Dawn M.; Johnson, Nicole L.; Perez, Sara K.; Palmieri, Patrick A.; Zlotnick, Caron

    2016-01-01

    This study explored the acceptability, feasibility, and initial efficacy of an expanded version of a PTSD treatment developed for residents of battered women’s shelters, Helping to Overcome PTSD through Empowerment (HOPE) in women who received standard shelter services (SSSs). A Phase I randomized clinical trial comparing HOPE + SSSs (n = 30) to SSSs (n = 30) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (Blake et al., 1995) and the Revised Conflict Tactic Scales (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). Participants were followed at 1-week, and 3- and 6-months posttreatment. Only 2 women dropped out of HOPE + SSS treatment. Latent growth curve analyses found significant treatment effects for PTSD from intimate partner violence (IPV) (β = −.007, p = .021), but not for future IPV (β = .002, p = .709) across follow-up points. Significant effects were also found for secondary outcomes of depression severity (β = −.006, p = .052), empowerment (β = .155, p = .022), and resource gain (β = .158, p = .036). Additionally, more women in HOPE + SSSs were employed at 3- and 6-month follow-up compared to those in SSSs only. Results showed the acceptability and feasibility of adding IPV-related treatment to standard services. They also suggested that HOPE may be a promising treatment for residents of battered women’s shelters. Further research with a larger sample, utilizing more diverse shelter settings and a more rigorous control condition, is needed to confirm these findings. PMID:27459503

  1. A simple model for prediction postpartum PTSD in high-risk pregnancies.

    PubMed

    Shlomi Polachek, Inbal; Dulitzky, Mordechai; Margolis-Dorfman, Lilia; Simchen, Michal J

    2016-06-01

    This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population. PMID:26399873

  2. Pharmacological Modulation of Acute Trauma Memories to Prevent PTSD: Considerations from a Developmental Perspective

    PubMed Central

    Hruska, Bryce; Cullen, Patrick K.; Delahanty, Douglas L.

    2014-01-01

    Estimates of the lifetime prevalence of posttraumatic stress disorder (PTSD) in American adults range from 6.4–6.8%. PTSD is associated with increased risk for comorbid major depression, substance use disorder, suicide, and a variety of other mental and physical health conditions. Given the negative sequelae of trauma/PTSD, research has focused on identifying efficacious interventions that could be administered soon after a traumatic event to prevent or reduce the subsequent incidence of PTSD. While early psychosocial interventions have been shown to be relatively ineffective, early (secondary) pharmacological interventions have shown promise. These pharmacological approaches are largely based on the hypothesis that disruption of altered stress hormone levels and the consequent formation of trauma memories could protect against the development of PTSD. The present manuscript reviews the literature regarding the role of peri-traumatic stress hormones as risk factors for the development of PTSD and reviews evidence for the efficacy of exogenously modulating stress hormone levels to prevent/buffer the development of PTSD symptoms. Whereas prior literature has focused primarily on either child or adult studies, the present review incorporates both child and adult studies in a developmental approach to understanding risk for PTSD and how pharmacological modulation of acute memories may buffer the development of PTSD symptoms. PMID:24513176

  3. An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse

    PubMed Central

    Knefel, Matthias; Lueger-Schuster, Brigitte

    2013-01-01

    Background The WHO recently launched the proposal for the 11th version of the International Classification of Diseases (ICD-11) that also includes two diagnoses related to traumatic stress. In contrast to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ICD-11 will probably, in addition to posttraumatic stress disorder (PTSD), also define a new diagnosis termed “complex posttraumatic stress disorder” (CPTSD). Objective We aimed to apply the proposed ICD-11 criteria for PTSD and CPTSD and to compare their prevalence to the ICD-10 (International Classification of Diseases [10th revision]) PTSD prevalence. In addition, we compiled a list of symptoms for CPTSD based on subthreshold PTSD so as to include a wider group of individuals. Methods To evaluate the appropriateness of the WHO ICD-11 proposal compared to the criteria of ICD-10, we applied the newly introduced criteria for PTSD and CPTSD deriving from the Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C) and the Brief Symptom Inventory (BSI) scales, to a sample of adult survivors (N=229) of childhood institutional abuse. We evaluated the construct validity of CPTSD using confirmatory factor analysis (CFA). Results More individuals fulfilled the criteria for PTSD according to ICD-10 (52.8%) than the ICD-11 proposal (17% for PTSD only; 38.4% if combined with complex PTSD). The new version of PTSD neutralized the gender effects. The prevalence of CPTSD was 21.4%, and women had a significantly higher rate of CPTSD than men (40.4 and 15.8%, respectively). Those survivors who were diagnosed with CPTSD experienced institutional abuse for a longer time. CFA showed a strong model fit. Conclusion CPTSD is a highly relevant classification for individuals with complex trauma history, but surprisingly, effects of gender were apparent. Further research should thus address gender effects. PMID:24312721

  4. Social support and mental health service use among individuals with PTSD in a nationally-representative survey

    PubMed Central

    Sripada, Rebecca Kaufman; Pfeiffer, Paul Nelson; Rauch, Sheila A. M.; Bohnert, Kipling

    2014-01-01

    Objective Despite continued outreach efforts, levels of mental healthcare utilization for posttraumatic stress disorder (PTSD) remain low. As such, it is important to identify factors that may promote or discourage treatment engagement. The current study was designed to examine the association between perceived social support and utilization of several types of PTSD services. Methods Data come from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which was administered between 2004 and 2005. PTSD was assessed via structured interview, and perceived social support was assessed via the Interpersonal Support Evaluation List-12 (ISEL-12). Participants were asked about PTSD-specific treatment of the following modalities: outpatient, hospitalization, emergency department visits, and psychiatric medication prescriptions. Weighted logistic regression modeling was performed to examine associations between social support scores and the odds of receiving treatment for PTSD, adjusting for sociodemographic characteristics and PTSD severity. Results The final sample consisted of 2811 individuals with PTSD. Social support was not associated with the odds of receiving any type of PTSD treatment. Conclusions Among individuals in the general population with PTSD, perceived social support may not be related to PTSD treatment utilization. Other factors such as sociodemographic characteristics and symptom severity may be more important with respect to receiving PTSD-specific treatment. PMID:25269889

  5. Development and Validation of a Computer-Administered Number Sense Scale for Fifth-Grade Children in Taiwan

    ERIC Educational Resources Information Center

    Li, Mao-Neng Fred; Yang, Der-Ching

    2010-01-01

    To investigate the structure of number sense and then to assess its uses in fifth-grade children's number sense development, a computerized number sense scale was developed and evaluated. The findings of the study indicate that the newly developed scale, with four dominant factors identified and reconfirmed, is internally consistent and…

  6. Changes in diagnostic criteria of PTSD: implications from two prospective longitudinal studies.

    PubMed

    Solomon, Zahava; Horesh, Danny

    2007-04-01

    This study assesses differences in PTSD rates according to different sets of diagnostic criteria. Two samples have been studied: one comprised of 286 combat stress reaction (CSR) casualties and 218 non-CSR veterans from the Lebanon war (Study 1); the other of 95 ex-POWs and 101 non-POWs from the Yom Kipur war (Study 2). Participants were administered two versions of the PTSD inventory based on different Diagnostic and Statistical Manual of Mental Disorders (DSM) editions: DSM-III and DSM-IV in Study 1 and DSM-III-R and DSM-IV in Study 2. PTSD rates declined when criteria of more recent DSM editions were applied. In addition, findings clearly demonstrate the importance of the dysfunction criterion (F) in PTSD. The highly complex nature of the PTSD diagnosis is discussed, as well as the important role of dysfunction and distress. PMID:17535115

  7. Role and treatment of early maladaptive schemas in Vietnam Veterans with PTSD.

    PubMed

    Cockram, David M; Drummond, Peter D; Lee, Christopher W

    2010-01-01

    The role of early maladaptive schemas in understanding and treating post-traumatic stress disorder (PTSD) was investigated. The first study examined the role of perceived adverse parenting and early maladaptive schemas in the development of PTSD in Australian and New Zealand Vietnam war veterans (n = 220). Veterans diagnosed with PTSD scored higher on the Young Schema Questionnaire (L3) and had higher scores on the Measure of Parental Style than veterans not diagnosed with PTSD. The results suggest that early maladaptive schemas have an important role in the development or maintenance of PTSD in Vietnam veterans. The second study measured at baseline, termination and 3 months the early maladaptive schemas, PTSD, anxiety and depression of war veterans (n = 54) participating in a PTSD group treatment programme that included schema-focused therapy. Scores on the PTSD Checklist, the Hospital Anxiety and Depression Scale, and 17 schemas decreased significantly after treatment. Change scores for the schema treatment were compared with change scores of war veterans (n = 127) who had completed a manualized cognitive-behavioural therapy programme without schema-focused therapy. Pre-treatment measures were similar in both groups. Nevertheless, PTSD and anxiety improved more significantly for the schema-focused therapy group. Together, these findings support the feasibility of schema-focused therapy to assist veterans with PTSD. PMID:20486158

  8. Preliminary evaluation of PTSD Coach, a smartphone app for post-traumatic stress symptoms.

    PubMed

    Kuhn, Eric; Greene, Carolyn; Hoffman, Julia; Nguyen, Tam; Wald, Laura; Schmidt, Janet; Ramsey, Kelly M; Ruzek, Josef

    2014-01-01

    PTSD Coach is a mobile application (app) designed to help individuals who have post-traumatic stress disorder (PTSD) symptoms better understand and self-manage their symptoms. It has wide-scale use (over 130,000 downloads in 78 countries) and very favorable reviews but has yet to be evaluated. Therefore, this study examines user satisfaction, perceived helpfulness, and usage patterns of PTSD Coach in a sample of 45 veterans receiving PTSD treatment. After using PTSD Coach for several days, participants completed a survey of satisfaction and perceived helpfulness and focus groups exploring app use and benefit from use. Data indicate that participants were very satisfied with PTSD Coach and perceived it as being moderately to very helpful with their PTSD symptoms. Analysis of focus group data resulted in several categories of app use: to manage acute distress and PTSD symptoms, at scheduled times, and to help with sleep. These findings offer preliminary support for the acceptability and perceived helpfulness of PTSD Coach and suggest that it has potential to be an effective self-management tool for PTSD. Although promising, future research is required to validate this, given study limitations.

  9. Role and treatment of early maladaptive schemas in Vietnam Veterans with PTSD.

    PubMed

    Cockram, David M; Drummond, Peter D; Lee, Christopher W

    2010-01-01

    The role of early maladaptive schemas in understanding and treating post-traumatic stress disorder (PTSD) was investigated. The first study examined the role of perceived adverse parenting and early maladaptive schemas in the development of PTSD in Australian and New Zealand Vietnam war veterans (n = 220). Veterans diagnosed with PTSD scored higher on the Young Schema Questionnaire (L3) and had higher scores on the Measure of Parental Style than veterans not diagnosed with PTSD. The results suggest that early maladaptive schemas have an important role in the development or maintenance of PTSD in Vietnam veterans. The second study measured at baseline, termination and 3 months the early maladaptive schemas, PTSD, anxiety and depression of war veterans (n = 54) participating in a PTSD group treatment programme that included schema-focused therapy. Scores on the PTSD Checklist, the Hospital Anxiety and Depression Scale, and 17 schemas decreased significantly after treatment. Change scores for the schema treatment were compared with change scores of war veterans (n = 127) who had completed a manualized cognitive-behavioural therapy programme without schema-focused therapy. Pre-treatment measures were similar in both groups. Nevertheless, PTSD and anxiety improved more significantly for the schema-focused therapy group. Together, these findings support the feasibility of schema-focused therapy to assist veterans with PTSD.

  10. Depression, not PTSD, is associated with attentional biases for emotional visual cues in early traumatized individuals with PTSD

    PubMed Central

    Wittekind, Charlotte E.; Muhtz, Christoph; Jelinek, Lena; Moritz, Steffen

    2015-01-01

    Using variants of the emotional Stroop task (EST), a large number of studies demonstrated attentional biases in individuals with PTSD across different types of trauma. However, the specificity and robustness of the emotional Stroop effect in PTSD have been questioned recently. In particular, the paradigm cannot disentangle underlying cognitive mechanisms. Transgenerational studies provide evidence that consequences of trauma are not limited to the traumatized people, but extend to close relatives, especially the children. To further investigate attentional biases in PTSD and to shed light on the underlying cognitive mechanism(s), a spatial-cueing paradigm with pictures of different emotional valence (neutral, anxiety, depression, trauma) was administered to individuals displaced as children during World War II (WWII) with (n = 22) and without PTSD (n = 26) as well as to non-traumatized controls (n = 22). To assess whether parental PTSD is associated with biased information processing in children, each one adult offspring was also included in the study. PTSD was not associated with attentional biases for trauma-related stimuli. There was no evidence for a transgenerational transmission of biased information processing. However, when samples were regrouped based on current depression, a reduced inhibition of return (IOR) effect emerged for depression-related cues. IOR refers to the phenomenon that with longer intervals between cue and target the validity effect is reversed: uncued locations are associated with shorter and cued locations with longer RTs. The results diverge from EST studies and demonstrate that findings on attentional biases yield equivocal results across different paradigms. Attentional biases for trauma-related material may only appear for verbal but not for visual stimuli in an elderly population with childhood trauma with PTSD. Future studies should more closely investigate whether findings from younger trauma populations also manifest in older

  11. Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART(®)).

    PubMed

    Kip, Kevin E; Elk, Carrie A; Sullivan, Kelly L; Kadel, Rajendra; Lengacher, Cecile A; Long, Christopher J; Rosenzweig, Laney; Shuman, Amy; Hernandez, Diego F; Street, Jennifer D; Girling, Sue Ann; Diamond, David M

    2012-06-01

    Post-Traumatic Stress Disorder (PTSD) is a prevalent, disabling anxiety disorder. This prospective cohort study reports on a new exposure-based therapy known as Accelerated Resolution Therapy (ART(®)) that incorporates the use of eye movements administered in a brief treatment period (1-5 one-hour sessions within three weeks). Eighty adults aged 21-60 years with symptoms of PTSD were recruited from the Tampa Bay area. The ART-based psychotherapy was designed to minimize anxiety and body sensations associated with recall of traumatic memories and to replace distressing images with favorable ones. Participants' mean age was 40 years, 77% were female, and 29% were Hispanic. Participants underwent a median of three ART sessions, 66 of 80 (82.5%) completed treatment, and 54 of 66 (81.8%) provided 2-month follow-up data. Mean scores pre- and post-ART and at 2-month follow-up were: PTSD Checklist: 54.5 ± 12.2 vs. 31.2 ± 11.4 vs. 30.0 ± 12.4; Brief Symptom Inventory: 30.8 ± 14.6 vs. 10.1 ± 10.8 vs. 10.1 ± 12.1; Center for Epidemiologic Studies Depression Scale: 29.5 ± 10.9 vs. 11.8 ± 11.1 vs. 13.5 ± 12.1; Trauma Related Growth Inventory-Distress scale: 18.9 ± 4.1 vs. 7.4 ± 5.9 vs. 8.2 ± 5.9 (p < 0.0001 for all pre-ART vs. post-ART and 2-month comparisons). No serious adverse events were reported. ART appears to be a brief, safe, and effective treatment for symptoms of PTSD.

  12. The assessment of generalized anxiety disorder: psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice

    PubMed Central

    2012-01-01

    Aim To psychometrically validate the Spanish version of the self-administered 2-item GAD-2 scale for screening probable patients with generalised anxiety disorder (GAD). Methods The GAD-2 was self-administered by patients diagnosed with GAD according to DSM-IV criteria and by age- and sex-matched controls who were recruited at random in mental health and primary care centres. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity and positive and negative predictive values were determined for different cut-off values. Concurrent validity was also established using the HAM-A, HADS, and WHODAS II scales. Results The study sample consisted of 212 subjects (106 patients with GAD) with a mean age of 50.38 years (SD = 16.76). No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to complete the questionnaire. Reliability (internal consistency) was high; Cronbach’s α = 0.875. A cut-off point of 3 showed adequate sensitivity (91.5%) and specificity (85.8%), with a statistically significant area under the curve (AUC = 0.937, p < 0.001), to distinguish GAD patients from controls. Concurrent validity was also high and significant with HAM-A (0.806, p < 0.001), HADS (anxiety domain, 0.825, p < 0.001) and WHO-DAS II (0.642, p < 0.001) scales. Conclusion The Spanish version of the GAD-2 scale has been shown to have appropriate psychometric properties to rapidly detect probable cases of GAD in the Spanish cultural context under routine clinical practice conditions. PMID:22992432

  13. Effects of PTSD on Family

    MedlinePlus

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  14. A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers.

    PubMed

    Difede, JoAnn; Malta, Loretta S; Best, Suzanne; Henn-Haase, Clare; Metzler, Thomas; Bryant, Richard; Marmar, Charles

    2007-10-01

    This article describes a controlled clinical trial of cognitive-behavioral treatment (CBT) for disaster workers. Despite high rates of PTSD in disaster workers worldwide, there have been no randomized trials of PTSD treatment. Participants were randomly assigned to a 12-week cognitive-behavioral exposure treatment (CBT, N = 15) or a treatment-as-usual (N = 16) condition. Eight CBT and 14 treatment-as-usual participants completed treatment. An ANOVA examining changes in Clinician-Administered PTSD Scale scores found significant main effects of Time, Group, and a Time x Group interaction (p's < 0.010) with a significantly greater decline in symptom scores in the CBT group. Between-group effect sizes were large. Dropout was associated with lower income, less education, and higher alcohol consumption. This project demonstrates the feasibility of recruitment in the aftermath of a catastrophic event, the relevance of a brief focused intervention comprised of CBT and exposure, and the need to eliminate barriers to treatment retention associated with income and education. PMID:18043528

  15. Prolonged exposure and virtual reality-enhanced imaginal exposure for PTSD following a terrorist bulldozer attack: a case study.

    PubMed

    Freedman, Sara A; Hoffman, Hunter G; Garcia-Palacios, Azucena; Tamar Weiss, Patrice L; Avitzour, Sara; Josman, Naomi

    2010-02-01

    In this case study, virtual reality was used to augment imaginal exposure in a protocol based on prolonged exposure. A 29-year-old male patient developed posttraumatic stress disorder after surviving a deadly terrorist bulldozer attack on two civilian buses and several cars in Jerusalem; the traumas witnessed by the survivor included a decapitation. The crowded bus in which the patient was riding was pushed over onto its side by the terrorist, injuring, trapping, and terrifying the passengers and causing gasoline to leak. Guided by his therapist, the patient entered an immersive computer-generated virtual world to go "back" to the scene of the traumatic event to help him gain access to his memories of the event, process and reduce the intensity of the emotions (fear/anger) associated with his pathological memories, and change unhealthy thought patterns. Traumatic memories of childhood abuse and traumatic memories of the bulldozer terrorist attack were treated using imaginal exposure while the patient was in the virtual environment BusWorld. The patient showed large posttreatment reductions in PTSD symptoms, and his Clinician-Administered PTSD Scale (CAPS) scores dropped from 79 pretreatment to zero immediately posttreatment, and CAPS was still at zero 6 months later. Although case studies are inconclusive by nature, these encouraging preliminary results suggest that further exploration of the use of virtual reality during modified prolonged exposure for PTSD is warranted. As terrorist attacks increase in frequency and severity worldwide, research is needed on how to minimize the psychological consequences of terrorism.

  16. Childhood trauma, PTSD, and problematic alcohol and substance use in low-income, African-American men and women.

    PubMed

    Cross, Dorthie; Crow, Thomas; Powers, Abigail; Bradley, Bekh

    2015-06-01

    Previous studies demonstrate that PTSD mediates the relationship between childhood trauma and alcohol and substance use disorders and that PTSD and alcohol/substance use comorbidity is greater in men than in women. We sought to replicate and extend these findings in a predominantly low-income, African-American sample recruited from a public hospital. We administered measures of childhood trauma, PTSD symptoms, problematic alcohol use, and problematic substance use to 803 men and 2084 women. We examined rates of comorbidity in men and women. Next, two bootstrap analyses were used to test whether PTSD is a mediator between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. Finally, two bootstrap analyses were used to test whether gender would moderate the indirect effect of PTSD in both the alcohol and substance use models. Results showed that although men and women reported similar overall PTSD symptom frequency, men were more likely than women to report PTSD comorbid with alcohol and/or substance use problems. In addition, PTSD partially mediated the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. The indirect effects of PTSD on the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use were greater in men. This study demonstrates the important interplay of gender, childhood trauma, PTSD, and alcohol and substance use. Mental health providers should consider childhood trauma histories and diagnostic comorbidities when treatment planning.

  17. The Effectiveness of the Personality Assessment Inventory With Feigned PTSD: An Initial Investigation of Resnick's Model of Malingering.

    PubMed

    Wooley, Chelsea N; Rogers, Richard

    2015-08-01

    Malingered posttraumatic stress disorder (PTSD) poses a formidable clinical challenge because of the apparent ease in feigning PTSD. As an additional confound, some patients with genuine PTSD produce elevated profiles on feigning indicators that are difficult to distinguish from feigned PTSD. The current study utilized 109 inpatients from a trauma unit to examine whether the Personality Assessment Inventory and the Detailed Assessment of Posttraumatic Stress can effectively differentiate between genuine and feigned PTSD. As a primary focus, Resnick's model of malingered PTSD was evaluated with its three subtypes: pure malingering, partial malingering, and false imputation. They were tested on their ability to (a) effectively simulate PTSD and (b) avoid being classified as feigning. The partial malingering group proved to be the best feigning group in achieving these two goals. Overall, the Personality Assessment Inventory Malingering Index and Negative Distortion Scale were the most effective at identifying feigning.

  18. Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks.

    PubMed

    DiGrande, Laura; Perrin, Megan A; Thorpe, Lorna E; Thalji, Lisa; Murphy, Joseph; Wu, David; Farfel, Mark; Brackbill, Robert M

    2008-06-01

    Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD. PMID:18553414

  19. Differences in relationship conflict, attachment, and depression in treatment-seeking veterans with hazardous substance use, PTSD, or PTSD and hazardous substance use.

    PubMed

    Owens, Gina P; Held, Philip; Blackburn, Laura; Auerbach, John S; Clark, Allison A; Herrera, Catherine J; Cook, Jerome; Stuart, Gregory L

    2014-05-01

    Veterans (N = 133) who were seeking treatment in either the Posttraumatic Stress Program or Substance Use Disorders Program at a Veterans Affairs Medical Center (VAMC) and, based on self-report of symptoms, met clinical norms for posttraumatic stress disorder (PTSD) or hazardous substance use (HSU) completed a survey related to relationship conflict behaviors, attachment styles, and depression severity. Participants were grouped into one of three categories on the basis of clinical norm criteria: PTSD only, HSU only, and PTSD + HSU. Participants completed the PTSD Checklist-Military, Experiences in Close Relationships Scale-Short Form, Center for Epidemiologic Studies-Depression scale, Alcohol Use Disorders Identification Test, Drug Use Disorders Identification Test, and Psychological Aggression and Physical Violence subscales of the Conflict Tactics Scale. Most participants were male and Caucasian. Significant differences were found between groups on depression, avoidant attachment, psychological aggression perpetration and victimization, and physical violence perpetration and victimization. Post hoc analyses revealed that the PTSD + HSU group had significantly higher levels of depression, avoidant attachment, and psychological aggression than the HSU only group. The PTSD + HSU group had significantly higher levels of physical violence than did the PTSD only group, but both groups had similar mean scores on all other variables. Potential treatment implications are discussed.

  20. Factor Structure and Psychometric Properties of the Posttraumatic Stress Disorder (PTSD) Checklist and DSM-5 PTSD Symptom Set in a Long-Term Postearthquake Cohort in Armenia.

    PubMed

    Demirchyan, Anahit; Goenjian, Armen K; Khachadourian, Vahe

    2015-10-01

    Psychometric properties of the Armenian-language posttraumatic stress disorder (PTSD) Checklist-Civilian version (PCL-C) and the DSM-5 PTSD symptom set were examined in a long-term cohort of earthquake survivors. In 2012, 725 survivors completed the instruments. Item-/scale-level analysis and confirmatory factor analysis (CFA) were performed for both scales. In addition, exploratory factor analysis (EFA) was conducted for DSM-5 symptoms. Also, the differential internal versus external specificity of PTSD symptom clusters taken from the most supported PTSD structural models was examined. Both scales had Cronbach's alpha greater than .9. CFA of PCL-C structure demonstrated an excellent fit by a four-factor (reexperiencing, avoidance, numbing, and hyperarousal) model known as numbing model; however, a superior fit was achieved by a five-factor model (Elhai et al.). EFA yielded a five-factor structure for DSM-5 symptoms with the aforementioned four domains plus a negative state domain. This model achieved an acceptable fit during CFA, whereas the DSM-5 criteria-based model did not. The Armenian-language PCL-C was recommended as a valid PTSD screening tool. The study findings provided support to the proposed new classification of common mental disorders, where PTSD, depression, and generalized anxiety are grouped together as a subclass of distress disorders. Recommendations were made to further improve the PTSD diagnostic criteria.

  1. The Utility and Comparative Incremental Validity of the MMPI-2 and Trauma Symptom Inventory Validity Scales in the Detection of Feigned PTSD

    ERIC Educational Resources Information Center

    Efendov, Adele A.; Sellbom, Martin; Bagby, R. Michael

    2008-01-01

    The authors examined the comparative predictive capacity of the Trauma Symptom Inventory (TSI) Atypical Response Scale (ATR) and the standard set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) fake-bad validity scales (i.e., F, F[subscript B[prime

  2. The psychobiology and psychopharmacology of PTSD.

    PubMed

    Van Der Kolk, Bessel A.

    2001-01-01

    This paper reviews the currently available knowledge about the psychobiology and psychopharmacology of post-traumatic stress disorder (PTSD). It also reviews the various studies that have elucidated changes in brain function and structure in PTSD populations, including position emission tomography (PET), single photon emission computed tomography (SPECT), and event-related potential (ERP) studies. It then reviews the literature on catecholamine and hypothalamic-pituitary-adrenal (HPA) axis abnormalities in PTSD, and finally reviews the literature available on the psychopharmacology of PTSD. It discusses how the pathophysiology of PTSD determines the nature of psychopharmacological interventions. Psychopharmacological interventions in PTSD are largely limited to good studies on the effects of the selective serotonin reuptake inhibitors (SSRIs). In order to effectively intervene in PTSD, studies of other psychopharmacological agents are necessary, specifically of agents which affect limbic activation, decreased frontal lobe functioning, altered HPA activity, and other biological features of PTSD. Copyright 2001 John Wiley & Sons, Ltd.

  3. Beyond Exposure for Posttraumatic Stress Disorder (PTSD) Symptoms: Broad-Spectrum PTSD Treatment Strategies

    ERIC Educational Resources Information Center

    Lombardo, Thomas W.; Gray, Matt J.

    2005-01-01

    Although cases of posttraumatic stress disorder (PTSD) with comorbid disorders are common, the first generation of PTSD treatment approaches, including exposure and cognitive-behavioral therapy, generally ignore symptoms beyond those specific to PTSD. Optimum PTSD treatment outcome requires more comprehensive strategies, and the development and…

  4. Neural Correlates of Trait Rumination During an Emotion Interference Task in Women With PTSD.

    PubMed

    Buchholz, Katherine R; Bruce, Steven E; Koucky, Ellen M; Artime, Tiffany M; Wojtalik, Jessica A; Brown, Wilson J; Sheline, Yvette I

    2016-08-01

    Rumination, defined as repetitive, negative, self-focused thinking, is hypothesized to be a transdiagnostic factor that is associated with depression, anxiety, and posttraumatic stress disorder (PTSD). Theory has suggested that in individuals with PTSD, rumination serves as a cognitive avoidance factor that contributes to the maintenance of symptoms by inhibiting the cognitive and emotional processing of the traumatic event, subsequently interfering with treatment engagement and outcome. Little is known about the neural correlates of rumination in women with PTSD. The current study utilized functional magnetic resonance imaging (fMRI) to examine neural correlates during an emotion interference task of self-reported rumination in women with PTSD. Women with PTSD (39 participants) were recruited at a university-based trauma clinic and completed a clinical evaluation that included measures of PTSD symptoms, rumination, and depressive symptoms, as well as a neuroimaging session in which the participants were administered an emotion interference task. There was a significant relationship between self-reported rumination and activity in the right orbital frontal cortex, BA 11; t(37) = 5.62, p = .004, k = 46 during the task. This finding suggested that women with PTSD, who had higher levels of rumination, may experience greater difficulty inhibiting negative emotional stimuli compared to women with lower levels of rumination. PMID:27472504

  5. Is ideology a risk factor for PTSD symptom severity among Israeli political evacuees?

    PubMed

    Oren, Lior; Possick, Chaya

    2010-08-01

    To study the role of ideology in situations of extreme stress, a research questionnaire, measuring posttraumatic stress disorder (PTSD), settlement ideology (the importance of Jewish settlement in Gaza), and type of evacuation was administered to 326 Jewish residents who were evacuated from Gaza settlements by the Israeli government. Forty percent of the participants met the criteria of probable PTSD. Forcibly evicted individuals reported higher levels of settlement ideology and higher levels of PTSD symptom severity compared to voluntarily evacuated individuals. Contrary to previous studies, ideology was found to be positively associated with PTSD symptom severity. The results are explained by the conservation of resources and terror management theories. Theoretical and practical implications are discussed.

  6. Trauma centrality and PTSD in veterans returning from Iraq and Afghanistan.

    PubMed

    Brown, Adam D; Antonius, Daniel; Kramer, Michael; Root, James C; Hirst, William

    2010-08-01

    Research has demonstrated that the extent to which an individual integrates a traumatic event into their identity ("trauma centrality") positively correlates with posttraumatic stress disorder (PTSD) symptom severity. No research to date has examined trauma centrality in individuals exposed to combat stress. This study investigated trauma centrality using the abridged Centrality of Event Scale (Berntsen & Rubin, 2006) among Operation Enduring Freedom/Operation Iraqi Freedom combat veterans (n = 46). Multiple regression analyses demonstrated that trauma centrality predicted PTSD symptoms. Trauma centrality and PTSD symptoms remained significantly correlated when controlling for depression in subgroups of veterans with or without probable PTSD. This study replicates and extends findings that placing trauma at the center of one's identity is associated with PTSD symptomatology.

  7. PTSD in active combat soldiers: to treat or not to treat.

    PubMed

    Wangelin, Bethany C; Tuerk, Peter W

    2014-01-01

    In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as well as the potential difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible.

  8. Identification of Trauma Exposure and PTSD in Adolescent Psychiatric Inpatients: An Exploratory Study

    PubMed Central

    Havens, Jennifer F.; Gudiño, Omar G.; Biggs, Emily A.; Diamond, Ursula N.; Weis, J. Rebecca; Cloitre, Marylene

    2013-01-01

    Trauma exposure and posttraumatic stress disorder (PTSD), though prevalent among adolescent psychiatric inpatients, are under-identified in standard clinical practice. In a retrospective chart review of 140 adolescents admitted to a psychiatric inpatient unit, we examine associations between probable PTSD identified through the Child PTSD Symptom Scale and adolescents' service use and clinical characteristics. Results suggest a large discrepancy between rates of probable PTSD identified through standardized assessment and during the emergency room psychiatric evaluation (28.6% vs. 2.2%). Adolescents with probable PTSD had greater clinical severity and service utilization, an increased likelihood of being diagnosed with bipolar disorder (27.5% vs. 9.2%) and being prescribed antipsychotic medications (47.5% vs. 27.6%), and were prescribed more psychotropic medications. Upon discharge, those with probable PTSD were more likely to be assigned a diagnosis of PTSD (45% vs. 7.1%), a comorbid diagnoses of major depressive disorder (30% vs. 14.3%), to be prescribed an antidepressant medication (52.5% vs. 33.7%), and they continued to be prescribed more medications. The under-identification of trauma exposure and PTSD have important implications for the care of adolescents given that accurate diagnosis is a prerequisite for providing effective care. Improved methods for identifying trauma-related problems in standard clinical practice are needed. PMID:22522731

  9. Biomarkers of PTSD: military applications and considerations

    PubMed Central

    Lehrner, Amy; Yehuda, Rachel

    2014-01-01

    Background Although there are no established biomarkers for posttraumatic stress disorder (PTSD) as yet, biological investigations of PTSD have made progress identifying the pathophysiology of PTSD. Given the biological and clinical complexity of PTSD, it is increasingly unlikely that a single biomarker of disease will be identified. Rather, investigations will more likely identify different biomarkers that indicate the presence of clinically significant PTSD symptoms, associate with risk for PTSD following trauma exposure, and predict or identify recovery. While there has been much interest in PTSD biomarkers, there has been less discussion of their potential clinical applications, and of the social, legal, and ethical implications of such biomarkers. Objective This article will discuss possible applications of PTSD biomarkers, including the social, legal, and ethical implications of such biomarkers, with an emphasis on military applications. Method Literature on applications of PTSD biomarkers and on potential ethical and legal implications will be reviewed. Results Biologically informed research findings hold promise for prevention, assessment, treatment planning, and the development of prophylactic and treatment interventions. As with any biological indicator of disorder, there are potentially positive and negative clinical, social, legal, and ethical consequences of using such biomarkers. Conclusions Potential clinical applications of PTSD biomarkers hold promise for clinicians, patients, and employers. The search for biomarkers of PTSD should occur in tandem with an interdisciplinary discussion regarding the potential implications of applying biological findings in clinical and employment settings. PMID:25206945

  10. Concurrent Treatment of Substance Use and PTSD.

    PubMed

    Flanagan, Julianne C; Korte, Kristina J; Killeen, Therese K; Back, Sudie E

    2016-08-01

    Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are chronic, debilitating conditions that frequently co-occur. Individuals with co-occurring SUD and PTSD suffer a more complicated course of treatment and less favorable treatment outcomes compared to individuals with either disorder alone. The development of effective psychosocial and pharmacological interventions for co-occurring SUD and PTSD is an active and critically important area of investigation. Several integrated psychosocial treatments for co-occurring SUD and PTSD have demonstrated promising outcomes. While recent studies examining medications to treat co-occurring SUD and PTSD have yielded encouraging findings, there remain substantial gaps in the evidence base regarding the treatment of co-occurring SUD and PTSD. This review will summarize the findings from clinical trials targeting a reduction in SUD and PTSD symptoms simultaneously. These results may improve our knowledge base and subsequently enhance our ability to develop effective interventions for this complex comorbid condition. PMID:27278509

  11. Sleep disturbances and PTSD: a perpetual circle?

    PubMed Central

    van Liempt, Saskia

    2012-01-01

    Background Sleep facilitates the consolidation of fear extinction memory. Nightmares and insomnia are hallmark symptoms of posttraumatic stress disorder (PTSD), possibly interfering with fear extinction and compromising recovery. A perpetual circle may develop when sleep disturbances increase the risk for PTSD and vice versa. To date, therapeutic options for alleviating sleep disturbances in PTSD are limited. Methods We conducted three studies to examine the relationship between sleep and posttraumatic symptoms: (1) a prospective longitudinal cohort study examining the impact of pre-deployment insomnia symptoms and nightmares on the development of PTSD; (2) a cross-sectional study examining subjective sleep measures, polysomnography, endocrinological parameters, and memory in veterans with PTSD, veterans without PTSD, and healthy controls (HCs); (3) a randomized controlled trial (RCT) (n=14) comparing the effect of prazosin and placebo on sleep disturbances in veterans with PTSD. In addition to these studies, we systematically reviewed the literature on treatment options for sleep disturbances in PTSD. Results Pre-deployment nightmares predicted PTSD symptoms at 6 months post-deployment; however, insomnia symptoms did not. Furthermore, in patients with PTSD, a correlation between the apnea index and PTSD severity was observed, while obstructive sleep apnea syndrome was not more prevalent. We observed a significant increase in awakenings during sleep in patients with PTSD, which were positively correlated with adrenocorticotropic hormone (ACTH) levels, negatively correlated with growth hormone (GH) secretion, and the subjective perception of sleep depth. Also, heart rate was significantly increased in PTSD patients. Interestingly, plasma levels of GH during the night were decreased in PTSD. Furthermore, GH secretion and awakenings were independent predictors for delayed recall, which was lower in PTSD. In our RCT, prazosin was not associated with improvement of any

  12. The Role of Couples’ Interacting World Assumptions and Relationship Adjustment in Women’s Postdisaster PTSD Symptoms

    PubMed Central

    Monson, Candice M.; Gradus, Jaimie L.; La Bash, Heidi A. J.; Griffin, Michael G.; Resick, Patricia A.

    2010-01-01

    This study examined 58 heterosexual couples’ interacting assumptions about the world and relationship adjustment in predicting wives’ posttraumatic stress disorder (PTSD) symptoms after severe flooding. Both partners completed the World Assumptions Scale (Janoff-Bulman, 1989), and wives reported on their intimate relationship adjustment and PTSD symptomatology. Neither husbands’ nor wives’ assumptions alone predicted wives’ PTSD symptoms. However, the interaction of husbands’ and wives’ benevolent world assumptions significantly predicted wives’ PTSD symptoms. When husbands held less benevolent world assumptions, there was a negative association between wives’ assumptions and PTSD symptoms. Additionally, wives’ relationship adjustment predicted their PTSD symptomatology when taking into account individual and interacting self-worth assumptions. Implications for understanding the role of intimate relationships in postdisaster mental health and interpersonally oriented prevention efforts are discussed. PMID:19626677

  13. Prevalence and Predictors of PTSD and Depression among Adolescent Victims of the Spring 2011 Tornado Outbreak

    ERIC Educational Resources Information Center

    Adams, Zachary W.; Sumner, Jennifer A.; Danielson, Carla Kmett; McCauley, Jenna L.; Resnick, Heidi S.; Grös, Kirstin; Paul, Lisa A.; Welsh, Kyleen E.; Ruggiero, Kenneth J.

    2014-01-01

    Background: Relatively few studies have examined prevalence and predictors of posttraumatic stress disorder (PTSD) or major depressive episode (MDE) in disaster-affected adolescents. Fewer still have administered diagnostic measures or studied samples exposed to tornadoes, a common type of disaster. Further, methodologic problems limit the…

  14. Variation in practices and attitudes of clinicians assessing PTSD-related disability among veterans.

    PubMed

    Jackson, James C; Sinnott, Patricia L; Marx, Brian P; Murdoch, Maureen; Sayer, Nina A; Alvarez, Joann M; Greevy, Robert A; Schnurr, Paula P; Friedman, Matthew J; Shane, Andrea C; Owen, Richard R; Keane, Terence M; Speroff, Theodore

    2011-10-01

    One hundred thirty-eight Veterans Affairs mental health professionals completed a 128-item Posttraumatic Stress Disorder (PTSD) Practice Inventory that asked about their practices and attitudes related to disability assessment of PTSD. Results indicate strikingly wide variation in the attitudes and practices of clinicians conducting disability assessments for PTSD. In a high percentage of cases, these attitudes and practices conflict with best-practice guidelines. Specifically, 59% of clinicians reported rarely or never using testing, and only 17% indicated routinely using standardized clinical interviews. Less than 1% of respondents reported using functional assessment scales.

  15. Avoidant symptoms in PTSD predict fear circuit activation during multimodal fear extinction.

    PubMed

    Sripada, Rebecca K; Garfinkel, Sarah N; Liberzon, Israel

    2013-01-01

    Convergent evidence suggests that individuals with posttraumatic stress disorder (PTSD) exhibit exaggerated avoidance behaviors as well as abnormalities in Pavlonian fear conditioning. However, the link between the two features of this disorder is not well understood. In order to probe the brain basis of aberrant extinction learning in PTSD, we administered a multimodal classical fear conditioning/extinction paradigm that incorporated affectively relevant information from two sensory channels (visual and tactile) while participants underwent fMRI scanning. The sample consisted of fifteen OEF/OIF veterans with PTSD. In response to conditioned cues and contextual information, greater avoidance symptomatology was associated with greater activation in amygdala, hippocampus, vmPFC, dmPFC, and insula, during both fear acquisition and fear extinction. Heightened responses to previously conditioned stimuli in individuals with more severe PTSD could indicate a deficiency in safety learning, consistent with PTSD symptomatology. The close link between avoidance symptoms and fear circuit activation suggests that this symptom cluster may be a key component of fear extinction deficits in PTSD and/or may be particularly amenable to change through extinction-based therapies.

  16. PTSD and Trauma-Related Difficulties in Sexual Minority Women: The Impact of Perceived Social Support.

    PubMed

    Weiss, Brandon J; Garvert, Donn W; Cloitre, Marylène

    2015-12-01

    This study examined posttraumatic stress disorder (PTSD) and related symptoms among sexual minority (SM) and heterosexual women and the influence of social support on the relationship between SM status and symptoms. We hypothesized that SM women would endorse higher symptoms of PTSD and related difficulties and that social support would moderate the relationship between SM status and symptoms. The sample, women seeking treatment for PTSD related to interpersonal violence (n = 477; mean age = 36.07 years; 22.9% SM) completed clinician-administered measures of PTSD and self-report measures of trauma-related difficulties and social support. The rate of PTSD diagnosis was higher for SM women. Social support and SM status were significantly associated with suicidality, self-perceptions, depression, somatic complaints, and functional impairment. The interaction between social support and SM status was significant for both functional impairment (β = -.26) and somatic complaints (β = -.39). High social support had an equal, positive effect among SM and nonminority women, whereas low social support had a greater negative impact among SM women. Results suggested the particular salience of social support on functioning and symptom severity among SM women and the potential importance of including interventions addressing social support into PTSD treatments for SM women.

  17. PTSD, a Disorder with an Immunological Component

    PubMed Central

    Wang, Zhewu; Young, M. Rita I.

    2016-01-01

    Post-traumatic stress disorder (PTSD) has been associated with an inflammatory state. However, few studies have addressed the mechanisms underlying this immune imbalance that favors inflammation or how this imbalance contributes to PTSD. Whether the immune imbalance influences responsiveness or unresponsiveness of patients to PTSD treatments is currently not known. This review brings forward an immune emphasis to a mental health disorder that is unprecedented in its prevalence among combat Veterans of the ongoing conflicts in Iraq and Afghanistan and which also afflicts civilians who have undergone extreme traumatic experiences, such as following natural disasters, serious accidents, or assaults. Included is an overview of the correlative associations in human subjects between PTSD and inflammation and studies in animal models of PTSD, demonstrating causal contributions of inflammation and immune dysregulation to PTSD-like behavior following stress exposure. PMID:27375619

  18. PTSD, a Disorder with an Immunological Component.

    PubMed

    Wang, Zhewu; Young, M Rita I

    2016-01-01

    Post-traumatic stress disorder (PTSD) has been associated with an inflammatory state. However, few studies have addressed the mechanisms underlying this immune imbalance that favors inflammation or how this imbalance contributes to PTSD. Whether the immune imbalance influences responsiveness or unresponsiveness of patients to PTSD treatments is currently not known. This review brings forward an immune emphasis to a mental health disorder that is unprecedented in its prevalence among combat Veterans of the ongoing conflicts in Iraq and Afghanistan and which also afflicts civilians who have undergone extreme traumatic experiences, such as following natural disasters, serious accidents, or assaults. Included is an overview of the correlative associations in human subjects between PTSD and inflammation and studies in animal models of PTSD, demonstrating causal contributions of inflammation and immune dysregulation to PTSD-like behavior following stress exposure. PMID:27375619

  19. Prevalence and predictors of PTSD and depression among adolescent victims of the Spring 2011 tornado outbreak

    PubMed Central

    Adams, Zachary W.; Sumner, Jennifer A.; Danielson, Carla Kmett; McCauley, Jenna L.; Resnick, Heidi S.; Grös, Kirstin; Paul, Lisa A.; Welsh, Kyleen E.; Ruggiero, Kenneth J.

    2014-01-01

    Background Relatively few studies have examined prevalence and predictors of posttraumatic stress disorder (PTSD) or major depressive episode (MDE) in disaster-affected adolescents. Fewer still have administered diagnostic measures or studied samples exposed to tornadoes, a common type of disaster. Further, methodological problems limit the generalizability of previous findings. This study addressed prevalence estimates and risk factors for PTSD and MDE among adolescents exposed to the spring 2011 tornado outbreak in Alabama and Joplin, Missouri. Methods A large (N=2,000), population-based sample of adolescents and caregivers, recruited randomly from tornado-affected communities, participated in structured telephone interviews. PTSD and MDE prevalence were estimated for the overall sample, by gender, and by age. Hierarchical logistic regression was used to identify risk factors for PTSD and MDE. Results Overall, 6.7% of adolescents met diagnostic criteria for PTSD and 7.5% of adolescents met diagnostic criteria for MDE since the tornado. Girls were significantly more likely than boys to meet diagnostic criteria for MDE, and older adolescents were more likely than younger adolescents to report MDE since the tornado. Female gender, prior trauma exposure, and an injured family member were associated with greater risk for PTSD and MDE. Specific incident characteristics (loss of services, concern about others’ safety) were associated with greater PTSD risk; prior disaster exposure was associated with lower MDE risk. Conclusions Whereas most adolescents were resilient following tornado exposure, roughly 1 in 15 developed PTSD, 1 in 13 developed MDE, and many more endorsed subclinical mental health problems. Information regarding specific risk factors can guide early screening, prevention, and intervention efforts in disaster-affected communities. PMID:24580551

  20. Approximating a DSM-5 Diagnosis of PTSD Using DSM-IV Criteria

    PubMed Central

    Rosellini, Anthony J.; Stein, Murray B.; Colpe, Lisa J.; Heeringa, Steven G.; Petukhova, Maria V.; Sampson, Nancy A.; Schoenbaum, Michael; Ursano, Robert J.; Kessler, Ronald C.

    2015-01-01

    Background Diagnostic criteria for DSM-5 posttraumatic stress disorder (PTSD) are in many ways similar to DSM-IV criteria, raising the possibility that it might be possible to closely approximate DSM-5 diagnoses using DSM-IV symptoms. If so, the resulting transformation rules could be used to pool research data based on the two criteria sets. Methods The Pre-Post Deployment Study (PPDS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) administered a blended 30-day DSM-IV and DSM-5 PTSD symptom assessment based on the civilian PTSD Checklist for DSM-IV (PCL-C) and the PTSD Checklist for DSM-5 (PCL-5). This assessment was completed by 9,193 soldiers from three US Army Brigade Combat Teams approximately three months after returning from Afghanistan. PCL-C items were used to operationalize conservative and broad approximations of DSM-5 PTSD diagnoses. The operating characteristics of these approximations were examined compared to diagnoses based on actual DSM-5 criteria. Results The estimated 30-day prevalence of DSM-5 PTSD based on conservative (4.3%) and broad (4.7%) approximations of DSM-5 criteria using DSM-IV symptom assessments were similar to estimates based on actual DSM-5 criteria (4.6%). Both approximations had excellent sensitivity (92.6-95.5%), specificity (99.6-99.9%), total classification accuracy (99.4-99.6%), and area under the receiver operating characteristic curve (0.96-0.98). Conclusions DSM-IV symptoms can be used to approximate DSM-5 diagnoses of PTSD among recently-deployed soldiers, making it possible to recode symptom-level data from earlier DSM-IV studies to draw inferences about DSM-5 PTSD. However, replication is needed in broader trauma-exposed samples to evaluate the external validity of this finding. PMID:25845710

  1. The efficacies of three relaxation regimens in the treatment of PTSD in Vietnam War veterans.

    PubMed

    Watson, C G; Tuorila, J R; Vickers, K S; Gearhart, L P; Mendez, C M

    1997-12-01

    Ninety male Vietnam veterans with posttraumatic stress disorder (PTSD) were administered relaxation instructions, relaxation instruction with deep breathing exercises, or relaxation instructions with deep breathing training and thermal biofeedback. Improvement appeared on only 4 of the 21 PTSD and physiological dependent variables studied. All 21 Treatment x Time interactions were nonsignificant. This suggests that the treatments were mildly therapeutic, but that the additions of training in deep breathing and thermal biofeedback did not produce improvement beyond that associated with simple instructions to relax in a comfortable chair.

  2. CUMULATIVE TRAUMAS AND RISK THRESHOLDS: 12-MONTH PTSD IN THE WORLD MENTAL HEALTH (WMH) SURVEYS

    PubMed Central

    Karam, Elie G.; Friedman, Matthew J.; Hill, Eric D.; Kessler, Ronald C.; McLaughlin, Katie A.; Petukhova, Maria; Sampson, Laura; Shahly, Victoria; Angermeyer, Matthias C.; Bromet, Evelyn J.; de Girolamo, Giovanni; de Graaf, Ron; Demyttenaere, Koen; Ferry, Finola; Florescu, Silvia E.; Haro, Josep Maria; He, Yanling; Karam, Aimee N.; Kawakami, Norito; Kovess-Masfety, Viviane; Medina-Mora, María Elena; Browne, Mark A. Oakley; Posada-Villa, José A.; Shalev, Arieh Y.; Stein, Dan J.; Viana, Maria Carmen; Zarkov, Zahari; Koenen, Karestan C.

    2014-01-01

    Background Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. Methods Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. Results 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyper-arousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. Conclusions A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more “complex” clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies. Depression and Anxiety 31:130–142, 2014. PMID:23983056

  3. The impact of social support on psychological distress for U.S. Afghanistan/Iraq era veterans with PTSD and other psychiatric diagnoses.

    PubMed

    Brancu, Mira; Thompson, Nivonne L; Beckham, Jean C; Green, Kimberly T; Calhoun, Patrick S; Elbogen, Eric B; Robbins, Allison T; Fairbank, John A; Wagner, H Ryan

    2014-06-30

    This study aimed to examine the degree to which posttraumatic stress disorder (PTSD) affects the relationship between social support and psychological distress for U.S. Afghanistan/Iraq era veterans with and without co-occurring psychiatric disorders. Veterans (N=1825) were administered self-report questionnaires and a structured diagnostic interview as part of a multi-site study of post-deployment mental health through the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Main and interaction effects models assessed the association between psychological distress and social support for three comparisons conditions (Controls vs. PTSD-only, non-PTSD, and PTSD plus co-morbid diagnoses). Having PTSD was a critical factor in attenuating the strength of this association, more so than other diagnoses. Furthermore, those with PTSD plus co-morbid diagnoses did not demonstrate significantly larger attenuation in that association compared to the PTSD-only group, indicating that psychiatric comorbidity may be less important in considering the role of social support in PTSD. By understanding this relationship, new avenues for engaging and enhancing treatment outcomes related to social support for veterans of this cohort may be identified. Additional longitudinal research could help evaluate the effect of PTSD symptom clusters, social support type, and trauma exposure type on these relationships.

  4. ASD and PTSD in Rape Victims

    ERIC Educational Resources Information Center

    Elklit, Ask; Christiansen, Dorte M.

    2010-01-01

    In recent years, a number of studies have investigated the prediction of posttraumatic stress disorder (PTSD) through the presence of acute stress disorder (ASD). The predictive power of ASD on PTSD was examined in a population of 148 female rape victims who visited a center for rape victims shortly after the rape or attempted rape. The PTSD…

  5. [PTSD in young children after medical procedure].

    PubMed

    Sepers, J W; van der Boon, N; Landsmeer-Beker, N E A

    2016-01-01

    An eight-year-old boy with spastic type bilateral cerebral palsy and a two-year-old girl with biliary atresia were referred to a psycho-trauma centre. Both children developed post-traumatic stress disorder (PTSD) symptoms as a result of the medical procedure. Because of their symptoms, they were resisting further medical treatment. The children were given trauma-focused treatment (eye movement and desensitisation reprocessing and cognitive behavioural therapy). This article argues that hypnosis and distraction can play a role in preventing PTSD symptoms after undergoing a medical procedure. If PTSD is unavoidable, it is important to recognise the symptoms and to treat these children. Furthermore, their parents might also be traumatised. PTSD symptoms in children and their parents can be successfully treated. Also children with sub-threshold PTSD can benefit from trauma treatment. PMID:27353156

  6. Psychometric Properties of the Child PTSD Checklist in a Community Sample of South African Children and Adolescents

    PubMed Central

    Boyes, Mark E.; Cluver, Lucie D.; Gardner, Frances

    2012-01-01

    Objective The current study assessed the basic psychometric properties of the Child PTSD Checklist and examined the structure of symptoms of posttraumatic stress disorder (PTSD) in a large sample of South African youth. Methodology The checklist was completed by 1025 (540 male; 485 female) South African youth (aged between 10 and 19 years). The factor structure of the scale was assessed with a combination of confirmatory and exploratory techniques. Internal consistencies for the full scale and all subscales were evaluated with Cronbach’s alpha and McDonald’s omega. Validity was assessed by comparing PTSD scores obtained by children who had and had not experienced a traumatic event, and by examining associations between total PTSD scores and known correlates of PTSD. Results Scores on the Child PTSD Checklist clearly discriminated between youth who had experienced a traumatic event and those who had not. Internal consistencies for the full scale (and all subscales) were acceptable to good and hypothesized correlations between PTSD, depression, anxiety, somatic symptoms, and age were observed. Two of the reported fit statistics for the tripartite DSM-IV-TR model of PTSD did not meet traditional criteria and further exploratory analyses revealed a four-factor structure (broadly consistent with Simms and colleagues’ Dysphoria Model of PTSD symptoms) which provided a better fit to the observed data. Conclusion Given the continued use of the Child PTSD Checklist in South Africa, findings offer an important first step in establishing the reliability and validity of the checklist for use with South African youth. However, further evaluation of the checklist in South African samples is clearly required before conclusions regarding its use as diagnostic tool in this context can be made. PMID:23056523

  7. Evaluating a media campaign that targeted PTSD after Hurricane Katrina.

    PubMed

    Beaudoin, Christopher E

    2009-09-01

    This study evaluates a media campaign that targeted posttraumatic stress disorder (PTSD) in New Orleans following Hurricane Katrina. Evaluation data come from telephone survey interviews of African Americans (N = 968), who were the target audience of the media campaign. Ordinary Least Squares (OLS) regression indicates over-time improvements in campaign attention, PTSD beliefs, and PTSD preventive behaviors, whereas PTSD remained constant. Structural equation modeling offers support for a multistep model in which campaign attention influences PTSD beliefs, which influence PTSD preventive behaviors, which, in turn, influence PTSD. There is one across-step path from campaign attention directly to PTSD preventive behaviors. These two sets of findings signify the media campaign's positive role in influencing beliefs and preventive behaviors. Although PTSD remained unchanged, the improvements in PTSD beliefs and preventive behaviors may have been a means to subsequent abatement in PTSD.

  8. Psychometric Properties of the Modified Posttraumatic Stress Disorder Symptom Scale among Women with Posttraumatic Stress Disorder and Substance Use Disorders Receiving Outpatient Group Treatments

    PubMed Central

    Ruglass, Lesia M; Papini, Santiago; Trub, Leora; Hien, Denise A

    2015-01-01

    Objective The use of psychometrically sound measures to assess and monitor PTSD treatment response over time is critical for better understanding the relationship between PTSD symptoms and Substance Use Disorder (SUD) symptoms throughout treatment. We examined the psychometric properties of the Modified Posttraumatic Stress Disorder (PTSD) Symptom Scale, Self-Report (MPSS-SR). Methods Three hundred fifty three women diagnosed with co-occurring PTSD (full or sub-threshold) and SUD who participated in a multisite treatment trial completed the MPSS-SR at pre-treatment, weekly during treatment, and posttreatment. Reliability and validity analyses were applied to the data. Results Internal consistency was excellent throughout the course of the trial demonstrating the MPSS-SR's high reliability. Strong correlations between MPSS-SR scores and the Brief Symptom Inventory and the Clinician Administered PTSD Scale (CAPS) severity scores demonstrated the MPSS-SR's convergent and concurrent validity. We conducted a classification analysis at posttreatment and compared the MPSS-SR at various cutoff scores with the CAPS diagnosis. A cutoff score of 29 on the MPSS-SR yielded a sensitivity rate of 89%, a specificity rate of 77%, and an overall classification rate of 80%, indicating the measure's robust ability to accurately identify individuals with PTSD in our sample at posttreatment. Conclusions Findings support the use of the MPSS-SR as a reliable and valid tool to assess and monitor changes in PTSD symptoms over the course of treatment and as an alternative to structured clinical interviews to assess PTSD symptoms among populations with SUDs. PMID:26543877

  9. Main and Interactive Effects of a Nonclinical Panic Attack History and Distress Tolerance in Relation to PTSD Symptom Severity

    PubMed Central

    Marshall-Berenz, Erin C.; Vujanovic, Anka A.; Zvolensky, Michael J.

    2010-01-01

    The current study investigated the main and interactive effects of a nonclinical panic attack history and distress tolerance in relation to PTSD symptoms. The sample consisted of 91 adults (62.6% women; Mage = 23.45, SD = 9.56) who met DSM-IV criteria for trauma exposure, 53.8% of whom met criteria for a recent (past two years) history of nonclinical panic attacks. Results indicated that distress tolerance, as measured by the Distress Tolerance Scale (Simons & Gaher, 2005), was significantly related to all PTSD symptom clusters, and a nonclinical panic attack history was significantly related to PTSD re-experiencing and hyperarousal symptoms. The interaction of a nonclinical panic attack history and distress tolerance significantly predicted unique variance in only PTSD hyperarousal symptoms. Implications and future directions are discussed for the role of nonclinical panic attacks and distress tolerance in PTSD symptom expression. PMID:20888732

  10. PTSD symptom dimensions and their relationship to functioning in World Trade Center responders.

    PubMed

    Ruggero, Camilo J; Kotov, Roman; Callahan, Jennifer L; Kilmer, Jared N; Luft, Benjamin J; Bromet, Evelyn J

    2013-12-30

    Post-traumatic stress disorder (PTSD) symptoms are common among responders to the 9/11 attacks on the World Trade Center and can lead to impairment, yet it is unclear which symptom dimensions are responsible for poorer functioning. Moreover, how best to classify PTSD symptoms remains a topic of controversy. The present study tested competing models of PTSD dimensions and then assessed which were most strongly associated with social/occupational impairment, depression, and alcohol abuse. World Trade Center responders (n=954) enrolled in the Long Island site of the World Trade Center Health Program between 2005 and 2006 were administered standard self-report measures. Confirmatory factor analysis confirmed the superiority of four-factor models of PTSD over the DSM-IV three-factor model. In selecting between four-factor models, evidence was mixed, but some support emerged for a broad dysphoria dimension mapping closely onto depression and contributing strongly to functional impairment. This study confirmed in a new population the need to revise PTSD symptom classification to reflect four dimensions, but raises questions about how symptoms are categorized. Results suggest that targeted treatment of symptoms may provide the most benefit, and that treatment of dysphoria-related symptoms in disaster relief workers may have the most benefit for social and occupational functioning. PMID:24064462

  11. Hypothalamic-Pituitary-Adrenal Axis Function in Dissociative Disorders, PTSD, and Healthy Volunteers

    PubMed Central

    Simeon, Daphne; Knutelska, Margaret; Yehuda, Rachel; Putnam, Frank; Schmeidler, James; Smith, Lisa M.

    2007-01-01

    Background This study investigated basal and stress-induced HPA axis alterations in dissociative disorders (DD). Methods Forty-six subjects with DD without lifetime PTSD, 35 subjects with PTSD, and 58 HC subjects, free of current major depression, were studied as inpatients. After a 24-hour urine collection and hourly blood sampling for ambient cortisol determination, a low-dose dexamethasone suppression test was administered, followed by the Trier Social Stress Test. Results The DD group had significantly elevated urinary cortisol compared to the HC group, more pronounced in the absence of lifetime major depression, whereas the PTSD and HC groups did not differ. The DD group demonstrated significantly greater resistance to, and faster escape from, dexamethasone suppression compared to the HC group, whereas the PTSD and HC groups did not differ. The three groups did not differ in cortisol stress reactivity, but both psychiatric groups demonstrated a significant inverse correlation between dissociation severity and cortisol reactivity, after controlling for all other symptomatology. The PTSD subgroup with comorbid DD tended to have blunted reactivity compared to the HC group. Conclusions The study demonstrates a distinct pattern of HPA axis dysregulation in DD, emphasizing the importance of further study of stress response systems in dissociative psychopathology. PMID:17137559

  12. PTSD symptom dimensions and their relationship to functioning in World Trade Center responders.

    PubMed

    Ruggero, Camilo J; Kotov, Roman; Callahan, Jennifer L; Kilmer, Jared N; Luft, Benjamin J; Bromet, Evelyn J

    2013-12-30

    Post-traumatic stress disorder (PTSD) symptoms are common among responders to the 9/11 attacks on the World Trade Center and can lead to impairment, yet it is unclear which symptom dimensions are responsible for poorer functioning. Moreover, how best to classify PTSD symptoms remains a topic of controversy. The present study tested competing models of PTSD dimensions and then assessed which were most strongly associated with social/occupational impairment, depression, and alcohol abuse. World Trade Center responders (n=954) enrolled in the Long Island site of the World Trade Center Health Program between 2005 and 2006 were administered standard self-report measures. Confirmatory factor analysis confirmed the superiority of four-factor models of PTSD over the DSM-IV three-factor model. In selecting between four-factor models, evidence was mixed, but some support emerged for a broad dysphoria dimension mapping closely onto depression and contributing strongly to functional impairment. This study confirmed in a new population the need to revise PTSD symptom classification to reflect four dimensions, but raises questions about how symptoms are categorized. Results suggest that targeted treatment of symptoms may provide the most benefit, and that treatment of dysphoria-related symptoms in disaster relief workers may have the most benefit for social and occupational functioning.

  13. Is there a biological difference between trauma-related depression and PTSD? DST says 'NO'.

    PubMed

    Savic, Danka; Knezevic, Goran; Damjanovic, Svetozar; Spiric, Zeljko; Matic, Gordana

    2012-09-01

    The use of the low-dose dexamethasone suppression test (DST) as a potentially discriminative marker between post-traumatic stress disorder (PTSD) and depression is still under discussion. In order to compare the influence of these psychopathologies on the DST results, we examined suppression in war-traumatized subjects with one or both of these disorders, as well as in healthy controls. Based on our previous findings, we hypothesized that subjects with any disorder would exhibit higher dexamethasone suppression than healthy controls due to traumatic experiences. This study was a part of a broader project in which simultaneous psychological and biological investigations were carried out in hospital conditions on 399 male participants: 57 with PTSD, 28 with depression, 76 with PTSD+depression, and 238 healthy controls. Cortisol was measured in blood samples taken at 0900 h before and after administering 0.5mg of dexamethasone (at 2300 h). Group means ± standard deviation of cortisol suppression were: 79.4±18.5 in the PTSD group, 80.8±11.6 in the depression group, 77.5±24.6 in the group with PTSD+depression, and 66.8±34.6 in healthy controls. The first three groups suppressed significantly more than the fourth. When the number of traumas was introduced as a covariate, the differences disappeared. The hypothesis was confirmed: in respect to DST, the examined trauma-related psychopathologies showed the same pattern: hypersuppression, due to multiple traumatic experiences.

  14. The MMPI-2 Restructured Clinical Scales in the Assessment of Posttraumatic Stress Disorder and Comorbid Disorders

    PubMed Central

    Wolf, Erika J.; Miller, Mark W.; Orazem, Robert J.; Weierich, Mariann R.; Castillo, Diane T.; Milford, Jaime; Kaloupek, Danny G.; Keane, Terence M.

    2008-01-01

    This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared to that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties along with patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared to the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs. PMID:19086756

  15. PTSD in Depressed Mothers in Home Visitation

    PubMed Central

    Ammerman, Robert T.; Putnam, Frank W.; Chard, Kathleen M.; Stevens, Jack; Van Ginkel, Judith B.

    2013-01-01

    Recent research has suggested that mothers participating in home visitation programs have a high incidence of mental health problems, particularly depression. Posttraumatic stress disorder (PTSD) is a common comorbidity with depression, yet its prevalence among home visiting populations and implications for parenting and maternal functioning have not been examined. This study contrasted depressed mothers with (n = 35) and without PTSD (n = 55) who were enrolled in a home visitation program. Results indicated that depressed mothers with comorbid PTSD were more likely to have experienced childhood sexual abuse, had greater severity of depressive symptoms, increased social isolation, and lower overall functioning than their counterparts without PTSD. Among PTSD mothers, greater severity of PTSD symptoms, in particular avoidance and emotional numbness, were associated with increased maternal psychopathology and parenting deficits even after controlling for depression severity. These findings add to the literature documenting the negative impacts of PTSD on maternal functioning and parenting. Implications for screening and treatment in the context of home visitation are discussed. PMID:24307928

  16. A Pilot Study of Neurofeedback for Chronic PTSD.

    PubMed

    Gapen, Mark; van der Kolk, Bessel A; Hamlin, Ed; Hirshberg, Laurence; Suvak, Michael; Spinazzola, Joseph

    2016-09-01

    EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research. PMID:26782083

  17. A Pilot Study of Neurofeedback for Chronic PTSD.

    PubMed

    Gapen, Mark; van der Kolk, Bessel A; Hamlin, Ed; Hirshberg, Laurence; Suvak, Michael; Spinazzola, Joseph

    2016-09-01

    EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.

  18. Psychometric Properties of the Schedule for Nonadaptive and Adaptive Personality in a PTSD Sample

    ERIC Educational Resources Information Center

    Wolf, Erika J.; Harrington, Kelly M.; Miller, Mark W.

    2011-01-01

    This study evaluated the psychometric characteristics of the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1996) in 280 individuals who screened positive for posttraumatic stress disorder (PTSD). The SNAP validity, trait, temperament, and personality disorder (PD) scales were compared with scales on the Brief Form of the…

  19. Sleep and Posttraumatic Stress Disorder (PTSD)

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  20. Lifestyle Changes Recommended for PTSD Patients

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  1. Pharmacotherapy of PTSD: Premises, Principles, and Priorities

    PubMed Central

    Ravindran, Lakshmi N.; Stein, Murray B.

    2009-01-01

    Post-traumatic stress disorder (PTSD) is a prevalent anxiety disorder that results in multiple disabling symptoms. Research into the underlying neurobiology has implicated dysregulation in multiple neurotransmitter systems including norepinephrine, serotonin, and glutamate as well as the hypothalamic-pituitary axis. Understanding how these biological systems interact with each other and how they may affect key neural structures, such as the amygdala, hippocampus, and prefrontal cortex, to produce post-traumatic symptoms is critical for the development of effective pharmacological treatments. We briefly discuss the proposed biological dysfunctions underlying PTSD and how agents that target these dysfunctions may be utilized in PTSD. We then provide a review of the different pharmacological agents that have been investigated in PTSD. These drugs include: antidepressants, anti-adrenergic agents, anticonvulsants, benzodiazepines, atypical antipsychotics, and novel agents. PMID:19332035

  2. PTSD and Problems with Alcohol Use

    MedlinePlus

    ... Ethics VA/DOD Clinical Practice Guidelines Hospital Quality Data Medical Inspector Patient ... and Problems with Alcohol Use PTSD and alcohol use problems are often found together. This pairing can be big trouble for the trauma survivor and his or ...

  3. Comorbidity - a troublesome factor in PTSD treatment.

    PubMed

    Dadić-Hero, Elizabeta; Torić, Ines; Ruzić, Klementina; Medved, Paola; Graovac, Mirjana

    2009-09-01

    Posttraumatic stress syndrome (PTSD) is a disorder which emerges after the patient has experienced one or more psychotraumatic events, which equally include neurobiological deregulation and psychological dysfunction. Comorbidity is present in more than 80% of the diagnosed cases of PTSD, which makes treatment of the primary disorder very difficult. It has been identified that PTSD can be found in comorbidity with other psychiatric disorders as well as with physical illnesses. This study presents aged 42, who has been psychiatrically treated for the past 12 years, with a diagnose of chronic PTSD and who subsequently developed depression. The patient has been treated for psoriasis for the past seven years, and two years ago, had to undergo surgery due to bladder carcinoma, followed by a radiotherapy course. Multiple comorbidity significantly makes the treatment of the primary illness very difficult and it limits the choice of pharmacotherapy in ambulatory conditions.

  4. Combining group-based exposure therapy with prolonged exposure to treat U.S. Vietnam veterans with PTSD: a case study.

    PubMed

    Ready, David J; Vega, Edward M; Worley, Virginia; Bradley, Bekh

    2012-10-01

    Group-based exposure therapy (GBET) of 16-week duration was developed to treat combat-related posttraumatic stress disorder (PTSD) and decreased PTSD symptoms in 3 noncontrolled open trials with low attrition (0%-5%). Group-based exposure therapy has not produced as much PTSD symptom reduction as Prolonged Exposure (PE) within a U.S. Veterans Affairs PTSD treatment program, although PE had more dropouts (20%). This pilot study was of a model that combined key elements of GBET with components of PE in an effort to increase the effectiveness of a group-based treatment while reducing its length and maintaining low attrition. Twice per week, 8 Vietnam combat veterans with PTSD were treated for 12 weeks, with an intervention that included 2 within-group war trauma presentations per participant, 6 PE style individual imaginal exposure (IE) sessions per participant, daily listening to recorded IE sessions, and daily in vivo exposure exercises. All completed treatment and showed Significant reductions on all measures of PTSD with large effect sizes; 7 participants no longer met PTSD criteria on treating clinician administered interviews and a self-report measure at posttreatment. Significant reductions in depression with large effect sizes and moderate reductions in PTSD-related cognitions were also found. Most gains were maintained 6 months posttreatment. PMID:22965936

  5. Uniformity of Evidence-Based Treatments in Practice? Therapist Effects in the Delivery of Cognitive Processing Therapy for PTSD

    ERIC Educational Resources Information Center

    Laska, Kevin M.; Smith, Tracey L.; Wislocki, Andrew P.; Minami, Takuya; Wampold, Bruce E.

    2013-01-01

    Objective: Various factors contribute to the effective implementation of evidence-based treatments (EBTs). In this study, cognitive processing therapy (CPT) was administered in a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinic in which training and supervision were provided following VA implementation guidelines. The…

  6. Pharmacology for sleep disturbance in PTSD.

    PubMed

    Lipinska, Gosia; Baldwin, David S; Thomas, Kevin G F

    2016-03-01

    Symptoms of sleep disturbance, particularly nightmares and insomnia, are a central feature of post-traumatic stress disorder (PTSD). Emerging evidence suggests that specific treatment of PTSD-related sleep disturbance improves other symptoms of the disorder, which in turn suggests that such disturbance may be fundamental to development and maintenance of the disorder. This mini-review focuses on pharmacological treatment of sleep disturbance in adult PTSD (specifically, studies testing the efficacy of antidepressants, adrenergic inhibiting agents, antipsychotics and benzodiazepine and non-benzodiazepine hypnotics). We conclude that only prazosin, an adrenergic inhibiting agent, has had its efficacy established by multiple randomised controlled trials. There is also high-level evidence supporting use of eszopiclone, as well as risperidone and olanzapine as adjunct therapy. Antidepressants such as sertraline, venlafaxine and mirtazapine, benzodiazepines such as alprazolam and clonazepam and non-benzodiazepine hypnotics such as zolpidem appear ineffective in treating PTSD-related sleep disturbance. Most studies that report reduced frequency of nightmares and insomnia also report decreases in overall symptom severity. Such findings suggest that (i) sleep disruption is central to PTSD; (ii) treating sleep disruption may be an effective way to address other symptoms of the disorder and (iii) PTSD symptoms tend to cluster together in predictable ways. PMID:26856810

  7. Early Intervention Following Trauma May Mitigate Genetic Risk for PTSD in Civilians: A Pilot Prospective Emergency Department Study

    PubMed Central

    Rothbaum, Barbara O.; Kearns, Megan C.; Reiser, Emily; Davis, Jennifer S.; Kerley, Kimberly A.; Rothbaum, Alex O.; Mercer, Kristina B.; Price, Matthew; Houry, Debra; Ressler, Kerry J.

    2015-01-01

    Background Civilian posttraumatic stress disorder (PTSD) and combat PTSD are major public health concerns. Although a number of psychosocial risk factors have been identified related to PTSD risk, there are no accepted, robust biological predictors that identify who will develop PTSD or who will respond to early intervention following trauma. We wished to examine whether genetic risk for PTSD can be mitigated with an early intervention. Method 65 emergency department patients recruited in 2009–2010 at Grady Memorial Hospital in Atlanta, Georgia, who met criterion A of DSM-IV PTSD received either 3 sessions of an exposure intervention, beginning in the emergency department shortly after trauma exposure or assessment only. PTSD symptoms were assessed 4 and 12 weeks after trauma exposure. A composite additive risk score was derived from polymorphisms in 10 previously identified genes associated with stress-response (ADCYAP1R1, COMT, CRHR1, DBH, DRD2, FAAH, FKBP5, NPY, NTRK2, and PCLO), and gene x treatment effects were examined. The intervention included 3 sessions of imaginal exposure to the trauma memory and additional exposure homework. The primary outcome measure was the PTSD Symptom Scale-Interview Version or DSM-IV–based PTSD diagnosis in patients related to genotype and treatment group. Results A gene x intervention x time effect was detected for individual polymorphisms, in particular the PACAP receptor, ADCYAP1R1, as well as with a combined genotype risk score created from independent SNP markers. Subjects who did not receive treatment had higher symptoms than those who received intervention. Furthermore, subjects with the “risk” genotypes who did not receive intervention had higher PTSD symptoms compared to those with the “low-risk” or “resilience” genotypes or those who received intervention. Additionally, PTSD symptoms correlated with level of genetic risk at week 12 (P < .005) in the assessment-only group, but with no relationship in the

  8. Effect of the APOE ε4 Allele and Combat Exposure on PTSD among Iraq/Afghanistan-Era Veterans

    PubMed Central

    Kimbrel, Nathan A.; Hauser, Michael A.; Garrett, Melanie; Ashley-Koch, Allison; Liu, Yutao; Dennis, Michelle F.; Klein, Rebecca C.; Beckham, Jean C.

    2015-01-01

    Background The apolipoprotein E (APOE) ε4 allele has been implicated in a range of neuropsychiatric conditions. The present research examined if the ε4 allele of the APOE gene moderated the effect of combat exposure on posttraumatic stress disorder (PTSD) among Iraq/Afghanistan-era veterans. Method Participants included 765 non-Hispanic White (NHW) and 859 non-Hispanic Black (NHB) Iraq/Afghanistan-era veterans. A structured interview established psychiatric diagnoses. Combat exposure and PTSD symptom severity were assessed via self-report. Results The most common lifetime diagnoses were depression (39.2%), PTSD (38.4%), and alcohol dependence (24.38%). After correcting for multiple comparisons, no significant effects were observed on any of the outcomes among the NHW sample; however, within the NHB sample, significant gene x environment (GxE) interactions were observed for lifetime PTSD (p = .0029) and PTSD symptom severity (p = .0009). In each case, the APOE ε4 allele had no effect on the outcomes when combat exposure was low; however, when combat exposure was high, an additive effect was observed such that ε4 homozygotes exposed to high levels of combat reported the highest rates of PTSD (92%) and the worst symptom severity scores on the Davidson Trauma Scale (M = 79.5). Conclusions While preliminary, these findings suggest that the APOE ε4 allele, in conjunction with exposure to high levels of combat exposure, may increase veterans’ risk for developing PTSD. PMID:25709077

  9. Depression Sudden Gains and Transient Depression Spikes During Treatment for PTSD

    PubMed Central

    Keller, Stephanie M.; Feeny, Norah C.; Zoellner, Lori A.

    2014-01-01

    Objective We know little about how change unfolds in depression symptoms during PTSD treatment or how patient characteristics predict depression symptom change. This study examined critical transition points in depression symptoms during PTSD treatment, namely depression sudden gains, which are rapid symptom improvements and transient depression spikes, which are transient depression worsenings. Social support, one of the strongest predictors of PTSD development, was examined as a predictor of depression symptom discontinuities. Method At pre-treatment, 200 participants (76.6% female; 64.9% Caucasian; age (M = 37.1 (SD = 11.3) years) completed measures of PTSD severity (PTSD Symptom Scale-Self Report), depression severity (Beck Depression Inventory), general social support (Inventory of Socially Supportive Behaviors; Social Support Questionnaire), and trauma-related social support (Social Reactions Questionnaire). During 10 weeks of prolonged exposure (PE) or sertraline, depression was assessed weekly. Results Overall, 18.0% of participants experienced a depression sudden gain and 22.5% experienced a transient depression spike. The presence of a depression sudden gain predicted better treatment outcome, β = −4.82, SE = 1.17, p = .001, 95% CI [−6.79, −2.90]. Higher perceptions of negative trauma-related reactions, albeit modestly, were associated with experiencing a transient depression spike (r = .18, p = .01). There were no differences in rates of depression sudden gains or transient depression spikes between treatments. Conclusions Encouragingly, rapid improvements in depression symptoms are beneficial for PTSD treatment outcome but transient spikes in depressive symptoms do not strongly influence outcome. Understanding symptom discontinuities may help us to personalize current PTSD treatment options. PMID:24364793

  10. Early interventions for PTSD: a review.

    PubMed

    Kearns, Megan C; Ressler, Kerry J; Zatzick, Doug; Rothbaum, Barbara Olasov

    2012-10-01

    The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic.

  11. EARLY INTERVENTIONS FOR PTSD: A REVIEW

    PubMed Central

    Kearns, Megan C.; Ressler, Kerry J.; Zatzick, Doug; Rothbaum, Barbara Olasov

    2013-01-01

    The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic. PMID:22941845

  12. Latino Veterans with PTSD: A Systematic Review

    PubMed Central

    Pittman, James O. E.

    2014-01-01

    Latinos have a long history of military service with recent service including combat conditions and multiple deployments, which are highly associated with posttraumatic stress disorder (PTSD). Clinical acumen underscores the importance of culture in assessment and treatment, but there has been little scientific literature that investigates the unique needs of veteran Latinos with PTSD. The primary goal of this systematic review was to analyze the existing literature on Latino veterans with PTSD and to critically evaluate attention to cultural issues. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this review. Peer-reviewed, research reports written in English on Latino Veterans with PTSD since 1980 were included; 20 were assessment related, and nine were treatment related. All studies were quantitative. Only 13 studies mentioned culture as part of the context for Latino veterans, and only seven included cultural factors as part of the study design. Present findings highlight a lack of research focused on understanding cultural factors related to the assessment and treatment of Latino veterans with PTSD. Culturally-informed research on Latino veterans from current wars, Latina veterans and Latino veteran treatment outcomes are necessary to provide culturally-appropriate care to this growing veteran subgroup. PMID:25379284

  13. Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview

    PubMed Central

    Kolassa, Iris-Tatjana; Eckart, Cindy; Ruf, Martina; Neuner, Frank; de Quervain, Dominique JF; Elbert, Thomas

    2007-01-01

    Background According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences. Methods Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the Vivo Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time. Results Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in

  14. Forgiveness and PTSD among veterans: the mediating role of anger and negative affect.

    PubMed

    Karaırmak, Özlem; Güloğlu, Berna

    2014-11-30

    Man-made traumatic events such as combat and terrorism may cause individuals to develop various forms of psychopathology, including Post-Traumatic Stress Disorder (PTSD) and depression. Veterans who engage in combat experienced negative emotions such as anger, hostility and aggression. Forgiveness may buffer these feelings and prevent the development of psychiatric problems, in that it is a way of decreasing negative feelings and increasing positive feelings. The aim of the current study was to examine the mediating role of anger and negative affect on the relationship between forgiveness and both PTSD and depression co-morbid to PTSD among Turkish veterans who were exposed to combat experience because of terrorist attacks during their compulsory military service. Two hundred and forty-seven injured veterans participated in this study. Veterans were assessed using the Traumatic Stress Symptom Checklist (TSSC), Heartland Forgiveness Scale (HFS), State Trait Anger Expression Inventory (STAXI), and Positive and Negative Affect Schedule (PANAS). A path analysis supported the hypothesized model that both anger and negative affect fully mediated the relationship between forgiveness and both PTSD and depression co-morbid to PTSD.

  15. Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD

    PubMed Central

    Kopacz, Marek S.; Currier, Joseph M.; Drescher, Kent D.; Pigeon, Wilfred R.

    2016-01-01

    Abstract: Background: Spiritual well-being has been lauded to exert a protective effect against suicidal behavior. This study examines the characteristics of spiritual functioning and their association with a self-reported history of suicidal thoughts and behavior in a sample of Veterans being treated for post-traumatic stress disorder (PTSD). Methods: The sample includes 472 Veterans admitted to a PTSD Residential Rehabilitation Program. Measures included the Brief Multidimensional Measure of Religiousness and Spirituality, PTSD Checklist – Military Version, Combat Experiences Scale, and individual items pertaining to history of suicidal thoughts and attempts, spiritual practices, and select demographics. Results: Problems with forgiveness and negative religious coping were uniquely associated with suicide risk, above and beyond age, gender, or ethnicity, combat exposure, and severity of PTSD symptomatology. Organizational religiousness was associated with decreased risk for thinking about suicide in the presence of these covariates. Daily spiritual experiences were inversely associated with suicidal thoughts. Differences in spirituality factors did not distinguish Veterans with both suicidal ideation and prior attempts from those who had ideations absent any prior attempts. Conclusions: The findings suggest that enhanced or diminished spiritual functioning is associated with suicidal thoughts and attempts among Veterans dealing with PTSD. PMID:26353986

  16. Impulsivity is relevant for trauma exposure and PTSD symptoms in a non-clinical population.

    PubMed

    Netto, Liana R; Pereira, Juliana L; Nogueira, José F; Cavalcanti-Ribeiro, Patrícia; Santana, Rejane Conceição; Teles, Carlos A; Koenen, Karestan C; Quarantini, Lucas C

    2016-05-30

    Impulsivity is a relevant construct for explaining both normal individual differences in personality and more extreme personality disorder, and is often investigated within clinical populations. This study aims to explore the college students' impulsivity patterns and to investigate the association across levels of impulsivity with trauma exposure and PTSD development in a non-clinical population. A one-phase census survey of seven college institutions assessed 2213 students in three metropolitan regions of Northeastern Brazil. All subjects anonymously completed a self-applied protocol consisting of: a socio-demographic questionnaire, Trauma History Questionnaire (THQ), PTSD Checklist (PCL-C), and Barratt Impulsiveness Scale (BIS-11). The median for frequency of trauma exposure was 4 events for people with low and normal impulsivity, and 6 for highly impulsive ones. Individuals with higher impulsivity presented earlier exposition than non-impulsive ones, and worst outcome: 12.4% with PTSD, against 8.4% and 2.3% (normal and low impulsivity). Of the three factors of impulsivity, the Attentional factor conferred the strongest association with PTSD development. Results suggest that impulsivity is also a relevant trait in a non-clinical population and is associated with trauma exposure and PTSD. Strategies to promote mental health in adolescents may be pertinent, especially with the aim of managing impulsivity. PMID:27016879

  17. Design of VA Cooperative Study #591: CERV-PTSD, comparative effectiveness research in veterans with PTSD.

    PubMed

    Schnurr, Paula P; Chard, Kathleen M; Ruzek, Josef I; Chow, Bruce K; Shih, Mei-Chiung; Resick, Patricia A; Foa, Edna B; Marx, Brian P; Huang, Grant D; Lu, Ying

    2015-03-01

    CERV-PTSD is a randomized controlled trial of two of the most effective treatments for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Despite solid evidence that both treatments are effective, there is limited evidence about their effectiveness relative to one another. The primary objective is to compare the effectiveness of PE and CPT for reducing PTSD symptom severity in a healthcare system that offers both treatments. The secondary objective is to compare the effectiveness of PE and CPT for reducing the severity of comorbid mental health problems and service utilization as well as improving functioning and quality of life. The tertiary objective is to examine whether discrepancy between patient preferences and treatment assignment reduces the effectiveness of each treatment. Exploratory analyses will examine whether demographic and clinical characteristics predict differential response to PE and CPT. The study is designed to randomize 900 male and female veterans with PTSD due to any traumatic military event to receive PE or CPT. The standard dose of treatment is 12 weekly sessions but veterans who improve more rapidly may finish in fewer sessions and veterans who improve more slowly may have additional sessions. The primary outcome is improvement in PTSD symptoms, measured during and after treatment and then 3 and 6 months later. As a large multi-site trial with men and women, CERV-PTSD is designed to advance the delivery of care for PTSD by providing conclusive information about whether one treatment is better than the other, overall, and for different types of patients.

  18. Posttraumatic Stress Disorder (PTSD) and Stress Related Disorders

    PubMed Central

    Shalev, Arieh Y.

    2009-01-01

    Synopsis Post-traumatic Stress Disorder (PTSD) is a prevalent anxiety disorder. PTSD typically follows a psychologically traumatic event, and thus has a recognizable point of onset. PTSD symptoms are present shortly after an exposure to a traumatic event, abate with time in the majority of those who initially express them, and leave a significant minority with chronic PTSD. PTSD may be treated with pharmacotherapy or psychotherapy. The treatment of the early expressions of disorder constitutes a separate domain of theory and research. The treatment of chronic PTSD often stabilizes the condition, but rarely produces stable remission. This chapter reviews the empirical evidence on the treatment of acute and chronic PTSD, outlines similarities and differences between PTSD and other Axis I disorders, evaluates new therapeutic approaches, and discusses the implications of current knowledge for the forthcoming DSM V. PMID:19716997

  19. PTSD as a criminal defense: a review of case law.

    PubMed

    Berger, Omri; McNiel, Dale E; Binder, Renée L

    2012-01-01

    Posttraumatic stress disorder (PTSD) has been offered as a basis for criminal defenses, including insanity, unconsciousness, self-defense, diminished capacity, and sentencing mitigation. Examination of case law (e.g., appellate decisions) involving PTSD reveals that when offered as a criminal defense, PTSD has received mixed treatment in the judicial system. Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense. However, the courts have not always found the presentation of PTSD testimony to be relevant, admissible, or compelling in such cases, particularly when expert testimony failed to show how PTSD met the standard for the given defense. In cases that did not meet the standard for one of the complete defenses, PTSD has been presented as a partial defense or mitigating circumstance, again with mixed success.

  20. Should PTSD Criterion A be retained?

    PubMed

    Kilpatrick, Dean G; Resnick, Heidi S; Acierno, Ron

    2009-10-01

    Criterion A has been controversial since its inception, partially because it performs a key gate keeping function. Major criticisms of Criterion A of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) include that it has resulted in "criterion creep." The authors tested the hypothesis that a nonrestrictive definition would substantially increase posttraumatic stress disorder (PTSD) prevalence by determining PTSD based on Criteria B, C, D, E, and F, without restricting Criterion A in large probability samples of U.S. adolescents and Florida adults. Few PTSD cases occurred in the absence of Criterion A1 events, providing little support for the criterion creep hypothesis. Specific recommendations are to retain Criterion A; permit additional events; consider expanding Criterion A2; consider that either Criterion A1 or A2 be met; and place greater emphasis on Criterion F.

  1. The psychobiology of PTSD: coping with trauma.

    PubMed

    Olff, Miranda; Langeland, Willie; Gersons, Berthold P R

    2005-11-01

    Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.

  2. The Effectiveness of OSU-PTSD Screening Survey in Natural Disasters.

    ERIC Educational Resources Information Center

    Bulut, Sefa; Palmer, Linda; Oehler-Stinnett, Judy; Bulut, Solmaz

    There is little empirical research existing in the areas of natural disaster's effects on children's mental health. Therefore, the purpose of this study was twofold. First, it examined the effectiveness of the Oklahoma State University Posttraumatic Stress Disorder (OSU-PTSD) Screening Scale after two different types of natural disasters. The…

  3. Structure and Prevalence of PTSD Symptomology in Children Who Have Experienced a Severe Tornado

    ERIC Educational Resources Information Center

    Evans, Linda Garner; Oehler-Stinnett, Judy

    2006-01-01

    Children served by school psychologists are frequently impacted by natural disasters. In the United States, tornadoes are a particular threat but have been studied very little. The current investigation developed a scale for assessing posttraumatic stress disorder (PTSD) in children in Kindergarten to Grade 6 impacted by a severe tornado. Six…

  4. Treating PTSD in Suicidal and Self-injuring Women with Borderline Personality Disorder: Development and Preliminary Evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

    PubMed Central

    Harned, Melanie S.; Korslund, Kathryn E.; Foa, Edna B.; Linehan, Marsha M.

    2012-01-01

    This study focused on the development and pilot testing of a protocol based on Prolonged Exposure (PE) that can be added to Dialectical Behavior Therapy (DBT) to treat PTSD in suicidal and self-injuring individuals with borderline personality disorder (BPD). Women with BPD, PTSD, and recent and/or imminent serious intentional self-injury (n=13) received one year of DBT with the DBT PE Protocol, plus three months of follow up assessment. The treatment was associated with significant reductions in PTSD, with the majority of patients no longer meeting criteria for PTSD at post-treatment (71.4% of DBT PE Protocol completers, 60.0% of the intent-to-treat sample). A minority of patients (27.3%) engaged in intentional self-injury during the study. Improvements were also found for suicidal ideation, dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and social adjustment. There was no evidence that the DBT PE Protocol led to exacerbations of intentional self-injury urges or behaviors, PTSD, treatment dropout, or crisis service use. Overall, the results indicate that this integrated BPD and PTSD treatment is feasible to implement within one year of treatment, highly acceptable to patients and therapists, safe to administer, and shows promise as an effective intervention for PTSD in this complex and high-risk patient population. PMID:22503959

  5. Persistent Complex Bereavement Disorder Symptom Domains Relate Differentially to PTSD and Depression: A Study of War-Exposed Bosnian Adolescents.

    PubMed

    Claycomb, Meredith A; Charak, Ruby; Kaplow, Julie; Layne, Christopher M; Pynoos, Robert; Elhai, Jon D

    2016-10-01

    Persistent Complex Bereavement Disorder (PCBD) is a newly proposed diagnosis placed in the Appendix of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an invitation for further research. To date, no studies have examined the dimensionality of PCBD or explored whether different PCBD criteria domains relate in similar, versus differential, ways to other psychological conditions common to war-exposed bereaved youth, including symptoms of Posttraumatic Stress Disorder (PTSD) and depression. We evaluated the dimensionality of proposed PCBD B and C symptom domains, and their respective relations with measures of PTSD and depression, in 1142 bereaved Bosnian adolescents exposed to the 1992-1995 Bosnian civil war. Instruments included the UCLA PTSD Reaction Index, the Depression Self-Rating Scale, and the UCLA Grief Screening Scale (a prototype measure of PCBD symptoms). We investigated potential differences in grief, PTSD, and depression scores as a function of cause of death. We then examined hypothesized differential relations between PCBD B and C symptom domain subscales and selected external correlates, specifically measures of depression and the four-factor emotional numbing model of PTSD. Results of both analyses provide preliminary evidence of a multidimensional structure for PCBD in this population, in that the PCBD Criterion C subscale score covaried more strongly with each of the four PTSD factors and with depression than did PCBD Criterion B. We conclude by discussing theoretical, methodological, clinical, and policy-related implications linked to the ongoing study of essential features of PCBD. PMID:26695010

  6. Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial.

    PubMed

    Macdonald, Alexandra; Pukay-Martin, Nicole D; Wagner, Anne C; Fredman, Steffany J; Monson, Candice M

    2016-02-01

    Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing CBCT for PTSD with waitlist in a sample of 40 individuals with PTSD and their partners (N = 40; Monson et al., 2012). Compared with waitlist, patients who received CBCT for PTSD immediately demonstrated greater improvements in all PTSD symptom clusters, trauma-related beliefs, and guilt cognitions (Hedge's gs -.33 to -1.51). Results suggest that CBCT for PTSD improves all PTSD symptom clusters and trauma-related cognitions among individuals with PTSD and further supports the value of utilizing a couple-based approach to the treatment of PTSD.

  7. Taxometric Investigation of PTSD: Data from Two Nationally Representative Samples

    ERIC Educational Resources Information Center

    Broman-Fulks, Joshua J.; Ruggiero, Kenneth J.; Green, Bradley A.; Kilpatrick, Dean G.; Danielson, Carla Kmett; Resnick, Heidi S.; Saunders, Benjamin E.

    2006-01-01

    Current psychiatric nosology depicts posttraumatic stress disorder (PTSD) as a discrete diagnostic category. However, only one study has examined the latent structure of PTSD, and this study suggested that PTSD may be more accurately conceptualized as an extreme reaction to traumatic life events rather than a discrete clinical syndrome. To build…

  8. Effects of beta blockade, PTSD diagnosis, and explicit threat on the extinction and retention of an aversively conditioned response.

    PubMed

    Orr, Scott P; Milad, Mohammed R; Metzger, Linda J; Lasko, Natasha B; Gilbertson, Mark W; Pitman, Roger K

    2006-10-01

    An aversively conditioned SC response was assessed in 18 males meeting DSM-IV criteria for chronic posttraumatic stress disorder (PTSD) and 10 trauma-exposed males who never developed PTSD. Effects of beta blockade on acquisition and retention of a conditioned response (CR) were examined by administering propranolol HCl before acquisition or following extinction trials. Retention of the CR was assessed 1 week following acquisition under conditions of non-threat and threat. Conditioned stimuli were colored circles and the unconditioned stimulus (UCS) was a "highly annoying" electrical stimulus. The propranolol failed to produce any measurable effects on acquisition or retention of the CR and there was no evidence of increased conditionability in individuals diagnosed with PTSD. One week following acquisition, the differential CR to the reinforced stimulus was evident only in the threat condition. This suggests that belief in the presence of a threat is necessary and sufficient for activating a previously established CR.

  9. National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM-IV and DSM-5 Criteria

    PubMed Central

    Kilpatrick, Dean G.; Resnick, Heidi S.; Milanak, Melissa E.; Miller, Mark W.; Keyes, Katherine M.; Friedman, Matthew J.

    2014-01-01

    Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association’s Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom. PMID:24151000

  10. Aggression in US soldiers post-deployment: Associations with combat exposure and PTSD and the moderating role of trait anger.

    PubMed

    Wilk, Joshua E; Quartana, Phillip J; Clarke-Walper, Kristina; Kok, Brian C; Riviere, Lyndon A

    2015-01-01

    Anger and aggression are among the most common issues reported by returning service members from combat deployments. However, the pathways between combat exposure and anger and aggression have not been comprehensively characterized. The present study aimed to characterize the relationship between trait anger, combat exposure, post-deployment PTSD, and aggression. U.S. Army soldiers (N = 2,420) were administered anonymous surveys assessing combat exposure, current PTSD symptoms and aggression, as well as trait anger items 3 months after returning from deployment to Afghanistan. PTSD symptom levels were related to aggression at higher levels of trait anger, but not evident among soldiers who had lower levels of trait anger. The pathway from combat exposure to PTSD, and then to aggression, was conditional upon levels of trait anger, such that the pathway was most evident at high levels of trait anger. This was the first study to our knowledge that concurrently modeled unconditional and conditional direct and indirect associations between combat exposure, PTSD, trait anger, and aggression. The findings can be helpful clinically and for developing screening protocols for combat exposed Soldiers. The results of this study suggest the importance of assessing and managing anger and aggression in soldiers returning from combat deployment. Anger is one of the most common complaints of returning soldiers and can have debilitating effects across all domains of functioning. It is imperative that future research efforts are directed toward understanding this phenomenon and developing and validating effective treatments for it.

  11. Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey

    PubMed Central

    2012-01-01

    Background Studies in developed countries indicate that psychotic-like symptoms are prevalent in the community and are related to trauma exposure and PTSD. No comparable studies have been undertaken in low-income, post-conflict countries. This study aimed to assess the prevalence of psychotic-like symptoms in conflict-affected Timor Leste and to examine whether symptoms were associated with trauma and PTSD. Methods The Psychosis Screening Questionnaire and the Harvard Trauma Questionnaire (assessing trauma exposure and PTSD) were administered in an epidemiological survey of 1245 adults (response rate 80.6%) in a rural and an urban setting in Timor Leste. We defined PSQ screen-positive cases as those people reporting at least one psychotic-like symptom (paranoia, hallucinations, strange experiences, thought interference, hypomania). Results The prevalence of PSQ screen-positive cases was 12 percent and these persons were more disabled. PSQ cases were more likely to reside in the urban area, experienced higher levels of trauma exposure and a greater prevalence of PTSD. PTSD only partially mediated the relationship between trauma exposure and psychotic-like symptoms. Conclusions Psychotic-like symptoms may be prevalent in countries exposed to mass conflict. The cultural and contextual meaning of psychotic-like symptoms requires further inquiry in low-income, post-conflict settings such as Timor Leste. PMID:23249370

  12. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria.

    PubMed

    Kilpatrick, Dean G; Resnick, Heidi S; Milanak, Melissa E; Miller, Mark W; Keyes, Katherine M; Friedman, Matthew J

    2013-10-01

    Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.

  13. Psychophysiologic identification of subthreshold PTSD in combat veterans.

    PubMed

    Roy, Michael J; Costanzo, Michelle; Leaman, Suzanne

    2012-01-01

    Posttraumatic stress disorder (PTSD) is linked with adverse health outcomes, and many military service members (SMs) are afflicted with it after they return from combat. Since many SMs have an initial honeymoon period characterized by limited symptoms before the onset of full-blown PTSD, the identification of independent predictors of PTSD upon return from deployment could facilitate early intervention. We measured psychophysiologic responses to stimuli including explosions in a Virtual Iraq/Afghanistan environment, as well as a fear potentiated startle paradigm, in a prospective cohort of SMs who did not meet criteria for PTSD and were within 2 months after return from deployment. We report marked psychophysiologic differences between those with (n = 29) and without (n = 30) subthreshold PTSD symptoms (PTSD Checklist score ≥ 28 vs. < 28). We believe this is evidence that psychophysiologic measures can help to identify individuals at high risk for PTSD. PMID:22954846

  14. Missed opportunity to screen and diagnose PTSD and depression among deploying shipboard US military personnel

    PubMed Central

    Hale, Braden R.; Michael, Nelson L.; Scott, Paul T.

    2016-01-01

    Background Depression and post-traumatic stress disorder (PTSD) are significant risks for suicide and other adverse events among US military personnel, but prevalence data among ship-assigned personnel at the onset of deployment are unknown. Aims To determine the prevalence of shipboard personnel who screen positive for PTSD and/or major depressive disorder (MDD) at the onset of deployment, and also those who reported these diagnoses made by a physician or healthcare professional in the year prior to deployment. Method Active-duty ship-assigned personnel (N = 2078) completed anonymous assessments at the beginning of deployment. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D; score of ≥22), and PTSD was assessed using the PTSD Checklist–Civilian Version (PCL-C; both score and symptom criteria were used). Results In total, 7.3% (n = 151 of 2076) screened positive for PTSD and 22% (n = 461 of 2078) for MDD at deployment onset. Only 6% and 15% of those who screened positive for PTSD or MDD, respectively, had been diagnosed by a healthcare professional in the past year. Conclusions Missed opportunities for mental healthcare among screen-positive shipboard personnel reduce the benefits associated with early identification and linkage to care. Improved methods of mental health screening that promote early recognition and referral to care may mitigate psychiatric events in theatre. Declaration of interest This work was performed as part of the official duties of the authors as military service members or employees of the US Government. Copyright and usage This work was prepared by military service members or employees of the US Government as part of their official duties. As such, copyright protection is not available for this work (Title 17, USC, §105). PMID:27713833

  15. Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study.

    PubMed

    Rosaura Polak, A; Witteveen, Anke B; Denys, Damiaan; Olff, Miranda

    2015-03-01

    Although trauma-focused cognitive behavioral therapy (TF-CBT) with exposure is an effective treatment for posttraumatic stress disorder (PTSD), not all patients recover. Addition of breathing biofeedback to exposure in TF-CBT is suggested as a promising complementary technique to improve recovery of PTSD symptoms. Patients (n = 8) with chronic PTSD were randomized to regular TF-CBT or TF-CBT with complementary breathing biofeedback to exposure. PTSD symptoms were measured before, during and after TF-CBT with the Impact of Event Scale-Revised. The results show that breathing biofeedback is feasible and can easily be complemented to TF-CBT. Although PTSD symptoms significantly decreased from pre to post treatment in both conditions, there was a clear trend towards a significantly faster (p = .051) symptom reduction in biofeedback compared to regular TF-CBT. The most important limitation was the small sample size. The hastened clinical improvement in the biofeedback condition supports the idea that breathing biofeedback may be an effective complementary component to exposure in PTSD patients. The mechanism of action of breathing biofeedback may relate to competing working memory resources decreasing vividness and emotionality, similar to eye movement desensitization and reprocessing. Future research is needed to examine this. PMID:25750106

  16. Sudden losses and sudden gains during a DBT-PTSD treatment for posttraumatic stress disorder following childhood sexual abuse

    PubMed Central

    Krüger, Antje; Ehring, Thomas; Priebe, Kathlen; Dyer, Anne S.; Steil, Regina; Bohus, Martin

    2014-01-01

    Background Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD). However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD. Objective The goal of the present study was to explore the frequency of sudden losses and sudden gains in the course of an exposure-based treatment programme for female patients suffering from PTSD related to childhood sexual abuse who also show severe comorbidity. In addition, the relationship between sudden changes and treatment outcome was examined. Methods Female participants (N=74) were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. The pattern of symptom change was assessed via weekly assessments using the Posttraumatic Diagnostic Scale (PDS). Sudden changes were computed as suggested by the literature on sudden gains. Results During treatment, only one participant (3%) experienced a sudden loss, whereas 25% of participants experienced sudden gains. In the waiting condition, 8% of the participants experienced sudden losses and 5% experienced sudden gains during the same time period. No symptom worsening was observed in response to exposure sessions. However, sudden gains occurred during exposure and non-exposure treatment weeks. Patients with sudden gains showed better treatment outcome in the post-treatment and follow-up assessments. Conclusions Exposure-based treatment did not lead to PTSD symptom worsening in the study sample. Results show that sudden gains occur frequently during PTSD treatment and have a prognostic value for treatment outcome. PMID:25317254

  17. ICD-11 Complex PTSD in US National and Veteran Samples: Prevalence and Structural Associations with PTSD

    PubMed Central

    Wolf, Erika J.; Miller, Mark W.; Kilpatrick, Dean; Resnick, Heidi S.; Badour, Christal L.; Marx, Brian P.; Keane, Terence M.; Rosen, Raymond C.; Friedman, Matthew J.

    2014-01-01

    The eleventh edition of the International Classification of Diseases (ICD-11) is under development and current proposals include major changes to trauma-related psychiatric diagnoses, including a heavily restricted definition of posttraumatic stress disorder (PTSD) and the addition of complex PTSD (CPTSD). We aimed to test the postulates of CPTSD in samples of 2695 community participants and 323 trauma-exposed military veterans. CPTSD prevalence estimates were 0.6% and 13% in the community and veteran samples, respectively; one-quarter to one-half of those with PTSD met criteria for CPTSD. There were no differences in trauma exposure across diagnoses. A factor mixture model with two latent dimensional variables and four latent classes provided the best fit in both samples: classes differed by their level of symptom severity but did not differ as a function of the proposed PTSD versus CPTSD diagnoses. These findings should raise concerns about the distinctions between CPTSD and PTSD proposed for ICD-11. PMID:25750837

  18. Orally administered grass pollen.

    PubMed

    Taudorf, E; Weeke, B

    1983-11-01

    In 1900 it was claimed that oral administration of ragweed could be used for the hyposensitization of hay fever patients. Several uncontrolled trials have been published, all showing an effect of oral hyposensitization. Only one study was controlled and showed no effect of oral hyposensitization. It was decided to undertake controlled clinical trials to determine the safety and effectiveness of orally administered enteric-coated grass pollen tablets in patients with hay fever. The actual grass pollen dose in the first trial was 30 times the dose that is normally recommended for preseasonal oral pollen hyposensitization using pollen aqueous solution or pollen powder. The safety study will be described here. Twelve young adults with a history of grass pollen hay fever positive skin prick test and positive nasal provocation test with extracts of timothy grass pollen were randomly allocated to one of the treatment groups with four patients in each group taking enteric-coated Conjuvac Timothy tablets or enteric-coated Whole Timothy pollen tablets or enteric-coated placebo tablets. The study was double blind. Preseasonally, the patients received 342,500 PNU and in total they received 4,500,000 PNU during 6 months. The patients receiving active treatment did not have any side effects. No significant changes were shown in the skin and nasal reactivity to grass pollen during the study. Neither were there any changes in timothy-specific IgE, IgG, total IgE nor histamine liberation from basophils.

  19. Prepulse inhibition deficits in women with PTSD.

    PubMed

    Pineles, Suzanne L; Blumenthal, Terry D; Curreri, Andrew J; Nillni, Yael I; Putnam, Katherine M; Resick, Patricia A; Rasmusson, Ann M; Orr, Scott P

    2016-09-01

    Prepulse inhibition (PPI) is an automatic and preattentive process, whereby a weak stimulus attenuates responding to a sudden and intense startle stimulus. PPI is a measure of sensorimotor filtering, which is conceptualized as a mechanism that facilitates processing of an initial stimulus and is protective from interruption by a later response. Impaired PPI has been found in (a) healthy women during the luteal phase of the menstrual cycle, and (b) individuals with types of psychopathology characterized by difficulty suppressing and filtering sensory, motor, or cognitive information. In the current study, 47 trauma-exposed women with or without posttraumatic stress disorder (PTSD) completed a PPI session during two different phases of the menstrual cycle: the early follicular phase, when estradiol and progesterone are both low, and the midluteal phase, when estradiol and progesterone are both high. Startle stimuli were 100 dB white noise bursts presented for 50 ms, and prepulses were 70 dB white noise bursts presented for 20 ms that preceded the startle stimuli by 120 ms. Women with PTSD showed deficits in PPI relative to the healthy trauma-exposed participants. Menstrual phase had no effect on PPI. These results provide empirical support for individuals with PTSD having difficulty with sensorimotor filtering. The potential utility of PPI as a Research Domain Criteria (RDoC) phenotype is discussed. PMID:27237725

  20. Epigenetic Risk Factors in PTSD and Depression

    PubMed Central

    Raabe, Florian Joachim; Spengler, Dietmar

    2013-01-01

    Epidemiological and clinical studies have shown that children exposed to adverse experiences are at increased risk for the development of depression, anxiety disorders, and posttraumatic stress disorder (PTSD). A history of child abuse and maltreatment increases the likelihood of being subsequently exposed to traumatic events or of developing PTSD as an adult. The brain is highly plastic during early life and encodes acquired information into lasting memories that normally subserve adaptation. Translational studies in rodents showed that enduring sensitization of neuronal and neuroendocrine circuits in response to early life adversity are likely risk factors of life time vulnerability to stress. Hereby, the hypothalamic-pituitary-adrenal (HPA) axis integrates cognitive, behavioral, and emotional responses to early-life stress and can be epigenetically programed during sensitive windows of development. Epigenetic mechanisms, comprising reciprocal regulation of chromatin structure and DNA methylation, are important to establish and maintain sustained, yet potentially reversible, changes in gene transcription. The relevance of these findings for the development of PTSD requires further studies in humans where experience-dependent epigenetic programing can additionally depend on genetic variation in the underlying substrates which may protect from or advance disease development. Overall, identification of early-life stress-associated epigenetic risk markers informing on previous stress history can help to advance early diagnosis, personalized prevention, and timely therapeutic interventions, thus reducing long-term social and health costs. PMID:23966957

  1. [Civil and criminal suits concerning PTSD in Japan].

    PubMed

    Sugita, Masahiko

    2002-01-01

    In civil and criminal trials in Japan, post-traumatic stress disorder (PTSD) issues have recently become a common topic of debate. In both types of (civil and criminal cases) judgments have been either affective or negative to PTSD. Contributing factors to the diagnosis of the accused that is identified to suffer from PTSD vary between cases. The difference in the establishment of the diagnosis for PTSD between psychiatrists reflects an aspect of the current situation in Japan where they have not used perfectly obvious and clearly defined diagnostic criterion, including ICD-10 and DSM-IV. To resolve this problem, a simple, clear and objective criterion of PTSD must be established. Instead of criterion that may take a long time to be established, a checklist can be used to relate PTSD with legal matters, as well as to determine liability in damages of the accused in civil cases and punishment in criminal cases.

  2. Utility of the Trauma Symptom Inventory's Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder

    ERIC Educational Resources Information Center

    Elhai, Jon D.; Gray, Matthew J.; Naifeh, James A.; Butcher, Jimmie J.; Davis, Joanne L.; Falsetti, Sherry A.; Best, Connie L.

    2005-01-01

    The authors examined the Trauma Symptom Inventorys (TSI) ability to discriminate 88 student post-traumatic stress disorder (PTSD) simulators screened for genuine PTSD from 48 clinical PTSD-diagnosed outpatients. Results demonstrated between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale.…

  3. Dresden PTSD treatment study: randomized controlled trial of motor vehicle accident survivors

    PubMed Central

    Maercker, Andreas; Zöllner, Tanja; Menning, Hans; Rabe, Sirko; Karl, Anke

    2006-01-01

    Background We translated, modified, and extended a cognitive behavioral treatment (CBT) protocol by Blanchard and Hickling (2003) for the purpose of treating survivors of MVA with full or subsyndromal posttraumatic stress disorder (PTSD) whose native language is German. The treatment manual included some additional elements, e. g. cognitive procedures, imaginal reliving, and facilitating of posttraumatic growth. The current study was conducted in order to test the efficacy of the modified manual by administering randomized controlled trial in which a CBT was compared to a wait-list control condition. Methods Forty-two motor vehicle accident survivors with chronic or severe subsyndromal posttraumatic stress disorder (PTSD) completed the treatment trial with two or three detailed assessments (pre, post, and 3-month follow-up). Results CAPS-scores showed significantly greater improvement in the CBT condition as compared to the wait list condition (group × time interaction effect size d = 1.61). Intent-to-treat analysis supported the outcome (d = 1.34). Categorical diagnostic data indicated clinical recovery of 67% (post-treatment) and 76% (3 months FU) in the treatment group. Additionally, patients of the CBT condition showed significantly greater reductions in co-morbid major depression than the control condition. At follow-up the improvements were stable in the active treatment condition. Conclusion The degree of improvement in our treatment group was comparable to that in previously reported treatment trials of PTSD with cognitive behavioral therapy. Trial registration ISRCTN66456536 PMID:16824221

  4. The relationship between negative expressivity, anger, and PTSD symptom clusters.

    PubMed

    Claycomb, Meredith; Roley, Michelle E; Contractor, Ateka A; Armour, Cherie; Dranger, Paula; Wang, Li; Elhai, Jon D

    2016-09-30

    More investigation is needed to understand how specific posttraumatic stress disorder (PTSD) symptom clusters relate to the internal experience of anger and overt negative behaviors in response to anger (negative expressivity). We investigated whether anger mediated relations between PTSD symptom clusters and negative expressivity. Multiple regression revealed lower PTSD intrusion symptoms associated with higher levels of negative expressivity. Anger mediated this relationship. Higher avoidance symptoms related to higher negative expressivity. Clinical implications, limitations, and strengths are discussed. PMID:27343408

  5. Sleep disturbances in veterans with chronic war-induced PTSD

    PubMed Central

    Khazaie, Habibolah; Ghadami, Mohammad Rasoul; Masoudi, Maryam

    2016-01-01

    Abstract: Post-traumatic stress disorder is related to a wide range of medical problems, with a majority of neurological, psychological, cardiovascular, respiratory, gastrointestinal disorders, diabetes, as well as sleep disorders. Although the majority of studies reveal the association between PTSD and sleep disturbances, there are few studies on the assessment of sleep disruption among veterans with PTSD. In this review, we attempt to study the sleep disorders including insomnia, nightmare, sleep-related breathing disorders, sleep-related movement disorders and parasomnias among veterans with chronic war-induced PTSD. It is an important area for further research among veterans with PTSD. PMID:27093088

  6. Response inhibition failure to visual stimuli paired with a "single-type" stressor in PTSD patients: an fMRI pilot study.

    PubMed

    Brunetti, Marcella; Sepede, Gianna; Ferretti, Antonio; Mingoia, Gianluca; Romani, Gian Luca; Babiloni, Claudio

    2015-05-01

    Patients with post-traumatic stress disorder (PTSD) tend to misinterpret innocuous stimuli as potential threats, possibly due to a conditioning provoked by traumatic episodes. Previous neuroimaging evidence has shown an abnormal activation of the amygdala and prefrontal cortex in PTSD patients during fear conditioning and extinction. Nevertheless, the effects of a single-type adverse stressor on that circuit remain poorly explored. We tested the hypothesis that a single-type adverse episode is able to affect the prefrontal cortex and amygdala response to conditioned stimuli. To test this hypothesis, fMRI recordings were performed in PTSD patients and trauma-exposed controls during the observation of neutral and negative paired or non-paired pictures with an adverse stimulus by means of a single association. Results showed that left amygdala activation during negative reinforced stimuli was correlated with the score of PTSD clinical scale across all subjects. Furthermore, in the traumatized non-PTSD group, the activation of the dorso-medial prefrontal cortex and bilateral amygdala was lower during the observation of the reinforced (CS(+)) versus non-reinforced pictures (CS(-)) in response to emotionally negative stimuli. This was not the case in the PTSD patients. These results suggest that in PTSD patients, a single-episode conditioning unveils the failure of an inhibitory mechanism moderating the activity of the prefrontal cortex and amygdala in response to adverse and neutral stimuli. PMID:25791360

  7. Guilt, Shame and Compassionate Imagery in War: Traumatized German Soldiers with PTSD, a Pilot Study

    PubMed Central

    Alliger-Horn, Christina; Zimmermann, Peter Lutz; Schmucker, Mervyn

    2016-01-01

    Background: The consideration of specific trauma-associated emotions poses a challenge for the differential treatment planning in trauma therapy. Soldiers experiencing deployment-related posttraumatic stress disorder often struggle with emotions of guilt and shame as a central component of their PTSD. Objective: The purpose of this study was to examine the extent to which soldiers’ PTSD symptoms and their trauma-related guilt and shame may be affected as a function of their ability to develop compassionate imagery between their CURRENT SELF (today) and their TRAUMATIZED SELF (back then). Method: The sample comprised 24 male German soldiers diagnosed with PTSD who were examined on the Posttraumatic Diagnostic Scale (PDS) and two additional measures: the Emotional Distress Inventory (EIBE) and the Quality of Interaction between the CURRENT SELF and the TRAUMATIZED SELF (QUI-HD: Qualität der Interaktion zwischen HEUTIGEN ICH und DAMALIGEN ICH) at pre- and post-treatment and again at follow-up. The treatment used was imagery rescripting and reprocessing therapy (IRRT). Results: Eighteen of the 24 soldiers showed significant improvement in their PTSD symptoms at post-treatment and at follow-up (on their reliable change index). A significant change in trauma-associated guilt and shame emerged when compassionate imagery was developed towards one’s TRAUMATIZED SELF. The degree and intensity of the guilt and shame felt at the beginning of treatment and the degree of compassionate imagery developed toward the TRAUMATIZED SELF were predictors for change on the PDS scores. Conclusions: For soldiers suffering from specific war-related trauma involving PTSD, the use of self-nurturing, compassionate imagery that fosters reconciling with the traumatized part of the self can effectively diminish trauma-related symptoms, especially when guilt and shame are central emotions. PMID:27775587

  8. Complex PTSD and phased treatment in refugees: a debate piece

    PubMed Central

    ter Heide, F. Jackie June; Mooren, Trudy M.; Kleber, Rolf J.

    2016-01-01

    Background Asylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD. Objective The aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD. Methods The first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees. Results Research shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high. Conclusions Complex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers. PMID:26886486

  9. An Experience Sampling Study of PTSD and Alcohol Related Problems

    PubMed Central

    Gaher, Raluca M.; Simons, Jeffrey S.; Hahn, Nicole L; Hofman, Jamie Hansen; Hofman, Jamie Hansen; Buchkoski, Jerome

    2014-01-01

    Posttraumatic stress disorder (PTSD) represents a debilitating psychiatric condition that is affecting the lives of many returning veterans. PTSD and alcohol use and dependence are highly comorbid. The purpose of this study was to understand the functional mechanisms between PTSD and alcohol use and problems. Specifically, the role of negative urgency and emotional intelligence were investigated as vulnerability and resiliency factors, respectively. This study utilized experience sampling to test associations between PTSD symptoms and alcohol use and related problems in a sample of 90 OIF/OEF veterans. Participants completed eight brief questionnaires daily for two weeks on palmtop computers. Elevations in PTSD symptoms during the day were associated with subsequent increases in alcohol use and associated problems that night. PTSD symptoms were associated with greater problems above and beyond the effect of drinking level at both the within- and between- person level. Emotional intelligence was associated with lower negative urgency, fewer PTSD symptoms, and less alcohol use and associated problems. The effects of emotional intelligence were primarily indirect via negative urgency and the effects of negative urgency on alcohol use and problems were indirect via its positive association with PTSD symptoms. Hypothesized cross-level effects of emotional intelligence and negative urgency were not supported. The findings suggest a functional association between PTSD symptoms and alcohol consumption. The association between PTSD symptoms and alcohol consumption is consistent with a self-medication model. However, the significant associations between PTSD symptoms and alcohol problems, after controlling for use level, suggest a broader role of dysregulation. PMID:25134021

  10. A Longitudinal Analysis of PTSD Symptom Course: Delayed-Onset PTSD in Somalia Peacekeepers

    ERIC Educational Resources Information Center

    Gray, Matt J.; Bolton, Elisa E.; Litz, Brett T.

    2004-01-01

    Posttraumatic stress disorder (PTSD) typically follows an acute to chronic course. However, some trauma victims do not report significant symptoms until a period of time has elapsed after the event. Although originally dismissed as an artifact of retrospective methodologies, recent prospective studies document apparent instances of delayed-onset…

  11. Feature: Post Traumatic Stres Disorder PTSD: A Growing Epidemic / Neuroscience and PTSD Treatments

    MedlinePlus

    ... by another person, as in a mugging or rape. Most PTSD sufferers repeatedly relive the trauma in their thoughts during the day and in ... new study will focus on intervening to help rape victims in the emergency room. "I do ... a trauma that can help," she says. Photo: iStock "I ...

  12. PTSD symptom severity as a predictor of cue-elicited drug craving in victims of violent crime.

    PubMed

    Saladin, Michael E; Drobes, David J; Coffey, Scott F; Dansky, Bonnie S; Brady, Kathleen T; Kilpatrick, Dean G

    2003-12-01

    This study examined posttraumatic stress disorder (PTSD) symptom severity as a predictor of cue-elicited craving among alcohol- and cocaine-dependent individuals with a history of at least one physical and/or sexual assault. Approximately half of the sample had current PTSD. Severity of PTSD symptoms was measured via the Impact of Events Scale-Revised (IES-R) total severity score. Subjects listened to four trials of a brief narrative imagery script followed by the presentation of an in vivo cue. The script presentation consisted of a description of either the subject's worst traumatic event or a neutral scene. The in vivo cues consisted of the presentation of either the subject's preferred drug or neutral cues. Craving was measured in response to both the script and in vivo cues. Results indicated a high degree of correlation between self-report craving and (a) PTSD symptom severity, (b) type of substance use disorder (SUD) [alcohol dependence (AD) vs. cocaine dependence (CD)], and (c) sex and race of participant. A series of stepwise multiple regressions indicated that PTSD severity was significantly predictive of trauma cue-elicited craving and drug cue-elicited craving. The results are discussed in the context of current research, theory, and clinical practice.

  13. PTSD and Sexual Orientation: An Examination of Criterion A1 and Non-Criterion A1 Events

    PubMed Central

    Alessi, Edward J.; Meyer, Ilan H.; Martin, James I.

    2015-01-01

    This large-scale cross-sectional study compared posttraumatic stress disorder (PTSD) prevalence among White, Black, and Latino lesbian, gay and bisexual individuals (LGBs; n = 382) and compared them with heterosexual individuals (n = 126). Building on previous research, we relaxed the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994), allowing non-Criterion A1 events such as ending a relationship, unemployment, homelessness, and separation from parents to qualify, and we assessed differences in PTSD prevalence between standard DSM–IV criteria and the relaxed criteria. Findings revealed that participants reporting a non-Criterion A1 event were more likely than those reporting a Criterion A1 event to have symptoms diagnosable as PTSD. There was no significant difference in either DSM–IV or relaxed Criterion A1 PTSD prevalence between lesbian and gay, and heterosexual individuals or between bisexual and heterosexual individuals. Compared with White LGBs, Black and Latino LGBs had higher prevalence of PTSD with the relaxed Criterion A1 definition, but this was statistically significant only for Latinos. PMID:26113955

  14. PTSD and Obesity in the Detroit Neighborhood Health Study

    PubMed Central

    Mitchell, Karen S.; Aiello, Allison E.; Galea, Sandro; Uddin, Monica; Wildman, Derek; Koenen, Karestan C.

    2013-01-01

    Objective Posttraumatic stress disorder (PTSD) has been associated with adverse health consequences, including overweight, obesity, and cardiovascular disease. African Americans, particularly women, have among the highest rates of overweight and obesity in the U.S. compared to other racial groups. High rates of violence exposure in urban African Americans may lead to the development of PTSD and increase risk for overweight and obesity. The current study investigated the comorbidity of lifetime PTSD and overweight/obesity in a population-based African American, urban sample. Method Data were from 463 African American male and female participants of the Detroit Neighborhood Health Study. Multivariable logistic regression models estimated the impact of lifetime PTSD on risk for overweight and obesity. Results The prevalence of obesity was significantly higher among women (60.9%) than men (33.1%; p<0.001). In sex-stratified models, after controlling for demographic variables, PTSD was associated obesity (OR=4.4, 95% CI: 1.3, 14.3) only among women. Conclusions PTSD was associated with obesity, after controlling for confounding variables, among African American women. Results underscore the contribution of PTSD to obesity among African American women and the importance of addressing the physical health correlates of women with PTSD. PMID:24035634

  15. Revisiting propranolol and PTSD: Memory erasure or extinction enhancement?

    PubMed

    Giustino, Thomas F; Fitzgerald, Paul J; Maren, Stephen

    2016-04-01

    Posttraumatic stress disorder (PTSD) has been described as the only neuropsychiatric disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted individuals. PTSD is characterized by heightened noradrenergic signaling, as well as a resistance to extinction learning. Research aimed at promoting more effective treatment of PTSD has focused on memory erasure (disrupting reconsolidation) and/or enhancing extinction retention through pharmacological manipulations. Propranolol, a β-adrenoceptor antagonist, has received considerable attention for its therapeutic potential in PTSD, although its impact on patients is not always effective. In this review, we briefly examine the consequences of β-noradrenergic manipulations on both reconsolidation and extinction learning in rodents and in humans. We suggest that propranolol is effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly preventing or dampening the later development of PTSD. In individuals who have already suffered from PTSD for a significant period of time, propranolol may be less effective at disrupting reconsolidation of strong fear memories. Also, when PTSD has already developed, chronic treatment with propranolol may be more effective than acute intervention, given that individuals with PTSD tend to experience long-term, elevated noradrenergic hyperarousal.

  16. Objective Ratings of Assault Safety as Predictors of PTSD.

    ERIC Educational Resources Information Center

    Cascardi, Michele; And Others

    1996-01-01

    Examines whether two trauma characteristics that are hypothesized to relate to perceptions of safety--assault location and assailant identity--predict rate and severity of posttraumatic stress disorder (PTSD) in female rape victims. Contrary to prediction, women assaulted by dangerous assailants reported significantly more severe PTSD symptoms…

  17. The relationship between forgiveness, spirituality, traumatic guilt and posttraumatic stress disorder (PTSD) among people with addiction.

    PubMed

    Langman, Louise; Chung, Man Cheung

    2013-03-01

    Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes.

  18. Ethnic differences in symptoms among female veterans diagnosed with PTSD.

    PubMed

    C'de Baca, Janet; Castillo, Diane; Qualls, Clifford

    2012-06-01

    Among U.S. male Vietnam veterans, Hispanics have been shown to have higher rates of posttraumatic stress disorder (PTSD) than African Americans and non-Hispanic Whites (Kulka et al., 1990). In terms of gender, Tolin and Foa's (2006) meta-analysis suggested women experience higher rates of PTSD than men. This study examined ethnic differences in PTSD and other symptomatology among 398 female veterans (63% non-Hispanic White, 28% Hispanic, 9% African American) seeking treatment for PTSD from 1995 to 2009 at a Veterans Administration (VA) behavioral health clinic. The following symptom clusters were examined: anxiety/PTSD, depression, anger/hostility, and psychotic/dissociative symptoms. Few differences were found among the groups, suggesting the 3 ethnic groups studied were more similar than different. African American female veterans, however, scored higher on measuring ideas of persecution/paranoia, although this may reflect an adaptive response to racism. These findings warrant further investigation to elucidate this relationship.

  19. Community violence and PTSD in selected South African townships.

    PubMed

    Dinan, B Ann; McCall, George J; Gibson, Diana

    2004-06-01

    Given the high rates of crime in South Africa's townships, nonpolitical violence out-side the home and its psychological impact on women were investigated within two samples, the primary a help-seeking sample and the secondary a community sample. In the help-seeking sample, two thirds of the women reported having experienced several traumatic events outside the home. Those women displayed a median of 9 PTSD (post-traumatic stress disorder) symptoms, with nearly half meeting all criteria for PTSD. In the community sample, 40 women of color were interviewed at a community festival for women, and again two thirds reported having experienced several traumatic events outside the home during the previous year. These women displayed a median of 8.8 PTSD symptoms, with none meeting all criteria for PTSD. South Africa's distinctive culture of violence is discussed as context for understanding issues of community violence and PTSD among women in its minority townships.

  20. Association of PTSD symptoms with asthma attacks among hurricane Katrina survivors.

    PubMed

    Arcaya, Mariana C; Lowe, Sarah R; Rhodes, Jean E; Waters, Mary C; Subramanian, S V

    2014-12-01

    The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre- and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale-Revised (IES-R), and self-reported postdisaster asthma attacks. A 1-point increase in the IES-R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning.

  1. Anhedonia, Emotional Numbing, and Symptom Overreporting in Male Veterans with PTSD

    PubMed Central

    Kashdan, Todd B.; Elhai, Jon D.; Frueh, B. Christopher

    2007-01-01

    We used measures of positive affect and emotional expression to distinguish and better understand veterans with PTSD with symptom overreporting presentation styles. Based on prior research, symptom overreporting was defined as scores greater than eight on the Fp (Infrequency-Psychopathology) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Data were drawn from an archival dataset of 227 combat veteran outpatients. Results were consistent with theory and research on the distinction between negative and positive affect. Major findings indicated that (a) veterans endorsing greater anhedonia had a greater likelihood of being classified as a symptom overreporter (controlling for PTSD symptoms), and (b) compared to non-symptom overreporting veterans, overreporters showed greater congruency in their presentation of diminished positive affect and their expression across self- and clinician-ratings. Our data suggest that diminished positive emotions and their behavioral expression are uniquely associated with veterans’ psychological experiences, providing insight into the nature of symptom overreporters. PMID:18769508

  2. Association of PTSD symptoms with asthma attacks among hurricane Katrina survivors.

    PubMed

    Arcaya, Mariana C; Lowe, Sarah R; Rhodes, Jean E; Waters, Mary C; Subramanian, S V

    2014-12-01

    The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre- and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale-Revised (IES-R), and self-reported postdisaster asthma attacks. A 1-point increase in the IES-R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning. PMID:25470787

  3. Preventive effects of ginsenoside Rg1 on post-traumatic stress disorder (PTSD)-like behavior in male C57/B6 mice.

    PubMed

    Wang, Zhongli; Zhu, Kexuan; Chen, Lin; Ou Yang, Liufeng; Huang, Yufang; Zhao, Yunan

    2015-09-25

    We investigated the preventive effects of Rg1 on a model of mouse post-traumatic stress disorder (PTSD) induced by electric shock combined with situation reminder and explored the underlying mechanism. In the experiment, before the PTSD animal model was developed, Rg1 (10, 5, and 2.5mg/kg) was orally administered for one week. After the animal model was established, PTSD-like behavior was observed using elevated plus maze, black and light box, and open field tests. One hour after the behavior test, all mice were sacrificed, and then serum corticosterone (CORT) and hypothalamus corticotrophin-releasing hormone (CRH) assays were performed. Results showed that Rg1 (5mg/kg) treatments relieved PTSD-like behavior by altering elevated serum corticosterone and hypothalamus CRH levels. By contrast, fluoxetine (3mg/kg) treatment reversed the behavior changes and had no effect on increased CORT and CRH levels. These findings confirmed the preventive effect of Rg1 in PTSD model. Decreasing CORT and CRH levels may be one of the underlying mechanisms.

  4. Examining potential contraindications for prolonged exposure therapy for PTSD

    PubMed Central

    van Minnen, Agnes; Harned, Melanie S.; Zoellner, Lori; Mills, Katherine

    2012-01-01

    Although prolonged exposure (PE) has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems. PMID:22893847

  5. Psychological Mechanisms of PTSD and Its Treatment.

    PubMed

    Sripada, Rebecca K; Rauch, Sheila A M; Liberzon, Israel

    2016-11-01

    Psychological mechanisms can be defined as processes or events that are responsible for specific changes in psychological outcomes. In psychotherapy research, mechanisms are the factors through which interventions produce change. In this article, we explain the importance of identifying psychological mechanisms, describe methods for identifying them, and analyze recent literature on the psychological mechanisms underlying the development and treatment of posttraumatic stress disorder (PTSD). Based on the findings of recent investigations (from 2013 to present), we focus on four putative mechanisms: emotional engagement, extinction and contextualization, distress tolerance, and negative posttraumatic cognitions. Future directions for psychological mechanism research are also outlined, including possible opportunities for capitalizing on the most promising mechanisms identified to date.

  6. Psychological Mechanisms of PTSD and Its Treatment.

    PubMed

    Sripada, Rebecca K; Rauch, Sheila A M; Liberzon, Israel

    2016-11-01

    Psychological mechanisms can be defined as processes or events that are responsible for specific changes in psychological outcomes. In psychotherapy research, mechanisms are the factors through which interventions produce change. In this article, we explain the importance of identifying psychological mechanisms, describe methods for identifying them, and analyze recent literature on the psychological mechanisms underlying the development and treatment of posttraumatic stress disorder (PTSD). Based on the findings of recent investigations (from 2013 to present), we focus on four putative mechanisms: emotional engagement, extinction and contextualization, distress tolerance, and negative posttraumatic cognitions. Future directions for psychological mechanism research are also outlined, including possible opportunities for capitalizing on the most promising mechanisms identified to date. PMID:27671916

  7. Are 60-minute prolonged exposure sessions with 20-minute imaginal exposure to traumatic memories sufficient to successfully treat PTSD? A randomized noninferiority clinical trial.

    PubMed

    Nacasch, Nitsa; Huppert, Jonathan D; Su, Yi-Jen; Kivity, Yogev; Dinshtein, Yula; Yeh, Rebecca; Foa, Edna B

    2015-05-01

    The study aims to determine whether 60-minute sessions of prolonged exposure (PE) that include 20 minutes of imaginal exposure (IE) are noninferior to the standard 90-minute sessions that include 40 minutes of IE in treating posttraumatic stress disorder (PTSD) and to explore the relationship of treatment outcome to within- and between-session habituation and change in negative cognitions. Thirty-nine adult veterans with chronic PTSD were randomly assigned to 90-minute (n=19) or 60-minute (n=20) sessions of PE. PTSD symptoms were assessed by an unaware independent evaluator before and after treatment and at 6-month follow-up. Self-reports of depression and negative cognitions were assessed before and after treatment. Participants in both conditions showed significant reductions in PTSD symptoms. Sixty-minute sessions were found to be noninferior to 90-minute sessions in reducing PTSD symptoms, as the upper bound of the 95% confidence interval for the difference between conditions in the PTSD Symptom Scale-Interview (posttreatment: 6.00; follow-up: 6.77) was below the predefined noninferiority margin (7.00). Participants receiving shorter sessions showed less within- and between-session habituation than those receiving longer sessions, but no group differences in reductions in negative cognitions were found. The current findings indicate that the outcomes of 60-minute sessions of PE do not differ from those of 90-minute sessions. In addition, change in trauma-related cognitions and between-session habituation are both potential mechanisms of PE.

  8. The Relationship Between Post-Deployment Factors and PTSD Severity in Recent Combat Veterans

    PubMed Central

    Possemato, Kyle; McKenzie, Shannon; McDevitt-Murphy, Meghan E.; Williams, Joah; Ouimette, Paige

    2014-01-01

    Combat traumas precipitate PTSD, however non-traumatic deployment and post-deployment factors may also contribute to PTSD severity. The Deployment Risk and Resilience Inventory was used to investigate pre, peri and post-deployment factors associated with current PTSD severity in 150 recent combat veterans with PTSD and hazardous alcohol use. Hierarchal linear regression analyzed what factors independently predicted PTSD severity when controlling for socio-demographic characteristics and combat specific variables. Four post-deployment factors independently predicted PTSD severity: unemployment, alcohol use, social support, stressful (non-traumatic) life events. The centrality of trauma in the maintenance of PTSD and clinical implications for treatment providers are discussed. PMID:25892847

  9. Unique PTSD clusters predict intention to seek mental health care and subsequent utilization in US veterans with PTSD symptoms.

    PubMed

    Blais, Rebecca K; Hoerster, Katherine D; Malte, Carol; Hunt, Stephen; Jakupcak, Matthew

    2014-04-01

    Many veterans return from deployment with posttraumatic stress disorder (PTSD), but most attend only a limited number of mental health care visits. Although global PTSD relates to seeking mental health care, it is unclear whether specific features of PTSD inform the low rates of mental health care utilization. This study examined PTSD cluster severities of avoidance, reexperiencing, dysphoria, and hyperarousal as predictors of intention to seek mental health care and prospective treatment utilization. US veterans with at least subthreshold PTSD (N = 189) completed a PTSD symptom measure and indicated whether they intended to seek mental health care. Prospective Department of Veterans Affairs mental health care utilization was extracted from the medical record. At the bivariate level, each cluster was positively associated with a positive intention to seek mental health care and prospective treatment utilization. In multivariate models, however, dysphoria severity (OR = 1.16, 95% CI [1.06, 1.26]) was uniquely and positively correlated with intention to seek mental health care, whereas higher avoidance severity (IRR = 0.86, 95% CI [0.76, 0.98]) predicted lower treatment utilization, and higher reexperiencing severity (IRR = 1.07, 95% CI [1.01, 1.14]) predicted greater treatment utilization. It is critical to tailor interventions to target specific features of PTSD and to meet patients where they are.

  10. Why are Iraq and Afghanistan War veterans seeking PTSD disability compensation at unprecedented rates?

    PubMed

    McNally, Richard J; Frueh, B Christopher

    2013-06-01

    The wars in Iraq and Afghanistan have produced historically low rates of fatalities, injuries, and posttraumatic stress disorder (PTSD) among U.S. combatants. Yet they have also produced historically unprecedented rates of PTSD disability compensation seeking from the U.S. Department of Veterans Affairs. The purpose of this article is to consider hypotheses that might potentially resolve this paradox, including high rates of PTSD, delayed onset PTSD, malingered PTSD, and economic variables.

  11. Why are Iraq and Afghanistan War veterans seeking PTSD disability compensation at unprecedented rates?

    PubMed

    McNally, Richard J; Frueh, B Christopher

    2013-06-01

    The wars in Iraq and Afghanistan have produced historically low rates of fatalities, injuries, and posttraumatic stress disorder (PTSD) among U.S. combatants. Yet they have also produced historically unprecedented rates of PTSD disability compensation seeking from the U.S. Department of Veterans Affairs. The purpose of this article is to consider hypotheses that might potentially resolve this paradox, including high rates of PTSD, delayed onset PTSD, malingered PTSD, and economic variables. PMID:23954726

  12. Relationship between PTSD and pathological personality traits in context of disasters.

    PubMed

    Reis, Ana Maria; de Francisco Carvalho, Lucas; Elhai, Jon D

    2016-07-30

    One of the recurrent outcomes after a stressor event as a disaster is post-traumatic stress disorder (PTSD), which appears to be mediated, in part, by emotional, behavioral, and psychological responses, arising from the belief system associated with the traumatic experience. Studies suggest that personality traits are related to how individuals face or adapt in the event of disaster phenomena. The present study aimed to investigate the relationship between PTSD, posttraumatic beliefs and personality traits in people who experienced disasters. 113 individuals participated in the survey, of both sexes (58.4% women) with ages ranging between 19 and 63 years (M=37.5; SD=12.1). We used the Dimensional Clinical Personality Inventory (IDCP), the Brazilian version of the Davidson Trauma Scale, and the Brazilian version of the Posttraumatic Cognitions Inventory. Among the findings, pathological personality characteristics relate positively with PTSD symptomatology, individuals who experienced disaster events presented more pathological personality traits when compared to those who did not experience these events, and negative beliefs were positively related with pathological characteristics of personality. We highlight the need for research on the relationships between personality characteristics and post-traumatic beliefs in order to promote more adequate interventions given the possible disease chronicity. PMID:27156030

  13. Child abuse predicts adult PTSD symptoms among individuals diagnosed with intellectual disabilities

    PubMed Central

    Catani, Claudia; Sossalla, Iris M.

    2015-01-01

    Prior research has shown that people with intellectual disabilities (ID) are more likely to experience child abuse as well as other forms of traumatic or negative events later in life compared to the general population. Little is known however, about the association of these experiences with adult mental health in intellectually disabled individuals. The present study aimed to assess whether child abuse in families and institutions as well as other types of adverse life events, were associated with current posttraumatic stress disorder (PTSD) and depression symptoms in individuals with ID. We conducted clinical interviews which included standardized self-report measures for childhood abuse, PTSD, and depression in an unselected sample of 56 persons with a medical diagnosis of ID who were attending a specialized welfare center. The frequency of traumatic experiences was very high, with physical and emotional child abuse being the most common trauma types. 87% of the persons reported at least one aversive experience on the family violence spectrum, and 50% of the sample reported a violent physical attack later in adulthood. 25% were diagnosed with PTSD and almost 27% had a critical score on the depression scale. Physical and emotional child abuse was positively correlated with the amount of institutional violence and the number of general traumatic events, whereas childhood sexual abuse was related to the experience of intimate partner violence in adult life. A linear regression model revealed child abuse in the family to be the only significant independent predictor of PTSD symptom severity. The current findings underscore the central role of child maltreatment in the increased risk of further victimization and in the development of mental health problems in adulthood in intellectually disabled individuals. Our data have important clinical implications and demonstrate the need for targeted prevention and intervention programs that are tailored to the specific needs

  14. Child abuse predicts adult PTSD symptoms among individuals diagnosed with intellectual disabilities.

    PubMed

    Catani, Claudia; Sossalla, Iris M

    2015-01-01

    Prior research has shown that people with intellectual disabilities (ID) are more likely to experience child abuse as well as other forms of traumatic or negative events later in life compared to the general population. Little is known however, about the association of these experiences with adult mental health in intellectually disabled individuals. The present study aimed to assess whether child abuse in families and institutions as well as other types of adverse life events, were associated with current posttraumatic stress disorder (PTSD) and depression symptoms in individuals with ID. We conducted clinical interviews which included standardized self-report measures for childhood abuse, PTSD, and depression in an unselected sample of 56 persons with a medical diagnosis of ID who were attending a specialized welfare center. The frequency of traumatic experiences was very high, with physical and emotional child abuse being the most common trauma types. 87% of the persons reported at least one aversive experience on the family violence spectrum, and 50% of the sample reported a violent physical attack later in adulthood. 25% were diagnosed with PTSD and almost 27% had a critical score on the depression scale. Physical and emotional child abuse was positively correlated with the amount of institutional violence and the number of general traumatic events, whereas childhood sexual abuse was related to the experience of intimate partner violence in adult life. A linear regression model revealed child abuse in the family to be the only significant independent predictor of PTSD symptom severity. The current findings underscore the central role of child maltreatment in the increased risk of further victimization and in the development of mental health problems in adulthood in intellectually disabled individuals. Our data have important clinical implications and demonstrate the need for targeted prevention and intervention programs that are tailored to the specific needs

  15. From War to Classroom: PTSD and Depression in Formerly Abducted Youth in Uganda

    PubMed Central

    Winkler, Nina; Ruf-Leuschner, Martina; Ertl, Verena; Pfeiffer, Anett; Schalinski, Inga; Ovuga, Emilio; Neuner, Frank; Elbert, Thomas

    2015-01-01

    Background: Trained local screeners assessed the mental-health status of male and female students in Northern Ugandan schools. The study aimed to disclose potential differences in mental health-related impairment in two groups, former child soldiers (n = 354) and other war-affected youth (n = 489), as well as to separate factors predicting mental suffering in learners. Methods: Participants were randomly selected. We used the Post-Traumatic Diagnostic Scale to assess symptoms of post-traumatic stress disorder (PTSD) and for potential depression the respective section of the Hopkins Symptom Checklist with a locally validated cut-off. Results: Almost all respondents had been displaced at least once in their life. 30% of girls and 50% of the boys in the study reported past abduction history. Trauma exposure was notably higher in the group of abductees. In former child soldiers, a PTSD rate of 32% was remarkably higher than that for non-abductees (12%). Especially in girls rates of potential depression were double those in the group of former abductees (17%) than in the group of non-abductees (8%). In all groups, trauma exposure increased the risk of developing PTSD. A path-analytic model for developing PTSD and potential depression revealed both previous trauma exposure as well as duration of abduction to have significant influences on trauma-related mental suffering. Findings also suggest that in Northern Ugandan schools trauma spectrum disorders are common among war-affected learners. Conclusions: Therefore, it is suggested the school context should be used to provide mental-health support structures within the education system for war-affected youth at likely risk of developing war-related mental distress. PMID:25788887

  16. PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women.

    PubMed

    Onoye, Jane M; Goebert, Deborah; Morland, Leslie; Matsu, Courtenay; Wright, Tricia

    2009-12-01

    To better understand the role of posttraumatic stress disorder (PTSD) in postpartum health, this study investigates the relationship of PTSD and associated perinatal behavioral risk factors in a sample of Caucasian, Asian, and Pacific Islander women. As part of a larger longitudinal study, 54 women (18-35 years of age) were interviewed at their postpartum clinic visit for PTSD, anxiety, depression, and alcohol and substance use. PTSD and subclinical PTSD during the postpartum period were associated with behavioral health risks, with PTSD at the onset of pregnancy being a predictor of postpartum PTSD by a factor of three. Women with PTSD and subclinical PTSD were more likely to also experience stress (73%), anxiety (64%), and depression (73%) during the postpartum period compared to those without PTSD. No significant differences were found by ethnicity for postpartum PTSD, depression, or anxiety. Regardless of ethnicity or PTSD status, one in four women in the sample had a probable mental health disorder or risk behavior of some type during the postpartum period. Given the rates of associated mental health risks with PTSD, these findings suggest further research examining the fluctuations of PTSD symptomatology throughout each pregnancy trimester to determine its role as a potential mediator during the perinatal period. Further research is also needed to elucidate the role of ethnic or cultural differences in trauma and PTSD and perinatal health.

  17. Why are hispanics at greater risk for PTSD?

    PubMed

    Pole, Nnamdi; Best, Suzanne R; Metzler, Thomas; Marmar, Charles R

    2005-05-01

    Several studies have found that Hispanic Americans have higher rates of posttraumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peritraumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States.

  18. PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals.

    PubMed

    Simpson, T L; Kaysen, D; Bowen, S; MacPherson, L M; Chawla, N; Blume, A; Marlatt, G A; Larimer, M

    2007-06-01

    The present study evaluated whether Posttraumatic Stress Disorder (PTSD) symptom severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample. This study utilizes secondary data. The original study demonstrated that Vipassana meditation is associated with reductions in substance use. The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course. Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual, regardless of PTSD symptom severity levels. These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.

  19. Chronic Pain and PTSD: A Guide for Patients

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  20. What Can I Do If I Think I Have PTSD?

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  1. Routine Work Environment Stress and PTSD Symptoms in Police Officers

    PubMed Central

    Maguen, Shira; Metzler, Thomas J.; McCaslin, Shannon E.; Inslicht, Sabra S.; Henn-Haase, Clare; Neylan, Thomas C.; Marmar, Charles R.

    2013-01-01

    This study examined the relationship between routine work environment stress and posttraumatic stress disorder (PTSD) symptoms in a sample of police officers (N = 180) who were first assessed during academy training and reassessed 1-year later. In a model that included gender, ethnicity, traumatic exposure prior to entering the academy, current negative life events, and critical incident exposure over the last year, routine work environment stress was most strongly associated with PTSD symptoms. We also found that routine work environment stress mediated the relationship between critical incident exposure and PTSD symptoms and between current negative life events and PTSD symptoms. Ensuring that the work environment is functioning optimally protects against the effects of duty-related critical incidents and negative life events outside police service. PMID:19829204

  2. Feature: Post Traumatic Stres Disorder PTSD: NIH Research to Results

    MedlinePlus

    ... including PTSD, persist for those affected by 2005's Hurricane Katrina. This is important because previously researchers found ... and resilience among survivors in Texas of 2008's Hurricane Ike. Other research is exploring whether certain drugs ...

  3. PTSD, depression and anxiety among former abductees in Northern Uganda

    PubMed Central

    2011-01-01

    Background The population in Northern Uganda has been exposed to extreme levels of traumatic stress and thousands abducted forcibly became rebel combatants. Methods Using structured interviews, the prevalence and severity of posttraumatic stress disorder (PTSD), depression and anxiety was assessed in 72 former abducted adults, 62 of them being former child soldiers. Results As retrospective reports of exposure to traumatic stress increased, anxiety and PTSD occurrence increased (r = .45). 49% of respondents were diagnosed with PTSD, 70% presented with symptoms of depression, and 59% with those of anxiety. In a multiple linear regression analysis four factors could best explain the development of PTSD symptoms: male respondents (sex) living in an IDP-Camp (location) with a kinship murdered in the war (family members killed in the war) and having experienced a high number of traumatic events (number of traumatic events) were more likely to develop symptoms of PTSD than others. In disagreement to a simple dose-response-effect though, we also observed a negative correlation between the time spent with the rebels and the PTSD symptom level. Conclusions Former abductees continue to suffer from severe mental ill-health. Adaptation to the living condition of rebels, however, may lower trauma-related mental suffering. PMID:21871069

  4. Law enforcement preferences for PTSD treatment and crisis management alternatives.

    PubMed

    Becker, Carolyn Black; Meyer, Glenn; Price, John S; Graham, Melissa M; Arsena, Ashley; Armstrong, David A; Ramon, Elizabeth

    2009-03-01

    Evidence-based treatments (EBT) for posttraumatic stress disorder (PTSD) remain underutilized. Analog research, however, indicates that patients may be more amenable to receiving EBT for PTSD than utilization rates suggest. This study sought to extend previous studies by investigating PTSD treatment preferences among law enforcement individuals (i.e., active duty officers, cadets, criminal justice students). We asked 379 participants, with varying trauma histories, to read a police traumatic event and imagine they had developed PTSD. Participants rated the credibility of six treatment options which they might encounter in a treatment setting, and chose their most and least preferred treatments. Next, they evaluated a widely used debriefing intervention aimed at preventing PTSD. Almost 90% of participants chose exposure or Cognitive Processing Therapy as their first or second most preferred treatment, and they rated these interventions as significantly more credible than the other four treatment options. The sample showed ambivalence regarding the perceived efficacy of debriefing but found the rationale credible. This study supports previous analog research indicating that patients may be more interested in EBT than indicated by utilization rates, and suggests that law enforcement departments should consider offering EBT to officers who develop PTSD.

  5. Mental health professionals’ attitudes toward patients with PTSD and depression

    PubMed Central

    Maier, Thomas; Moergeli, Hanspeter; Kohler, Michaela; Carraro, Giovanni E.; Schnyder, Ulrich

    2015-01-01

    Background To date, mental health professionals’ attitudes toward posttraumatic stress disorder (PTSD), compared to other psychiatric disorders such as schizophrenia or depression, have rarely been studied. Objective We assessed mental health professionals’ attitudes toward patients with PTSD compared to patients suffering from depression. Method Case vignettes of a patient with either PTSD or depression were presented to two samples of mental health professionals: attendees of a conference on posttraumatic stress (N=226) or of a lecture for psychiatry residents (N=112). Participants subsequently completed a questionnaire that assessed their attitude reactions to the presented case. Results Participants showed similarly positive attitudes toward depression and PTSD. PTSD elicited a more favorable attitude with regard to prosocial reactions, estimated dependency, attributed responsibility, and interest in the case, particularly in mental health professionals specializing in psychotraumatology. Across diagnoses, higher age and longer professional experience were associated with more positive attitudes toward patients. Conclusions Mental health professionals’ positive attitudes toward patients with depression and PTSD correlate with their specific knowledge about the disorder, their level of professional training, and their years of professional experience. Limitations The instruments used, although based on established theoretical concepts in attitude research, were not validated in their present versions. PMID:26507340

  6. Project VALOR: design and methods of a longitudinal registry of post-traumatic stress disorder (PTSD) in combat-exposed veterans in the Afghanistan and Iraqi military theaters of operations.

    PubMed

    Rosen, Raymond C; Marx, Brian P; Maserejian, Nancy N; Holowka, Darren W; Gates, Margaret A; Sleeper, Lynn A; Vasterling, Jennifer J; Kang, Han K; Keane, Terence M

    2012-03-01

    Few studies have investigated the natural history of post-traumatic stress disorder (PTSD). Project VALOR (Veterans' After-discharge Longitudinal Registry) was designed as a longitudinal patient registry assessing the course of combat-related PTSD among 1600 male and female Veterans who served in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF). Aims of the study include investigating patterns and predictors of progression or remission of PTSD and treatment utilization. The study design was based on recommendations from the Agency for Healthcare Quality and Research for longitudinal disease registries and used a pre-specified theoretical model to select the measurement domains for data collection and interpretation of forthcoming results. The registry will include 1200 male and female Veterans with a recent diagnosis of PTSD in the Department of Veteran Affairs (VA) electronic medical record and a comparison group of 400 Veterans without a medical record-based PTSD diagnosis, to also allow for case-control analyses. Data are collected from administrative databases, electronic medical records, a self-administered questionnaire, and a semi-structured diagnostic telephone interview. Project VALOR is a unique and timely registry study that will evaluate the clinical course of PTSD, psychosocial correlates, and health outcomes in a carefully selected cohort of returning OEF/OIF Veterans.

  7. Testing the validity of the proposed ICD-11 PTSD and complex PTSD criteria using a sample from Northern Uganda

    PubMed Central

    Murphy, Siobhan; Elklit, Ask; Dokkedahl, Sarah; Shevlin, Mark

    2016-01-01

    Background The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations. Objective The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes. Methods A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers (n=124) while the remaining participants were civilians (n=190). Results The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences. Conclusions To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made. Highlights of the article Examine the validity of CPTSD in a non-western sample Separate PTSD and CPTSD classes emerged Former child soldiers were more strongly associated with the CPTSD class CPTSD class reported significantly higher levels of anxiety, depression, somatic complaints and conduct problems PMID:27613369

  8. Association between facial expression and PTSD symptoms among young children exposed to the Great East Japan Earthquake: a pilot study.

    PubMed

    Fujiwara, Takeo; Mizuki, Rie; Miki, Takahiro; Chemtob, Claude

    2015-01-01

    "Emotional numbing" is a symptom of post-traumatic stress disorder (PTSD) characterized by a loss of interest in usually enjoyable activities, feeling detached from others, and an inability to express a full range of emotions. Emotional numbing is usually assessed through self-report, and is particularly difficult to ascertain among young children. We conducted a pilot study to explore the use of facial expression ratings in response to a comedy video clip to assess emotional reactivity among preschool children directly exposed to the Great East Japan Earthquake. This study included 23 child participants. Child PTSD symptoms were measured using a modified version of the Parent's Report of the Child's Reaction to Stress scale. Children were filmed while watching a 2-min video compilation of natural scenes ('baseline video') followed by a 2-min video clip from a television comedy ('comedy video'). Children's facial expressions were processed the using Noldus FaceReader software, which implements the Facial Action Coding System (FACS). We investigated the association between PTSD symptom scores and facial emotion reactivity using linear regression analysis. Children with higher PTSD symptom scores showed a significantly greater proportion of neutral facial expressions, controlling for sex, age, and baseline facial expression (p < 0.05). This pilot study suggests that facial emotion reactivity, measured using facial expression recognition software, has the potential to index emotional numbing in young children. This pilot study adds to the emerging literature on using experimental psychopathology methods to characterize children's reactions to disasters. PMID:26528206

  9. DSM-5 PTSD and posttraumatic stress spectrum in Italian emergency personnel: correlations with work and social adjustment

    PubMed Central

    Carmassi, Claudia; Gesi, Camilla; Simoncini, Marly; Favilla, Luca; Massimetti, Gabriele; Olivieri, Maria Cristina; Conversano, Ciro; Santini, Massimo; Dell’Osso, Liliana

    2016-01-01

    The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) has recently recognized a particular risk for posttraumatic stress disorder (PTSD) among first responders (criterion A4), acknowledging emergency units as stressful places of employment. Little data is yet available on DSM-5 among emergency health operators. The aim of this study was to assess DSM-5 symptomatological PTSD and posttraumatic stress spectrum, as well as their impact on work and social functioning, in the emergency staff of a major university hospital in Italy. One hundred and ten subjects (doctors, nurses, and health-care assistants) were recruited at the Emergency Unit of the Azienda Ospedaliero-Universitaria Pisana (Italy) and assessed by the Trauma and Loss Spectrum-Self Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). A 15.7% DSM-5 symptomatological PTSD prevalence rate was found. Nongraduated persons reported significantly higher TALS-SR Domain IV (reaction to loss or traumatic events) scores and a significantly higher proportion of individuals presenting at least one maladaptive behavior (TALS-SR Domain VII), with respect to graduate ones. Women reported significantly higher WSAS scores. Significant correlations emerged between PTSD symptoms and WSAS total scores among health-care assistants, nongraduates and women. Our results showed emergency workers to be at risk for posttraumatic stress spectrum and related work and social impairment, particularly among women and nongraduated subjects. PMID:26937192

  10. Association between facial expression and PTSD symptoms among young children exposed to the Great East Japan Earthquake: a pilot study.

    PubMed

    Fujiwara, Takeo; Mizuki, Rie; Miki, Takahiro; Chemtob, Claude

    2015-01-01

    "Emotional numbing" is a symptom of post-traumatic stress disorder (PTSD) characterized by a loss of interest in usually enjoyable activities, feeling detached from others, and an inability to express a full range of emotions. Emotional numbing is usually assessed through self-report, and is particularly difficult to ascertain among young children. We conducted a pilot study to explore the use of facial expression ratings in response to a comedy video clip to assess emotional reactivity among preschool children directly exposed to the Great East Japan Earthquake. This study included 23 child participants. Child PTSD symptoms were measured using a modified version of the Parent's Report of the Child's Reaction to Stress scale. Children were filmed while watching a 2-min video compilation of natural scenes ('baseline video') followed by a 2-min video clip from a television comedy ('comedy video'). Children's facial expressions were processed the using Noldus FaceReader software, which implements the Facial Action Coding System (FACS). We investigated the association between PTSD symptom scores and facial emotion reactivity using linear regression analysis. Children with higher PTSD symptom scores showed a significantly greater proportion of neutral facial expressions, controlling for sex, age, and baseline facial expression (p < 0.05). This pilot study suggests that facial emotion reactivity, measured using facial expression recognition software, has the potential to index emotional numbing in young children. This pilot study adds to the emerging literature on using experimental psychopathology methods to characterize children's reactions to disasters.

  11. A feasibility pilot study on the use of text messages to track PTSD symptoms after a traumatic injury

    PubMed Central

    Price, Matthew; Ruggiero, Kenneth J.; Ferguson, Pamela; Patel, Sachin K.; Treiber, Frank; Couillard, Deborah; Fahkry, Samir M.

    2014-01-01

    Objective Monitoring PTSD symptoms after a traumatic injury is beneficial for patients and providers. Text messages can be used to automatically monitor symptoms and impose minimal burden to patients and providers. The present study piloted such a strategy with traumatic injury patients. Method An automated daily text message was piloted to evaluate PTSD symptoms after discharge from the hospital. 29 patients who experienced a traumatic injury received 15 daily texts and were then followed up at 1-month and 3-months after discharge. Results 82.8% of the sample responded at least once and the average response rate per participant was 63.1%. Response rates were correlated with PTSD symptoms at baseline but not at any other time. Patient satisfaction with this approach was high. Conclusion Text messages are a viable method to monitor PTSD symptoms after a traumatic injury. Such an approach should be evaluated on a larger scale as part of a more comprehensive early intervention for traumatic stress. PMID:24636721

  12. Appetitive Aggression as a Resilience Factor against Trauma Disorders: Appetitive Aggression and PTSD in German World War II Veterans

    PubMed Central

    Weierstall, Roland; Huth, Sina; Knecht, Jasmin; Nandi, Corina; Elbert, Thomas

    2012-01-01

    Background Repeated exposure to traumatic stressors such as combat results in chronic symptoms of PTSD. However, previous findings suggest that former soldiers who report combat-related aggression to be appetitive are more resilient to develop PTSD. Appetitive Aggression should therefore prevent widespread mental suffering in perpetrators of severe atrocities even after decades. Methods and Findings To test the long-term relationship between trauma-related illness and attraction to aggression, we surveyed a sample of 51 German male World-War II veterans (age: M = 86.7, SD = 2.8). War-related appetitive aggression was assessed with the Appetitive Aggression Scale (AAS). Current- and lifetime PTSD symptoms were assessed with the PSS-I. In a linear regression analysis accounting for 31% of the variance we found that veterans that score higher on the AAS show lower PSS-I symptom severity scores across their whole post-war lifetime (β = − .31, p = .014). The effect size and power were sufficient (f2 = 0.51, (1-β) = .99). The same was true for current PTSD (β = − .27, p = .030). Conclusions Appetitive Aggression appears to be a resilience factor for negative long-term effects of combat experiences in perpetrators of violence. This result has practical relevance for preventing trauma-related mental suffering in Peace Corps and for designing adequate homecoming reception for veterans. PMID:23251398

  13. Cancer-related PTSD symptoms in a veteran sample: association with age, combat PTSD, and quality of life

    PubMed Central

    Wachen, Jennifer Schuster; Patidar, Seema M.; Mulligan, Elizabeth A.; Naik, Aanand D.; Moye, Jennifer

    2015-01-01

    Objective The diagnosis and treatment of cancer is a potentially traumatic experience that may evoke posttraumatic stress symptoms (PTSS) among survivors. This paper describes the rates of endorsement of cancer-related PTSS along with the relationship of demographic, cancer, and combat variables on PTSS and quality of life. Methods Veterans (N = 166) with head and neck, esophageal, gastric, or colorectal cancers were recruited through tumor registries at two regional Veterans Administration Medical Centers. Standardized scales were used to assess self-report of PTSS, combat, and quality of life. Results Most participants (86%) reported experiencing at least some cancer-related PTSS; 10% scored above a clinical cutoff for probable PTSD. In linear regressions, younger age and current combat PTSS were associated with cancer-related PTSS, whereas disease and treatment characteristics were not; in turn, cancer-related PTSS were negatively associated with physical and social quality of life. Conclusions Individual characteristics and psychosocial factors may play a larger role than disease-related variables in determining how an individual responds to the stress of cancer diagnosis and treatment. Given the rates of reported cancer-related PTSS in this sample, and other non-veteran samples, clinicians should consider screening these following diagnosis and treatment, particularly in younger adults and those with previous trauma histories. PMID:24519893

  14. Clinical implications of neuroscience research in PTSD.

    PubMed

    van der Kolk, Bessel A

    2006-07-01

    The research showing how exposure to extreme stress affects brain function is making important contributions to understanding the nature of traumatic stress. This includes the notion that traumatized individuals are vulnerable to react to sensory information with subcortically initiated responses that are irrelevant, and often harmful, in the present. Reminders of traumatic experiences activate brain regions that support intense emotions, and decrease activation in the central nervous system (CNS) regions involved in (a) the integration of sensory input with motor output, (b) the modulation of physiological arousal, and (c) the capacity to communicate experience in words. Failures of attention and memory in posttraumatic stress disorder (PTSD) interfere with the capacity to engage in the present: traumatized individuals "lose their way in the world." This article discusses the implications of this research by suggesting that effective treatment needs to involve (a) learning to tolerate feelings and sensations by increasing the capacity for interoception, (b) learning to modulate arousal, and (c) learning that after confrontation with physical helplessness it is essential to engage in taking effective action.

  15. Lifetime history of traumatic events in an American Indian Community Sample: Heritability and relation to substance dependence, affective disorder, conduct disorder and PTSD

    PubMed Central

    Ehlers, Cindy L.; Gizer, Ian R.; Gilder, David A.; Yehuda, Rachael

    2012-01-01

    American Indians appear to experience a higher rate of traumatic events than what has been reported in general population surveys. American Indians also suffer higher alcohol related death rates than any other ethnic group in the U.S. population. Therefore efforts to delineate factors which may uniquely contribute to increased likelihood of trauma, post traumatic stress disorder (PTSD), and substance use disorders (SUD) over the lifetime in American Indians are important because of the high burden of morbidity and mortality that they pose to American Indian communities. Participants were American Indians recruited from reservations that were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), family history assessment and the stressful-life-events scale. Of the 309 participants, equivalent numbers of men and women (94%) reported experiencing traumas; however, a larger proportion of women received a PTSD diagnosis (38%) than men (29%). Having experienced multiple trauma and sexual abuse were most highly associated with PTSD. Having experienced assaultive trauma and having PTSD symptoms were both found to be moderately heritable (30–50%). Logistic regression revealed that having an anxiety and/or affective disorder and having a substance dependent diagnosis, but not having antisocial personality disorder/conduct disorder, were significantly correlated with having a diagnosis of PTSD. These studies suggest that trauma is highly prevalent in this American Indian community, it is heritable, is associated with PTSD, affective/ anxiety disorders and substance dependence. Additionally, trauma, PTSD and substance dependence appear to all co-emerge in early adulthood in this high- risk population. PMID:23102628

  16. Relationship of early-life trauma, war-related trauma, personality traits, and PTSD symptom severity: a retrospective study on female civilian victims of war

    PubMed Central

    Stevanović, Aleksandra; Frančišković, Tanja; Vermetten, Eric

    2016-01-01

    Background Consequences of war-related traumatisation have mostly been investigated in military and predominant male populations, while research on female civilian victims of war has been neglected. Furthermore, research of post-war posttraumatic stress disorder (PTSD) in women has rarely included early-life trauma in their prediction models, so the contribution of trauma in childhood and early youth is still unexplored. Objective To examine the relationship of early-life trauma, war-related trauma, personality traits, and symptoms of posttraumatic stress among female civilian victims of the recent war in Croatia. Method The cross-sectional study included 394 participants, 293 war-traumatised adult women civilians, and 101 women without war-related trauma. Participants were recruited using the snowball sampling method. The applied instruments included the Clinician-Administrated PTSD Scale (CAPS), the NEO Personality Inventory-Revised (NEO-PI-R), the War Stressors Assessment Questionnaire (WSAQ), and the Early Trauma Inventory Self Report-Short Form (ETISR-SF). A hierarchical multiple regression analysis was performed to assess the prediction model of PTSD symptom severity measured by CAPS score for current PTSD. Results The prevalence of current PTSD (CAPS cut-off score=65) in this cohort was 20.7%. The regression model that included age, early-life trauma, war-related trauma, neuroticism, and extraversion as statistically significant predictors explained 45.8% of variance in PTSD symptoms. Conclusions Older age, exposure to early-life trauma, exposure to war-related traumatic events, high neuroticism, and low extraversion are independent factors associated with higher level of PTSD symptoms among women civilian victims of war. PMID:27056034

  17. Personality Heterogeneity in PTSD: Distinct Temperament and Interpersonal Typologies

    PubMed Central

    Thomas, Katherine M.; Hopwood, Christopher J.; Donnellan, M. Brent; Sanislow, Charles A.; Ansell, Emily B.; Grilo, Carlos M.; McGlashan, Thomas H.; Markowitz, John C.; Zanarini, Mary C.; Wright, Aidan G. C.; McDevitt-Murphy, Meghan E.; Shea, M. Tracie; Skodol, Andrew E.; Morey, Leslie C.

    2015-01-01

    Researchers examining personality typologies of posttraumatic stress disorder (PTSD) have consistently identified 3 groups: low pathology, internalizing, and externalizing. These groups have been found to predict functional severity and psychiatric comorbidity. In this study, we employed Latent Profile Analysis to compare this previously established typology, grounded in temperament traits (negative emotionality; positive emotionality; constraint), to a novel typology rooted in interpersonal traits (dominance; warmth) in a sample of individuals with PTSD (n = 155). Using Schedule for Nonadaptive and Adaptive Personality (SNAP) traits to create latent profiles, the 3-group temperament model was replicated. Using Interpersonal Circumplex (IPC) traits to create latent profiles, we identified a 4-group solution with groups varying in interpersonal style. These models were nonredundant, indicating that the depiction of personality variability in PTSD depends on how personality is assessed. Whereas the temperament model was more effective for distinguishing individuals based on distress and comorbid disorders, the interpersonal model was more effective for predicting the chronicity of PTSD over the 10 year course of the study. We discuss the potential for integrating these complementary temperament and interpersonal typologies in the clinical assessment of PTSD. PMID:24015858

  18. Maladaptive autonomic regulation in PTSD accelerates physiological aging

    PubMed Central

    Williamson, John B.; Porges, Eric C.; Lamb, Damon G.; Porges, Stephen W.

    2015-01-01

    A core manifestation of post-traumatic stress disorder (PTSD) is a disconnection between physiological state and psychological or behavioral processes necessary to adequately respond to environmental demands. Patients with PTSD experience abnormal oscillations in autonomic states supporting either fight and flight behaviors or withdrawal, immobilization, and dissociation without an intervening “calm” state that would provide opportunities for positive social interactions. This defensive autonomic disposition is adaptive in dangerous and life threatening situations, but in the context of every-day life may lead to significant psychosocial distress and deteriorating social relationships. The perpetuation of these maladaptive autonomic responses may contribute to the development of comorbid mental health issues such as depression, loneliness, and hostility that further modify the nature of cardiovascular behavior in the context of internal and external stressors. Over time, changes in autonomic, endocrine, and immune function contribute to deteriorating health, which is potently expressed in brain dysfunction and cardiovascular disease. In this theoretical review paper, we present an overview of the literature on the chronic health effects of PTSD. We discuss the brain networks underlying PTSD in the context of autonomic efferent and afferent contributions and how disruption of these networks leads to poor health outcomes. Finally, we discuss treatment approaches based on our theoretical model of PTSD. PMID:25653631

  19. Compelling Evidence that Exposure Therapy for PTSD Normalizes Brain Function.

    PubMed

    Roy, Michael J; Costanzo, Michelle E; Blair, James R; Rizzo, Albert A

    2014-01-01

    Functional magnetic resonance imaging (fMRI) is helping us better understand the neurologic pathways involved in posttraumatic stress disorder (PTSD). We previously reported that military service members with PTSD after deployment to Iraq or Afghanistan demonstrated significant improvement, or normalization, in the fMRI-measured activation of the amygdala, prefrontal cortex and anterior cingulate gyrus following exposure therapy for PTSD. However, our original study design did not include repeat scans of control participants, rendering it difficult to discern how much of the observed normalization in brain activity is attributable to treatment, rather than merely a practice effect. Using the same Affective Stroop task paradigm, we now report on a larger sample of PTSD-positive combat veterans that we treated with exposure therapy, as well as a combat-exposed control group of service members who completed repeat scans at 3-4 month intervals. Findings from the treatment group are similar to our prior report. Combat controls showed no significant change on repeat scanning, indicating that the observed differences in the intervention group were in fact due to treatment. We continue to scan additional study participants, in order to determine whether virtual reality exposure therapy has a different impact on regional brain activation than other therapies for PTSD. PMID:24875691

  20. The Economic Burden of PTSD in Northern Ireland.

    PubMed

    Ferry, Finola R; Brady, Sharon E; Bunting, Brendan P; Murphy, Samuel D; Bolton, David; O'Neill, Siobhan M

    2015-06-01

    The objective of this study was to estimate the economic costs of posttraumatic stress disorder (PTSD) among the Northern Ireland (NI) adult population. The authors present a prevalence-based, bottom-up study based primarily on data from 1,986 participants in the Northern Ireland Study of Health and Stress (NISHS). Both direct costs of treatment and indirect costs of productivity losses were included. Units of service and medication resource use were obtained from the NISHS and combined with their relevant unit costs from the Personal Social Services Research Unit and Prescription Costs Analysis data for NI. Indirect costs included the costs of incapacity days due to PTSD and presenteeism costs, with gender-specific wage rates used as the relevant unit costs. The total direct and indirect cost of PTSD in NI (2008) was £172,756,062. This figure is likely to be conservative due to the exclusion of a number of cost categories. Nevertheless, comparison of estimates of the burden of PTSD with the estimated cost of treating all adults with PTSD with the recommended treatments shows the potential for substantial economic gains to be made through extension and investment in effective evidence-based treatments. PMID:25990825

  1. Personality heterogeneity in PTSD: distinct temperament and interpersonal typologies.

    PubMed

    Thomas, Katherine M; Hopwood, Christopher J; Donnellan, M Brent; Wright, Aidan G C; Sanislow, Charles A; McDevitt-Murphy, Meghan E; Ansell, Emily B; Grilo, Carlos M; McGlashan, Thomas H; Shea, M Tracie; Markowitz, John C; Skodol, Andrew E; Zanarini, Mary C; Morey, Leslie C

    2014-03-01

    Researchers examining personality typologies of posttraumatic stress disorder (PTSD) have consistently identified 3 groups: low pathology, internalizing, and externalizing. These groups have been found to predict functional severity and psychiatric comorbidity. In this study, we employed Latent Profile Analysis to compare this previously established typology, grounded in temperament traits (negative emotionality; positive emotionality; constraint), to a novel typology rooted in interpersonal traits (dominance; warmth) in a sample of individuals with PTSD (n = 155). Using Schedule for Nonadaptive and Adaptive Personality (SNAP) traits to create latent profiles, the 3-group temperament model was replicated. Using Interpersonal Circumplex (IPC) traits to create latent profiles, we identified a 4-group solution with groups varying in interpersonal style. These models were nonredundant, indicating that the depiction of personality variability in PTSD depends on how personality is assessed. Whereas the temperament model was more effective for distinguishing individuals based on distress and comorbid disorders, the interpersonal model was more effective for predicting the chronicity of PTSD over the 10 year course of the study. We discuss the potential for integrating these complementary temperament and interpersonal typologies in the clinical assessment of PTSD.

  2. PTSD in asylum-seeking male adolescents from Afghanistan.

    PubMed

    Bronstein, Israel; Montgomery, Paul; Dobrowolski, Stephanie

    2012-10-01

    This study concerned the mental health of Afghan unaccompanied asylum-seeking children in the United Kingdom (UK). Afghans are the largest group of children seeking asylum in the UK, yet evidence concerning their mental health is limited. This study presents an estimate of probable posttraumatic stress disorder (PTSD) within this group and describes its associations with the cumulative effect of premigration traumatic events, immigration/asylum status, and social care living arrangements. Male adolescents (N = 222) aged 13-18 years completed validated self-report screening measures for traumatic experiences and likely PTSD. One-third (34.3%) scored above a selected cutoff, suggesting that they are likely to have PTSD. A higher incidence of premigration traumatic events was associated with greater PTSD symptomatology. Children living in semi-independent care arrangements were more likely to report increased PTSD symptoms when compared to their peers in foster care. A substantial majority in this study did not score above the cutoff, raising the possibility of notable levels of resilience. Future research should consider approaching mental health issues from a resilience perspective to further the understanding of protective mechanisms for this at-risk population. PMID:23070950

  3. The relationship of PTSD to key somatic complaints and cultural syndromes among Cambodian refugees attending a psychiatric clinic: the Cambodian Somatic Symptom and Syndrome Inventory (CSSI).

    PubMed

    Hinton, Devon E; Kredlow, M Alexandra; Pich, Vuth; Bui, Eric; Hofmann, Stefan G

    2013-06-01

    This article describes a culturally sensitive questionnaire for the assessment of the effects of trauma in the Cambodian refugee population, the Cambodian Somatic Symptom and Syndrome Inventory (CSSI), and gives the results of a survey with the instrument. The survey examined the relationship of the CSSI, the two CSSI subscales, and the CSSI items to posttraumatic stress disorder (PTSD) severity and self-perceived functioning. A total of 226 traumatized Cambodian refugees were assessed at a psychiatric clinic in Lowell, MA, USA. There was a high correlation of the CSSI, the CSSI somatic and syndrome scales, and all the CSSI items to the PTSD Checklist (PCL), a measure of PTSD severity. All the CSSI items varied greatly across three levels of PTSD severity, and patients with higher levels of PTSD had very high scores on certain CSSI-assessed somatic items such as dizziness, orthostatic dizziness (upon standing), and headache, and on certain CSSI-assessed cultural syndromes such as khyâl attacks, "fear of fainting and dying upon standing up," and "thinking a lot." The CSSI was more highly correlated than the PCL to self-perceived disability assessed by the Short Form-12 Health Survey (SF-12). The study demonstrates that the somatic symptoms and cultural syndromes described by the CSSI form a central part of the Cambodian refugee trauma ontology. The survey indicates that locally salient somatic symptoms and cultural syndromes need be profiled to adequately assess the effects of trauma. PMID:23630226

  4. Gender and PTSD: What Can We Learn From Female Police Officers?

    PubMed Central

    Lilly, Michelle M.; Ph.D., Nnamdi Pole.; Best, Suzanne R.; Metzler, Thomas; Marmar, Charles R.

    2009-01-01

    Studies of civilians typically find that female gender is a risk factor for posttraumatic stress disorder (PTSD). Police and military studies often find no gender differences in PTSD. We compared 157 female police officers and 124 female civilians on several variables including trauma exposure, peritraumatic emotional distress, current somatization, and cumulative PTSD symptoms. We found that despite greater exposure to assaultive violence in the officer group, female civilians reported significantly more severe PTSD symptoms. Elevated PTSD symptoms in female civilians were explained by significantly more intense peritraumatic emotional distress among female civilians. We also found that female officers showed a stronger direct relationship between peritraumatic emotional distress and current somatization. Our findings suggest that apparent gender differences in PTSD may result from differences in peritraumatic emotionality, which influence subsequent PTSD and somatization symptoms. Emotionality may be more important than biological sex in understanding gender differences in PTSD. PMID:19345556

  5. Greater hippocampal volume is associated with PTSD treatment response.

    PubMed

    Rubin, Mikael; Shvil, Erel; Papini, Santiago; Chhetry, Binod T; Helpman, Liat; Markowitz, John C; Mann, J John; Neria, Yuval

    2016-06-30

    Previous research associates smaller hippocampal volume with posttraumatic stress disorder (PTSD). It is unclear, however, whether treatment affects hippocampal volume or vice versa. Seventy-six subjects, 40 PTSD patients and 36 matched trauma-exposed healthy resilient controls, underwent clinical assessments and magnetic resonance imaging (MRI) at baseline, and 10 weeks later, during which PTSD patients completed ten weeks of Prolonged Exposure (PE) treatment. The resilient controls and treatment responders (n=23) had greater baseline hippocampal volume than treatment non-responders (n=17) (p=0.012 and p=0.050, respectively), perhaps due to more robust fear-extinction capacity in both the initial phase after exposure to trauma and during treatment. PMID:27179314

  6. Perceived Support From Multiple Sources: Associations With PTSD Symptoms.

    PubMed

    DiMauro, Jennifer; Renshaw, Keith D; Smith, Brian N; Vogt, Dawne

    2016-08-01

    Perceived social support is negatively associated with severity of posttraumatic stress disorder (PTSD), but the literature lacks data about specific sources of support. Using 2 service member (SM) samples (n = 207 and 465), this study examined perceived support from family/friends and the broader public. SMs perceived high support from both sources. In multivariate regressions, perceived support from the broader public was not significantly associated with severity of PTSD symptoms, but it demonstrated a nearly identical effect size (β = -.21) as support from family/friends (β = -.23) in a sample of active duty and National Guard/Reserve SMs. We found that, SMs perceived high levels of support from the broader public, with modest evidence that such perceptions may relate to severity of PTSD. PMID:27459310

  7. Commentary: deconstructing critiques on the internationalization of PTSD.

    PubMed

    de Jong, Joop T V M

    2005-09-01

    When PTSD entered the DSM, advocacy for the diagnosis was a critical part of advocacy for Vietnam veterans. Over the next two decades, the range of contexts in which this clinical concept was applied increased dramatically. In a recent article in Culture, Medicine and Psychiatry, Breslau (2004) describes PTSD as a "prominent cultural model" to account for suffering as well as the synergy between human rights or political advocacy and traumatic stress advocacy. In this article I question the sequence of steps that Breslau took to critique the internationalization of the PTSD construct. I also question Breslau's critique on our work in Nepal. Finally, I will formulate some future challenges for psychiatry and anthropology to bridge their universalistic and relativistic points of view.

  8. Clinical presentation of PTSD in World War II combat veterans.

    PubMed

    Hierholzer, R; Munson, J; Peabody, C; Rosenberg, J

    1992-08-01

    Clinicians have increasingly recognized posttraumatic stress disorder (PTSD) among Vietnam veterans, but the disorder may be easily overlooked among World War II combat veterans. The authors review recent studies of PTSD in older veterans and describe five cases that illustrate the diverse clinical presentations of PTSD in this population. Symptoms included anxiety, cognitive and somatic complaints, depression, alcohol dependence, and amnestic periods. Despite the varied presentations, a fairly consistent patient profile emerged. Patients avoided reminders of war, showed an exaggerated startle response, and experienced restless sleep and chronic anxiety. Factors associated with exacerbations of symptoms were retirement and reminders of war experiences. Although past studies have emphasized resuppression of the trauma, the authors encourage a flexible approach to treatment, including exploratory techniques. PMID:1427683

  9. PTSD symptom courseduring the first year of college

    PubMed Central

    Read, Jennifer P.; Bachrach, Rachel L.; Wright, Aidan G.C.; Colder, Craig R.

    2015-01-01

    In this study we examined patterns of transition in posttraumatic stress symptoms over the first year of college. We also examined two factors that might predict these transitions, trauma exposure and alcohol involvement. Matriculating students (N=944; 65% female) completed assessments of PTSD, trauma exposure, and alcohol use and consequences multiple times in their freshman year. Three symptom classes (No Symptoms, Moderate Symptoms, and Severe Symptoms) were identified. Examination of transitions from one status to another was conducted with latent transition analysis (LTA). These models revealed considerable variability in the course of PTSD symptoms. The most common pattern was resolution, yet a significant portion of students showed other patterns. Symptom worsening was more commonly observed in the second semester. Trauma exposure had a deleterious effect on PTSD symptom change trajectories, as did alcohol involvement, though less consistently so. Interventions that focus on the timing and correlates of symptom progression may benefit college students with posttraumatic distress. PMID:26828977

  10. UNDERSTANDING HETEROGENEITY IN PTSD: FEAR, DYSPHORIA, AND DISTRESS

    PubMed Central

    Zoellner, Lori A.; Pruitt, Larry D.; Farach, Frank J.; Jun, Janie J.

    2014-01-01

    Fear, dysphoria, and distress are prominent components in the conceptualization of posttraumatic stress disorder (PTSD). However, because our diagnostic categories are open concepts, relying on observed patterns of symptoms for classification, it is unclear whether these components represent core or auxiliary features of the disorder. Convergence across multiple indices is critical for this understanding. In this paper, we examine these components of PTSD across observed symptom patterns, broader theoretical conceptualizations, underlying information processing mechanisms of attention and memory, and underlying learning and neurobiological mechanisms. For each, evidence for similarity or distinctiveness of PTSD with other anxiety disorders and depression is examined. Throughout the review, key points of similarity to the anxiety disorders and divergence with depression argue for a distinction between core fear symptoms and auxiliary dysphoria and distress symptoms. Implications are discussed, noting that, as heterogeneity increases, core characteristics will become more diffused and ancillary constructs will gain an inflated degree of importance. PMID:23761021

  11. Victimization and PTSD in A Rural Kenyan Youth Sample.

    PubMed

    Karsberg, Sidsel H; Elklit, Ask

    2012-01-01

    Within the last ten years, there has been a growing number of epidemiological studies, examining the effect of trauma exposure in children and adolescents. Although studies concerning Post-traumatic Stress Disorder (PTSD) have been conducted in a wide array of different cultural contexts [1], the knowledge on traumatization and development of PTSD is still limited [2]. Most studies conducted are clinical studies, which deal with subjects that have already been traumatized or affected by specific single events such as war [3], natural disasters [1], serious accidents [4] or physical/sexual abuse [5-7]. Though research indicates that adolescents are very vulnerable to the exposure of Potentially Traumatic Events (PTEs) [8], studies targeting non-clinical youth populations and the impact of their life experiences are very few. With the increasing ethnic diversity of populations worldwide, it is of particular interest to compare the prevalence of exposure and PTSD in children and adolescents of different ethnic backgrounds. When designing preventive interventions and treatment programs for youth suffering from PTSD it is crucial to understand the complex interaction of variables behind the disorder. Differences in prevalence of exposure, PTSD and demographic variables between ethnicities may reveal some important clues to the etiology of the disease.The present study replicated six previous non-clinical studies which were designed to provide epidemiological information about exposure to PTEs, and the prevalence of PTSD among adolescents (see Table 1). The six studies were conducted in different countries and were very similar in their research methods and samples. The studies have been conducted in four European countries: Denmark [9], Iceland, [10], Lithuania [11], and the Faroe Islands [2], as well as in two Asian countries: Israel [12], and India [13] of which the four first samples were nationally representative.

  12. Comparative study on dermatoglyphics in patients with PTSD.

    PubMed

    Glamuzina, Ljubomir; Mihanović, Mate; Milicić, Jasna; Devcić, Sanja; Restek-Petrović, Branka

    2009-12-01

    The factors situated at the bases of the genesis and development of PTSD are divided in: biological, psychological and social factors. Primary factor is a stressful event of extremely dangerous and threatening nature. The sort and the intensity of the stressful event too play an important role, followed by the personality structure, the relation with the environment and the genetic constitution. The study was thought to determine the quantitative dermatoglyphic properties of the digito-palmar complex in patients with PTSD aiming to establish whether there are biological, that is, genetic bases for PTSD, in what measure they determine the clinical manifestation of the disorder, and whether there is a dermatoglyphic marker, characteristic for people with PTSD. We analyzed the quantitative properties of the digito-palmer complex on a group of 100 male examinees over 18 years of age with PTSD, no psychiatric comorbidity, and who were two or more times cured at the Psychiatric Hospital "Sveti Ivan", comparing them with the quantitative dermatoglyphic properties of a group of 100 phenotypically healthy male examinees over 18 years of age. Using the method of descriptive statistics, we found no statistically significant differences among the results of the examined groups. With the T-test we evaluated the heterogeneity of the groups, and the results showed the existence of statistically significant differences among the comparison group and the group of patients with PTSD on three variables. We calculated the Fluctuating Asymmetry (FA) measure, which illustrates the compatibility, that is, the symmetry of the observed property on the right and on the left side of the body, indicating a difference on one variable. The outcome did not confirm the existence of a connection between a particular dermatoglyphic result and the genesis of PTSD. This is, however, in line with the hypothesis that, in patients with PTSD and other psychiatric disorders, there is a multiple effect of

  13. Gene-Environment Interaction of ApoE Genotype and Combat Exposure on PTSD

    PubMed Central

    Lyons, Michael J.; Genderson, Margo; Grant, Michael D.; Logue, Mark; Zink, Tyler; McKenzie, Ruth; Franz, Carol E.; Panizzon, Matthew; Lohr, James B.; Jerskey, Beth; Kremen, William S.

    2015-01-01

    Factors determining who develops PTSD following trauma are not well understood. The €4 allele of the apolipoprotein E (apoE) gene is associated with dementia and unfavorable outcome following brain insult. PTSD is also associated with dementia. Given evidence that psychological trauma adversely affects the brain, we hypothesized that the apoE genotype moderates effects of psychological trauma on PTSD pathogenesis. To investigate the moderation of the relationship between PTSD symptoms and combat exposure, we used 172 participants with combat trauma sustained during the Vietnam War. PTSD symptoms were the dependent variable and number of combat experiences, apoE genotype, and the combat experiences × apoE genotype interaction were predictors. We also examined the outcome of a diagnosis of PTSD (n = 39) versus no PTSD diagnosis (n = 131). The combat × apoE genotype interaction was significant for both PTSD symptoms (P = .014) and PTSD diagnosis (P = .009). ApoE genotype moderates the relationship between combat exposure and PTSD symptoms. Although the pathophysiology of PTSD is not well understood, the €4 allele is related to reduced resilience of the brain to insult. Our results are consistent with the €4 allele influencing the effects of psychological trauma on the brain, thereby affecting the risk of PTSD. PMID:24132908

  14. Heterogeneity in the Latent Structure of PTSD Symptoms among Canadian Veterans

    ERIC Educational Resources Information Center

    Naifeh, James A.; Richardson, J. Don; Del Ben, Kevin S.; Elhai, Jon D.

    2010-01-01

    The current study used factor mixture modeling to identify heterogeneity (i.e., latent classes) in 2 well-supported models of posttraumatic stress disorder's (PTSD) factor structure. Data were analyzed from a clinical sample of 405 Canadian veterans evaluated for PTSD. Results were consistent with our hypotheses. Each PTSD factor model was best…

  15. Gene-environment interaction of ApoE genotype and combat exposure on PTSD.

    PubMed

    Lyons, Michael J; Genderson, Margo; Grant, Michael D; Logue, Mark; Zink, Tyler; McKenzie, Ruth; Franz, Carol E; Panizzon, Matthew; Lohr, James B; Jerskey, Beth; Kremen, William S

    2013-10-01

    Factors determining who develops PTSD following trauma are not well understood. The €4 allele of the apolipoprotein E (apoE) gene is associated with dementia and unfavorable outcome following brain insult. PTSD is also associated with dementia. Given evidence that psychological trauma adversely affects the brain, we hypothesized that the apoE genotype moderates effects of psychological trauma on PTSD pathogenesis. To investigate the moderation of the relationship between PTSD symptoms and combat exposure, we used 172 participants with combat trauma sustained during the Vietnam War. PTSD symptoms were the dependent variable and number of combat experiences, apoE genotype, and the combat experiences × apoE genotype interaction were predictors. We also examined the outcome of a diagnosis of PTSD (n = 39) versus no PTSD diagnosis (n = 131). The combat × apoE genotype interaction was significant for both PTSD symptoms (P = .014) and PTSD diagnosis (P = .009). ApoE genotype moderates the relationship between combat exposure and PTSD symptoms. Although the pathophysiology of PTSD is not well understood, the €4 allele is related to reduced resilience of the brain to insult. Our results are consistent with the €4 allele influencing the effects of psychological trauma on the brain, thereby affecting the risk of PTSD. PMID:24132908

  16. Understanding the Relationship Between Co-occurring PTSD and MDD: Symptom Severity and Affect

    PubMed Central

    Post, Loren M.; Zoellner, Lori A.; Youngstrom, Eric; Feeny, Norah C.

    2011-01-01

    How to best understand theoretically the nature of the relationship between co-occurring PTSD and MDD (PTSD+MDD) is unclear. In a sample of 173 individuals with chronic PTSD, we examined whether the data were more consistent with current co-occurring MDD as a separate construct or as a marker of posttraumatic stress severity, and whether the relationship between PTSD and MDD is a function of shared symptom clusters and affect components. Results showed that the more severe depressive symptoms found in PTSD+MDD as compared to PTSD remained after controlling for PTSD symptom severity. Additionally, depressive symptom severity significantly predicted co-occurring MDD even when controlling for PTSD severity. In comparison to PTSD, PTSD+MDD had elevated dysphoria and re-experiencing – but not avoidance and hyperarousal – PTSD symptom cluster scores, higher levels of negative affect, and lower levels of positive affect. These findings provide support for PTSD and MDD as two distinct constructs with overlapping distress components. PMID:21899984

  17. Resource Loss and Naturalistic Reduction of PTSD among Inner-City Women

    ERIC Educational Resources Information Center

    Walter, Kristen H.; Hobfoll, Stevan E.

    2009-01-01

    Halting the process of psychosocial and material resource loss has been theorized as being associated with the reduction of posttraumatic stress disorder (PTSD). This study examines how the limiting of resource loss is related to alleviation of PTSD symptoms among 102 inner-city women, who originally met diagnostic criteria for PTSD after…

  18. Relationships among Adult Attachment, Social Support, and PTSD Symptoms in Trauma-Exposed College Students

    ERIC Educational Resources Information Center

    Pruneau, Genevieve Mary Catherine

    2010-01-01

    Although many people are exposed to trauma, substantially fewer develop posttraumatic stress disorder (PTSD). Given this, studies have examined risk and protective factors for developing PTSD. This literature has established that there is a robust negative correlation between social support and PTSD. Attachment insecurity may be an informative…

  19. Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD.

    PubMed

    Tutus, D; Goldbeck, L

    2016-09-01

    Parents may develop symptoms of distress and dysfunctional cognitions in response to their child's exposure to traumatic events. Additionally, they may also be affected by their own traumatic experiences. This study investigated the frequency of traumatic experiences and of symptoms of posttraumatic stress and depression in a sample of parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional cognitions related to their child's trauma. Parents (N = 113) of children and adolescents with PTSD completed the Posttraumatic Diagnostic Scale (PDS), the Beck depression inventory (BDI-II), the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Correlations between symptom measures and dysfunctional cognitions were calculated. The majority (78.8 %) of the parents reported their own potentially traumatic experiences. Furthermore, 33.6 % evaluated their child's trauma as the worst event, 34.5 % rated their own experiences as their worst event, and 26.5 % indicated that their own worst traumatic event was the same type as their child's trauma. The frequency of clinically elevated parental symptoms on the PDS was 48.6 %, and on the BDI-II 32.7 %. Parental symptoms were independent of the reference person of the parental traumatic index event. However, they did correlate significantly with their dysfunctional cognitions (between r = 0.44 and 0.69, p < 0.01). Many parents report their own traumatic experiences and a significant proportion has its own clinically relevant symptoms of distress. Parental psychological symptoms are moderately associated with their dysfunctional cognitions. The results emphasize the need to consider parental distress when treating pediatric PTSD.

  20. The Incremental Validity and Clinical Utility of the MMPI-2 Infrequency Posttraumatic Stress Disorder Scale

    ERIC Educational Resources Information Center

    Marshall, Margarita B.; Bagby, R. Michael

    2006-01-01

    The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD.…

  1. Psychosocial predator-based animal model of PTSD produces physiological and behavioral sequelae and a traumatic memory four months following stress onset.

    PubMed

    Zoladz, Phillip R; Park, Collin R; Fleshner, Monika; Diamond, David M

    2015-08-01

    We have a well-established animal model of PTSD composed of predator exposure administered in conjunction with social instability that produces PTSD-like behavioral and physiological abnormalities one month after stress initiation. Here, we assessed whether the PTSD-like effects would persist for at least 4months after the initiation of the psychosocial stress regimen. Adult male Sprague-Dawley rats were exposed to either 2 or 3 predator-based fear conditioning sessions. During each session, rats were placed in a chamber for a 3-min period that terminated with a 30-s tone, followed by 1h of immobilization of the rats during cat exposure (Day 1). All rats in the stress groups received a second fear conditioning session 10days later (Day 11). Half of the stress rats received a third fear conditioning session 3weeks later (Day 32). The two cat-exposed groups were also exposed to daily unstable housing conditions for the entire duration of the psychosocial stress regimen. The control group received stable (conventional) housing conditions and an equivalent amount of chamber exposure on Days 1, 11 and 32, without cat exposure. Behavioral testing commenced for all groups on Day 116. The stress groups demonstrated increased anxiety on the elevated plus maze, impaired object recognition memory and robust contextual and cued fear conditioned memory 3months after the last conditioning session. Combined data from the two stress groups revealed lower post-stress corticosterone levels and greater diastolic blood pressure relative to the control group. These findings indicate that predator-based psychosocial stress produces persistent PTSD-like physiological and behavioral abnormalities that may provide insight into the neurobiological and endocrine sequelae in traumatized people with PTSD. PMID:25911267

  2. Putative Dopamine Agonist (KB220Z) Attenuates Lucid Nightmares in PTSD Patients: Role of Enhanced Brain Reward Functional Connectivity and Homeostasis Redeeming Joy

    PubMed Central

    McLaughlin, Thomas; Blum, Kenneth; Oscar-Berman, Marlene; Febo, Marcelo; Agan, Gozde; Fratantonio, James L.; Simpatico, Thomas; Gold, Mark S.

    2015-01-01

    Background Lucid dreams are frequently pleasant and training techniques have been developed to teach dreamers to induce them. In addition, the induction of lucid dreams has also been used as a way to ameliorate nightmares. On the other hand, lucid dreams may be associated with psychiatric conditions, including Post-Traumatic Stress Disorder (PTSD) and Reward Deficiency Syndrome-associated diagnoses. In the latter conditions, lucid dreams can assume an unpleasant and frequently terrifying character. Case Presentations We present two cases of dramatic alleviation of terrifying lucid dreams in patients with PTSD. In the first case study, a 51-year-old, obese woman, diagnosed with PTSD and depression, had attempted suicide and experienced terrifying lucid nightmares linked to sexual/physical abuse from early childhood by family members including her alcoholic father. Her vivid “bad dreams” remained refractory in spite of 6 months of treatment with Dialectical Behavioral Therapy (DBT) and standard pharmaceutical agents which included prazosin, clonidie and Adderall. The second 39-year-old PTSD woman patient had also suffered from lucid nightmares. Results The medication visit notes reveal changes in the frequency, intensity and nature of these dreams after the complex putative dopamine agonist KB220Z was added to the first patient’s regimen. The patient reported her first experience of an extended period of happy dreams. The second PTSD patient, who had suffered from lucid nightmares, was administered KB220Z to attenuate methadone withdrawal symptoms and incidentally reported dreams full of happiness and laughter. Conclusions These cases are discussed with reference to the known effects of KB220Z including enhanced dopamine homeostasis and functional connectivity of brain reward circuitry in rodents and humans. Their understanding awaits intensive investigation involving large-population, double-blinded studies. PMID:26132915

  3. Psychosocial predator-based animal model of PTSD produces physiological and behavioral sequelae and a traumatic memory four months following stress onset.

    PubMed

    Zoladz, Phillip R; Park, Collin R; Fleshner, Monika; Diamond, David M

    2015-08-01

    We have a well-established animal model of PTSD composed of predator exposure administered in conjunction with social instability that produces PTSD-like behavioral and physiological abnormalities one month after stress initiation. Here, we assessed whether the PTSD-like effects would persist for at least 4months after the initiation of the psychosocial stress regimen. Adult male Sprague-Dawley rats were exposed to either 2 or 3 predator-based fear conditioning sessions. During each session, rats were placed in a chamber for a 3-min period that terminated with a 30-s tone, followed by 1h of immobilization of the rats during cat exposure (Day 1). All rats in the stress groups received a second fear conditioning session 10days later (Day 11). Half of the stress rats received a third fear conditioning session 3weeks later (Day 32). The two cat-exposed groups were also exposed to daily unstable housing conditions for the entire duration of the psychosocial stress regimen. The control group received stable (conventional) housing conditions and an equivalent amount of chamber exposure on Days 1, 11 and 32, without cat exposure. Behavioral testing commenced for all groups on Day 116. The stress groups demonstrated increased anxiety on the elevated plus maze, impaired object recognition memory and robust contextual and cued fear conditioned memory 3months after the last conditioning session. Combined data from the two stress groups revealed lower post-stress corticosterone levels and greater diastolic blood pressure relative to the control group. These findings indicate that predator-based psychosocial stress produces persistent PTSD-like physiological and behavioral abnormalities that may provide insight into the neurobiological and endocrine sequelae in traumatized people with PTSD.

  4. Alienation appraisals distinguish adults diagnosed with DID from PTSD.

    PubMed

    DePrince, Anne P; Huntjens, Rafaële J C; Dorahy, Martin J

    2015-11-01

    Studies are beginning to show the importance of appraisals to different types and severities of psychiatric disorders. Yet, little work in this area has assessed whether trauma-related appraisals can differentiate complex trauma-related disorders, such as posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). The current study evaluated whether any of 6 trauma-related appraisals distinguished adults diagnosed with DID from those diagnosed with PTSD. To accomplish this, we first examined the basic psychometric properties of a Dutch-translated short-form of the Trauma Appraisals Questionnaire (TAQ) in healthy control (n = 57), PTSD (n = 27) and DID (n = 12) samples. The short-form Dutch translation of the TAQ showed good internal reliability and criterion-related validity for all 6 subscales (betrayal, self-blame, fear, alienation, shame, anger). Of the 6 subscales, the alienation appraisal subscale specifically differentiated DID from PTSD, with the former group reporting more alienation. Abuse-related appraisals that emphasize disconnection from self and others may contribute to reported problems of memory and identity common in DID. The current findings suggest that addressing experiences of alienation may be particularly important in treatment for clients diagnosed with DID. PMID:26168348

  5. Gratitude, depression and PTSD: Assessment of structural relationships.

    PubMed

    Van Dusen, John P; Tiamiyu, Mojisola F; Kashdan, Todd B; Elhai, Jon D

    2015-12-30

    Gratitude, the tendency to appreciate positive occurrences in one's life that can be partially attributed to another person, has been shown to be a robust predictor of greater well-being. Researchers have also found gratitude to be inversely related to several emotional disorders, including major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Both of these emotional disorders are highly comorbid and share dysphoric symptoms (e.g., restricted affect, detachment, anhedonia) that could account for deficits in the experience and expression of gratitude. We used confirmatory factor analysis to test the relationships between gratitude and the symptom factors of PTSD (using the DSM-5 model) and MDD in a sample of trauma-exposed college students (N=202). Results indicated that gratitude is more strongly related to PTSD's negative alterations in mood and cognition (NAMC) factor than to other PTSD factors. Implications of these findings for the study of gratitude and trauma are discussed, including whether gratitude and gratitude-based interventions might prove particularly suited to targeting depressive symptoms.

  6. PTSD and Impaired Eye Expression Recognition: A Preliminary Study

    ERIC Educational Resources Information Center

    Schmidt, Jakob Zeuthen; Zachariae, Robert

    2009-01-01

    This preliminary study examined whether posttraumatic stress disorder (PTSD) was related to difficulties in identifying the mental states of others in a group of refugees. Sixteen Bosnian refugees, referred to treatment in an outpatient treatment center for survivors of torture and war-related trauma in Denmark (CETT), were compared to 16 non-PTSD…

  7. Chronic PTSD Treated with Metacognitive Therapy: An Open Trial

    ERIC Educational Resources Information Center

    Wells, Adrian; Welford, Mary; Fraser, Janelle; King, Paul; Mendel, Elizabeth; Wisely, Julie; Knight, Alice; Rees, David

    2008-01-01

    This paper reports on an open trial of metacognitive therapy (MCT) for chronic PTSD. MCT does not require imaginal reliving, prolonged exposure, or challenging of thoughts about trauma. It is based on an information-processing model of factors that impede normal and in-built recovery processes. It is targeted at modifying maladaptive styles of…

  8. Psychosocial and Moral Development of PTSD-Diagnosed Combat Veterans

    ERIC Educational Resources Information Center

    Taylor, John G.; Baker, Stanley B.

    2007-01-01

    Two related studies were conducted in order to investigate whether psychosocial and moral development appeared to have been disrupted and arrested in veterans diagnosed as having posttraumatic stress disorder (PTSD). Study 1 was devoted to developing a measure of late adolescence, early adulthood, and adulthood stages of psychosocial…

  9. Latent Classes of PTSD Symptoms in Vietnam Veterans

    ERIC Educational Resources Information Center

    Steenkamp, Maria M.; Nickerson, Angela; Maguen, Shira; Dickstein, Benjamin D.; Nash, William P.; Litz, Brett T.

    2012-01-01

    The authors examined heterogeneity in posttraumatic stress disorder (PTSD) symptom presentation among veterans (n = 335) participating in the clinical interview subsample of the National Vietnam Veterans Readjustment Study. Latent class analysis was used to identify clinically homogeneous subgroups of Vietnam War combat veterans. Consistent with…

  10. Male combat veterans' narratives of PTSD, masculinity, and health.

    PubMed

    Caddick, Nick; Smith, Brett; Phoenix, Cassandra

    2015-01-01

    This article uniquely examines the ways a group of male combat veterans talk about masculinity and how, following post-traumatic stress disorder (PTSD), they performed masculinities in the context of a surfing group, and what effects this had upon their health and wellbeing. Participant observations and life history interviews were conducted with a group of combat veterans who belonged to a surfing charity for veterans experiencing PTSD. Data were rigorously explored via narrative analysis. Our findings revealed the ways in which veterans enacted masculinities in accordance with the values that were cultivated during military service. These masculine performances in the surfing group had important effects both on and for the veterans' wellbeing. Significantly, the study highlights how masculine performances can be seen alternately as a danger and as a resource for health and wellbeing in relation to PTSD. The article advances knowledge on combat veterans and mental health with critical implications for the promotion of male veterans' mental health. These include the original suggestion that health-promoting masculine performances might be recognised and supported in PTSD treatment settings. Rather than automatically viewing masculinity as problematic, this article moves the field forward by highlighting how hegemonic masculinities can be reconstructed in positive ways which might improve veterans' health and wellbeing. A video abstract of this article can be found at: https://www.youtube.com/watch?v=BaYzaOP1kAY.

  11. Treatment of a Case Example with PTSD and Chronic Pain

    ERIC Educational Resources Information Center

    Shipherd, Jillian C.

    2006-01-01

    This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronic pain and posttraumatic stress disorder (PTSD). The case formulation, assessment strategy, and treatment plan are informed by the relevant experimental literature and empirically supported treatments using a cognitive behavioral perspective. Given this…

  12. Contextual Behavior Therapies in the Treatment of PTSD: A Review

    ERIC Educational Resources Information Center

    Mulick, Patrick S.; Landers, Sara J.; Kanter, Jonathan W.

    2005-01-01

    Empirical evidence supports cognitive-behavioral interventions for the treatment Posttraumatic Stress Disorder (PTSD), with exposure therapy typically being the most frequently utilized. While the success of exposure treatments is well established there are factors which may hinder their use in "real-world" settings (e.g., poor treatment…

  13. Alienation appraisals distinguish adults diagnosed with DID from PTSD.

    PubMed

    DePrince, Anne P; Huntjens, Rafaële J C; Dorahy, Martin J

    2015-11-01

    Studies are beginning to show the importance of appraisals to different types and severities of psychiatric disorders. Yet, little work in this area has assessed whether trauma-related appraisals can differentiate complex trauma-related disorders, such as posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). The current study evaluated whether any of 6 trauma-related appraisals distinguished adults diagnosed with DID from those diagnosed with PTSD. To accomplish this, we first examined the basic psychometric properties of a Dutch-translated short-form of the Trauma Appraisals Questionnaire (TAQ) in healthy control (n = 57), PTSD (n = 27) and DID (n = 12) samples. The short-form Dutch translation of the TAQ showed good internal reliability and criterion-related validity for all 6 subscales (betrayal, self-blame, fear, alienation, shame, anger). Of the 6 subscales, the alienation appraisal subscale specifically differentiated DID from PTSD, with the former group reporting more alienation. Abuse-related appraisals that emphasize disconnection from self and others may contribute to reported problems of memory and identity common in DID. The current findings suggest that addressing experiences of alienation may be particularly important in treatment for clients diagnosed with DID.

  14. Reliability and Validity of the Korean Version of the Symptom Checklist-Post-Traumatic Stress Disorder Scale.

    PubMed

    Chang, Jae Hyeok; Kim, Daeho; Jang, Eonyoung; Park, Joo Eon; Bae, Hwallip; Han, Chang Woo; Kim, Seok Hyeon

    2016-05-01

    The Symptom Checklist - Post-Traumatic Stress Disorder Scale (SCL-PTSD), also known as Crime-Related PTSD Scale has been validated in survivors of interpersonal trauma in the general population. However, the psychometric properties have not been investigated in a clinical setting for patients with PTSD from diverse traumatic events. This study investigates the reliability and validity of the Korean version of the SCL-PTSD among 104 psychiatric outpatients with PTSD, caused by interpersonal (n = 50) or non-interpersonal trauma (n = 54). Self-report data of the SCL-PTSD, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Impact of Events Scale-Revised (IES-R) were gathered. The Korean version of the SCL-PTSD showed excellent internal consistency and moderate-to-good four-week temporal stability in both the interpersonal and non-interpersonal trauma groups. In comparison with other diagnostic groups, the scores of the SCL-PTSD were significantly higher compared to those of adjustment disorder, depression, other anxiety disorders, and schizophrenia, demonstrating its criteria-related validity. Convergent validity was confirmed because the scores of the SCL-PTSD were significantly correlated with BDI, SAI and TAI scores. Concurrent validity was demonstrated by significant correlation with the IES-R score. This study demonstrated the favorable psychometric prosperities of the Korean version of the SCL-PTSD, supporting its use in clinical research and practice.

  15. Reliability and Validity of the Korean Version of the Symptom Checklist-Post-Traumatic Stress Disorder Scale

    PubMed Central

    2016-01-01

    The Symptom Checklist - Post-Traumatic Stress Disorder Scale (SCL-PTSD), also known as Crime-Related PTSD Scale has been validated in survivors of interpersonal trauma in the general population. However, the psychometric properties have not been investigated in a clinical setting for patients with PTSD from diverse traumatic events. This study investigates the reliability and validity of the Korean version of the SCL-PTSD among 104 psychiatric outpatients with PTSD, caused by interpersonal (n = 50) or non-interpersonal trauma (n = 54). Self-report data of the SCL-PTSD, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Impact of Events Scale-Revised (IES-R) were gathered. The Korean version of the SCL-PTSD showed excellent internal consistency and moderate-to-good four-week temporal stability in both the interpersonal and non-interpersonal trauma groups. In comparison with other diagnostic groups, the scores of the SCL-PTSD were significantly higher compared to those of adjustment disorder, depression, other anxiety disorders, and schizophrenia, demonstrating its criteria-related validity. Convergent validity was confirmed because the scores of the SCL-PTSD were significantly correlated with BDI, SAI and TAI scores. Concurrent validity was demonstrated by significant correlation with the IES-R score. This study demonstrated the favorable psychometric prosperities of the Korean version of the SCL-PTSD, supporting its use in clinical research and practice. PMID:27134501

  16. Rational for Conducting PTSD Research and Challenges of Recruiting and Training Volunteers to Screen and Treat PTSD among the Nepal 2015 Earthquake Survivors.

    PubMed

    Jha, A; Shakya, S

    2015-01-01

    Post-traumatic Stress Disorder (PTSD) is common psychiatric morbidity among earthquake survivors, and if untreated people suffer from it for years. Government of Nepal and NGOs provided various short-term mental health services to the victims of the 2015 earthquake in Nepal, but there was no plan or provision for long-term mental health problems. The prevalence of PTSD following natural disasters depends on various local factors requiring understanding and further investigation before identifying affordable evidence based interventions. This paper discusses the need for PTSD research among the survivors of the 2015 earthquake in Nepal, and describes the challenges and difficulties of recruiting and training PTSD volunteers. PMID:27549507

  17. PTSD is negatively associated with physical performance and physical function in older overweight military veterans

    PubMed Central

    Hall, Katherine S.; Beckham, Jean C.; Bosworth, Hayden B.; Sloane, Richard; Pieper, Carl F.; Morey, Miriam C.

    2014-01-01

    This study examines the effect of posttraumatic stress disorder (PTSD) on function and physical performance in older overweight military Veterans with comorbid conditions. This is a secondary data analysis of older Veterans (mean age = 62.9 yr) participating in a physical activity counseling trial. Study participants with PTSD (n = 67) and without PTSD (n = 235) were identified. Self-reported physical function (36-item Short Form Health Survey) and directly measured physical performance (mobility, aerobic endurance, strength) were assessed. Multivariate analyses of variance controlling for demographic factors and psychiatric disorders demonstrated significant physical impairment among those with PTSD. PTSD was negatively associated with self-reported physical function, functioning in daily activities, and general health (p < 0.01). Those with PTSD also performed significantly worse on tests of lower-limb function (p < 0.05). Despite being significantly younger, Veterans with PTSD had comparable scores on gait speed, aerobic endurance, grip strength, and bodily pain compared with Veterans without PTSD. This study provides preliminary data for the negative association between PTSD and physical function in older military Veterans. These data highlight the importance of ongoing monitoring of physical performance among returning Veterans with PTSD and intervening in older overweight Veterans with PTSD, whose physical performance scores are indicative of accelerated risk of premature functional aging. PMID:24933726

  18. Relationship between PTSD symptomatology and nicotine dependence severity in crime victims.

    PubMed

    Baschnagel, Joseph S; Coffey, Scott F; Schumacher, Julie A; Drobes, David J; Saladin, Michael E

    2008-11-01

    Smoking rates are higher and cessation rates are lower among individuals with posttraumatic stress disorder (PTSD) compared to the general population, thus understanding the relationship between PTSD and nicotine dependence is important. In a sample of 213 participants with a crime-related trauma (109 with PTSD), the relationship between PTSD status, smoking status (smoker vs. non-smoker), substance abuse diagnosis (SUD), PTSD symptoms, and sex was assessed. SUD diagnosis was significantly related to smoking status, but PTSD symptomatology and sex were not. Among smokers (n=117), increased nicotine dependence severity was associated with being male and with increased level of PTSD avoidance symptoms. Correlations indicated that PTSD avoidance and hyperarousal symptom clusters and total PTSD symptom scores were significantly related to nicotine dependence severity in males, while PTSD symptomatology in general did not correlate with dependence severity for females. The results suggest that level of PTSD symptomatology, particularly avoidance symptoms, may be important targets for smoking cessation treatment among male smokers who have experienced a traumatic event.

  19. PTSD is negatively associated with physical performance and physical function in older overweight military Veterans.

    PubMed

    Hall, Katherine S; Beckham, Jean C; Bosworth, Hayden B; Sloane, Richard; Pieper, Carl F; Morey, Miriam C

    2014-01-01

    This study examines the effect of posttraumatic stress disorder (PTSD) on function and physical performance in older overweight military Veterans with comorbid conditions. This is a secondary data analysis of older Veterans (mean age = 62.9 yr) participating in a physical activity counseling trial. Study participants with PTSD (n = 67) and without PTSD (n = 235) were identified. Self-reported physical function (36-item Short Form Health Survey) and directly measured physical performance (mobility, aerobic endurance, strength) were assessed. Multivariate analyses of variance controlling for demographic factors and psychiatric disorders demonstrated significant physical impairment among those with PTSD. PTSD was negatively associated with self-reported physical function, functioning in daily activities, and general health (p < 0.01). Those with PTSD also performed significantly worse on tests of lower-limb function (p < 0.05). Despite being significantly younger, Veterans with PTSD had comparable scores on gait speed, aerobic endurance, grip strength, and bodily pain compared with Veterans without PTSD. This study provides preliminary data for the negative association between PTSD and physical function in older military Veterans. These data highlight the importance of ongoing monitoring of physical performance among returning Veterans with PTSD and intervening in older overweight Veterans with PTSD, whose physical performance scores are indicative of accelerated risk of premature functional aging.

  20. Differential treatment response trajectories in individuals with subclinical and clinical PTSD.

    PubMed

    Korte, Kristina J; Allan, Nicholas P; Gros, Daniel F; Acierno, Ron

    2016-03-01

    Subclinical presentations of posttraumatic stress disorder (PTSD), wherein patients are one or two symptom criteria short of the full disorder, are prevalent and associated with levels of distress and impaired functioning approximating that of full PTSD. Nonetheless, research examining treatment efficacy for this group is in the nascent stage. The purpose of the present study was to examine whether the subclinical PTSD group would: (1) show a greater reduction in PTSD symptoms at pre and post treatment in response to an exposure based treatment and (2) show a greater rate of change over the course of treatment, when compared to the full criteria PTSD group. We also examined whether differences would emerge when examining PTSD symptom clusters. Consistent with predictions, the subclinical PTSD group demonstrated a greater reduction in PTSD symptoms at post-treatment (29%) than those with a PTSD diagnosis (14%). Further, the groups had different treatment trajectories, with the subclinical PTSD group showing a marginally greater rate of change during the course of treatment. Findings also varied by symptom cluster with the subclinical group showing a greater rate of change in the intrusions, hypervigilance, and avoidance symptom clusters. There was not a significant between group difference in the numbing symptom cluster. This study provides preliminary evidence that treating PTSD symptoms at the subclinical level may result in a larger, and more rapid symptom reduction, and thus has implications supporting treatment earlier in the developmental trajectory of the disorder.

  1. Augmenting CPT to Improve Sleep Impairment in PTSD: A Randomized Clinical Trial

    PubMed Central

    Galovski, Tara E.; Mott, Juliette; Blain, Leah M.; Elwood, Lisa; Gloth, Chelsea; Fletcher, Thomas

    2015-01-01

    Objective Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory following treatment for PTSD. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy; CPT). Method Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. Results After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Conclusion Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. Public Health Significance: This study suggests that hypnosis may be a viable treatment option in a stepped-care approach for treating sleep impairment in individuals suffering from PTSD. PMID:26689303

  2. Prescription Stimulants and PTSD Among U.S. Military Service Members.

    PubMed

    Crum-Cianflone, Nancy F; Frasco, Melissa A; Armenta, Richard F; Phillips, Christopher J; Horton, Jaime; Ryan, Margaret A K; Russell, Dale W; LeardMann, Cynthia

    2015-12-01

    Posttraumatic stress disorder (PTSD) is a prevalent condition among military service members and civilians who have experienced traumatic events. Stimulant use has been postulated to increase the risk of incident PTSD; however, research in this area is lacking. In this study, the association between receipt of prescription stimulants and PTSD was examined in a secondary analysis among active duty U.S. military members (n = 25,971), participating in the Millennium Cohort Study, who completed a baseline (2001-2003) and two follow-up surveys (between 2004-2008). Prescription stimulant data were obtained from the military Pharmacy Data Transaction Service. PTSD was assessed using the PTSD Checklist-Civilian Version and incident PTSD was defined as meeting the criteria at follow-up among those who did not have a history of PTSD at baseline. Overall, 1,215 (4.7%) persons developed new-onset PTSD during follow-up. Receipt of prescription stimulants were significantly associated with incident PTSD, hazard ratio = 5.09, 95% confidence interval [3.05, 8.50], after adjusting for sociodemographic factors, military characteristics, attention-deficit/hyperactivity disorder, baseline mental and physical health status, deployment experiences, and physical/sexual trauma. Findings suggested that prescription stimulants are associated with incident PTSD among military personnel; these data may inform the underlying pathogenesis of and preventive strategies for PTSD.

  3. Cognitive dysfunctions associated with PTSD: evidence from World War II prisoners of war.

    PubMed

    Hart, John; Kimbrell, Timothy; Fauver, Peter; Cherry, Barbara J; Pitcock, Jeffery; Booe, Leroy Q; Tillman, Gail; Freeman, Thomas W

    2008-01-01

    The authors aim to delineate cognitive dysfunction associated with posttraumatic stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD patients only when they have comorbid psychiatric diagnoses.

  4. Experiences of Traumatic Events and Associations with PTSD and Depression Development in Urban Health Care-seeking Women

    PubMed Central

    Page, Gayle G.; Sharps, Phyllis; Campbell, Jacquelyn C.

    2008-01-01

    Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance. PMID:18581238

  5. The Treatment of Co-Occurring PTSD and Substance Use Disorders Using Trauma-Focused Exposure Therapy

    ERIC Educational Resources Information Center

    Baschnagel, Joseph S.; Coffey, Scott F.; Rash, Carla J.

    2006-01-01

    Co-morbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is high and there is a need for empirically validated treatments designed to address PTSD among SUD patients. One effective PTSD treatment that may be useful in treating PTSD-SUD is exposure therapy. This paper reviews the relationship between comorbid PTSD…

  6. Longitudinal associations of friend-based social support and PTSD symptomatology during a cannabis cessation attempt.

    PubMed

    Carter, Sarah P; DiMauro, Jennifer; Renshaw, Keith D; Curby, Timothy W; Babson, Kimberly A; Bonn-Miller, Marcel O

    2016-03-01

    Research supports bidirectional associations between social support and posttraumatic stress disorder (PTSD), whereby social support may buffer against PTSD, and individuals with PTSD may experience decreasing support over time. Research examining contexts that may affect these relations is needed. This study examined the longitudinal associations between PTSD and social support from friends over a 6-month period in 116 veterans with cannabis dependence who had recently initiated an attempt to quit cannabis use. A cross-lagged autoregressive model revealed a significant, negative relation between earlier PTSD symptoms and later support. An exploratory multigroup analysis comparing those with and without a relapse in the first month after their quit attempt revealed that the significant negative association between PTSD and future support was present only in those who relapsed. Although this analysis was limited by a small sample size, results suggest that substance use may be an influential contextual variable that impacts the longitudinal associations between PTSD and support.

  7. Evaluating the merits of using brief measures of PTSD or general mental health measures in two-stage PTSD screening.

    PubMed

    Steele, Nicole M; Benassi, Helen P; Chesney, Catherine J; Nicholson, Cherie; Fogarty, Gerard J

    2014-12-01

    Psychological screening of large numbers of personnel returning from deployments should be as brief as possible without sacrificing the ability to detect individuals who are experiencing serious psychological difficulties. This study focused on screening for posttraumatic stress disorder (PTSD) symptomatology in 421 deployed male members of the Australian Army while they were on deployment and again 3 to 6 months after they returned home. The first aim was to evaluate the performance of the Primary Care--Posttraumatic Stress Disorder Screen (PC-PTSD) and a 4-item version of the 17-item Posttraumatic Stress Disorder Checklist (PCL). A second aim was to evaluate the role of the Kessler-10 (K10) in psychological screening. The results indicated that the short form of the PCL was a better substitute for the full PCL than the PC-PTSD. Other results suggested that a more efficient screening process can be achieved using an initial K10 screening followed by more intensive PTSD screening for people identified as high risk. An additional advantage of an initial K10 filter is that other forms of mental illness could also be targeted in the second-stage screening. PMID:25469974

  8. Association between theta power in 6-month old infants at rest and maternal PTSD severity: A pilot study.

    PubMed

    Sanjuan, Pilar M; Poremba, Carly; Flynn, Lucinda R; Savich, Renate; Annett, Robert D; Stephen, Julia

    2016-09-01

    Compared to infants born to mothers without PTSD, infants born to mothers with active PTSD develop poorer behavioral reactivity and emotional regulation. However, the association between perinatal maternal PTSD and infant neural activation remains largely unknown. This pilot study (N=14) examined the association between perinatal PTSD severity and infant frontal neural activity, as measured by MEG theta power during rest. Results indicated that resting left anterior temporal/frontal theta power was correlated with perinatal PTSD severity (p=0.004). These findings suggest delayed cortical maturation in infants whose mothers had higher perinatal PTSD severity and generate questions regarding perinatal PTSD severity and infant neurophysiological consequences.

  9. Association between theta power in 6-month old infants at rest and maternal PTSD severity: A pilot study.

    PubMed

    Sanjuan, Pilar M; Poremba, Carly; Flynn, Lucinda R; Savich, Renate; Annett, Robert D; Stephen, Julia

    2016-09-01

    Compared to infants born to mothers without PTSD, infants born to mothers with active PTSD develop poorer behavioral reactivity and emotional regulation. However, the association between perinatal maternal PTSD and infant neural activation remains largely unknown. This pilot study (N=14) examined the association between perinatal PTSD severity and infant frontal neural activity, as measured by MEG theta power during rest. Results indicated that resting left anterior temporal/frontal theta power was correlated with perinatal PTSD severity (p=0.004). These findings suggest delayed cortical maturation in infants whose mothers had higher perinatal PTSD severity and generate questions regarding perinatal PTSD severity and infant neurophysiological consequences. PMID:27473944

  10. Change in Negative Cognitions Associated with PTSD Predicts Symptom Reduction in Prolonged Exposure

    PubMed Central

    Zalta, Alyson K.; Gillihan, Seth J.; Fisher, Aaron J.; Mintz, Jim; McLean, Carmen P.; Yehuda, Rachel; Foa, Edna B.

    2014-01-01

    Objective The goal of the current study was to examine mechanisms of change in Prolonged Exposure (PE) therapy for post-traumatic stress disorder (PTSD). Emotional Processing Theory of PTSD proposes that disconfirmation of erroneous cognitions associated with PTSD is a central mechanism in PTSD symptom reduction; but to date, the causal relationship between change in pathological cognitions and change in PTSD severity has not been established. Method Female sexual or nonsexual assault survivors (N = 64) with a primary diagnosis of PTSD received 10 weekly sessions of PE. Self-reported PTSD symptoms, depression symptoms, and PTSD-related cognitions were assessed at pre-treatment, each of the 10 PE treatment sessions, and post-treatment. Results Lagged mixed-effect regression models indicated that session-to-session reductions in PTSD-related cognitions drove successive reductions in PTSD symptoms. By contrast, the reverse effect of PTSD symptom change on change in cognitions was smaller and did not reach statistical significance. Similarly, reductions in PTSD-related cognitions drove successive reductions in depression symptoms whereas the reverse effect of depression symptoms on subsequent cognition change was smaller and not significant. Notably, the relationships between changes in cognitions and PTSD symptoms were stronger than the relationships between changes in cognitions and depression symptoms. Conclusions To our knowledge, this is the first study to establish change in PTSD-related cognitions as a central mechanism of PE treatment. These findings are consistent with Emotional Processing Theory and have important clinical implications for the effective implementation of PE. PMID:24188512

  11. Ethnic Differences in Personality Disorder Patterns among Women Veterans Diagnosed with PTSD.

    PubMed

    C'de Baca, Janet; Castillo, Diane T; Mackaronis, Julia E; Qualls, Clifford

    2014-03-01

    Personality Disorders (PDs) impair the ability to function socially and occupationally. PD prevalence rates among veterans who have also been diagnosed with posttraumatic stress disorder (PTSD) range from 45%-79%. This study examined ethnic differences in PDs assessed with the Millon Clinical Multiaxial Inventory-III in 260 non-Hispanic white (64%), Hispanic (27%), and African American (9%), mostly single, women veterans in treatment for PTSD. After adjusting for covariates including number and sexual-nature of trauma, findings revealed the adjusted odds ratio of having a cluster A PD was almost three times higher for African Americans (p = 0.046) then the other two ethnic groups, which may be driven by the paranoid PD scale and potentially reflects an adaptive response to racial discrimination. In cluster designation analysis, the odds were twice as high of having a cluster B PD with childhood trauma (p = 0.046), and a cluster C PD with sexual trauma (p = 0.004), demonstrating the significance of childhood and sexual trauma on long-term chronic personality patterns in women veterans. These results highlight the importance of using instruments with demonstrated diagnostic validity for minority populations.

  12. 16 CFR 1000.2 - Laws administered.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Laws administered. 1000.2 Section 1000.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.2 Laws administered. The Commission administers five acts: (a) The Consumer Product Safety Act...

  13. 16 CFR 1000.2 - Laws administered.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Laws administered. 1000.2 Section 1000.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.2 Laws administered. The Commission administers five acts: (a) The Consumer Product Safety Act...

  14. 16 CFR 1000.2 - Laws administered.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Laws administered. 1000.2 Section 1000.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.2 Laws administered. The Commission administers five acts: (a) The Consumer Product Safety Act...

  15. 16 CFR 1000.2 - Laws administered.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Laws administered. 1000.2 Section 1000.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.2 Laws administered. The Commission administers five acts: (a) The Consumer Product Safety Act...

  16. 16 CFR 1000.2 - Laws administered.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Laws administered. 1000.2 Section 1000.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.2 Laws administered. The Commission administers five acts: (a) The Consumer Product Safety Act...

  17. Women's experiences of symptoms of posttraumatic stress disorder (PTSD) after traumatic childbirth: a review and critical appraisal.

    PubMed

    James, Stella

    2015-12-01

    This paper critically analyses nine studies on postnatal posttraumatic stress disorder (PTSD) following traumatic childbirth, in order to find common themes of PTSD symptoms, using the cognitive model of PTSD as a guide; it critically appraised one of the studies in depth and it attempted to explain the lived experience of women suffering from postnatal PTSD following traumatic childbirth and the suitability of cognitive behavioural therapy (CBT) for postnatal PTSD. This paper found that women following traumatic childbirth do experience postnatal PTSD; postnatal PTSD symptoms are similar to PTSD symptoms of other events and that CBT for PTSD of other events is just as effective for postnatal PTSD. Future recommendations include more qualitative studies with interpretative phenomenological approach in order to establish evidence-based CBT treatment for this client group, and more referrals need to be sent to the psychological services for CBT intervention.

  18. Trauma-related altered states of consciousness in women with BPD with or without co-occurring PTSD

    PubMed Central

    Frewen, Paul; Kleindienst, Nikolaus; Lanius, Ruth; Schmahl, Christian

    2014-01-01

    Background A “4-D model” was recently described as a theoretical framework for categorizing trauma-related symptoms into four phenomenological dimensions (the experience of time, thought, body, and emotion) that can present either in the form of normal waking consciousness (NWC) or as dissociative experiences, that is, trauma-related altered states of consciousness (TRASC). Methods The present study examined the predictions of the 4-D model in 258 persons with borderline personality disorder (BPD) with (n=126) versus without (n=132) posttraumatic stress disorder (PTSD). Results As measured by the Borderline Symptom List, consistent with the predictions of the 4-D model, in comparison with symptom endorsements theorized to be associated with NWC, measures of TRASC were less frequent, and more strongly correlated with both Dissociative Experience Scale scores and severity of childhood emotional neglect, particularly in persons with both BPD and PTSD. Our prediction that symptoms of TRASC would be less intercorrelated in comparison with distress associated with NWC symptoms, however, was not supported. Conclusions Findings are discussed as they pertain to the symptomatology of BPD, PTSD, and dissociation. PMID:25206942

  19. Association between facial expression and PTSD symptoms among young children exposed to the Great East Japan Earthquake: a pilot study

    PubMed Central

    Fujiwara, Takeo; Mizuki, Rie; Miki, Takahiro; Chemtob, Claude

    2015-01-01

    “Emotional numbing” is a symptom of post-traumatic stress disorder (PTSD) characterized by a loss of interest in usually enjoyable activities, feeling detached from others, and an inability to express a full range of emotions. Emotional numbing is usually assessed through self-report, and is particularly difficult to ascertain among young children. We conducted a pilot study to explore the use of facial expression ratings in response to a comedy video clip to assess emotional reactivity among preschool children directly exposed to the Great East Japan Earthquake. This study included 23 child participants. Child PTSD symptoms were measured using a modified version of the Parent’s Report of the Child’s Reaction to Stress scale. Children were filmed while watching a 2-min video compilation of natural scenes (‘baseline video’) followed by a 2-min video clip from a television comedy (‘comedy video’). Children’s facial expressions were processed the using Noldus FaceReader software, which implements the Facial Action Coding System (FACS). We investigated the association between PTSD symptom scores and facial emotion reactivity using linear regression analysis. Children with higher PTSD symptom scores showed a significantly greater proportion of neutral facial expressions, controlling for sex, age, and baseline facial expression (p < 0.05). This pilot study suggests that facial emotion reactivity, measured using facial expression recognition software, has the potential to index emotional numbing in young children. This pilot study adds to the emerging literature on using experimental psychopathology methods to characterize children’s reactions to disasters. PMID:26528206

  20. The clinical picture of late-onset PTSD: a 20-year longitudinal study of Israeli war veterans.

    PubMed

    Horesh, Danny; Solomon, Zahava; Keinan, Giora; Ein-Dor, Tsachi

    2013-08-15

    Delayed-onset posttraumatic stress disorder (PTSD) has been under medico-legal debate for years. Previous studies examining the prevalence and clinical characteristics of delayed-onset PTSD have yielded inconclusive findings. This study prospectively examines the prevalence and clinical picture of late-onset PTSD among Israeli war veterans. It also evaluates whether or not late-onset PTSD erupts after a completely non-symptomatic period. 675 Israeli veterans from the 1982 Lebanon War, with and without antecedent combat stress reaction (CSR), have been assessed 1, 2 and 20 years post-war. They were divided into 4 groups, according to the duration of delay in PTSD onset. Participants completed self-report questionnaires tapping psychopathology, combat exposure and socio-demographics. 16.5% of the veterans suffered from late-onset PTSD. A longer delay in PTSD onset was associated with less severe psychopathology. Also, CSR was associated with a shorter delay in PTSD onset. Finally, the vast majority of veterans already suffered from PTSD symptoms prior to late PTSD onset. Our results offer further validation for the existence of delayed-onset PTSD. Delayed-onset PTSD appears to be a unique sub-type of PTSD, with an attenuated clinical picture. In addition, delayed-onset PTSD may be the result of an incubation process, wherein symptoms already exist prior to PTSD onset.

  1. Scales

    MedlinePlus

    Scales are a visible peeling or flaking of outer skin layers. These layers are called the stratum ... Scales may be caused by dry skin, certain inflammatory skin conditions, or infections. Eczema , ringworm , and psoriasis ...

  2. Resilient but addicted: The impact of resilience on the relationship between smoking withdrawal and PTSD.

    PubMed

    Asnaani, Anu; Alpert, Elizabeth; McLean, Carmen P; Foa, Edna B

    2015-06-01

    Nicotine use is common among people with posttraumatic stress disorder (PTSD). Resilience, which is reflected in one's ability to cope with stress, has been shown to be associated with lower cigarette smoking and posttraumatic stress symptoms, but relationships among these three variables have not been examined. This study investigates the relationships of resilience and nicotine withdrawal with each other and in relation to PTSD symptoms. Participants were 118 cigarette smokers with PTSD seeking treatment for PTSD and nicotine use. Data were randomly cross-sectionally sampled from three time points: week 0, week 12, and week 27 of the study. Hierarchical multiple regression analyses revealed main effects of both resilience and nicotine withdrawal symptoms on PTSD severity, controlling for the sampled time point, negative affect, and expired carbon monoxide concentration. Consistent with prior research, PTSD severity was higher among individuals who were less resilient and for those who had greater nicotine withdrawal. There was an interaction between resilience and nicotine withdrawal on self-reported PTSD severity, such that greater resilience was associated with lower PTSD severity only among participants with low nicotine withdrawal symptoms. Among individuals with high nicotine withdrawal, PTSD severity was high, regardless of resilience level. These results suggest that resilience is a protective factor for PTSD severity for those with low levels of nicotine withdrawal, but at high levels of nicotine withdrawal, the protective function of resilience is mitigated.

  3. Identifying Risk Factors for PTSD in Women Seeking Medical Help after Rape

    PubMed Central

    Tiihonen Möller, Anna; Bäckström, Torbjörn; Söndergaard, Hans Peter; Helström, Lotti

    2014-01-01

    Objectives Rape has been found to be the trauma most commonly associated with Posttraumatic Stress Disorder (PTSD) among women. It is therefore important to be able to identify those women at greatest risk of developing PTSD. The aims of the present study were to analyze the PTSD prevalence six months after sexual assaults and identify the major risk factors for developing PTSD. Methods Participants were 317 female victims of rape who sought help at the Emergency Clinic for Raped Women at Stockholm South Hospital, Sweden. Baseline assessments of mental health were carried out and followed up after six months. Results Thirty-nine percent of the women had developed PTSD at the six month assessment, and 47% suffered from moderate or severe depression. The major risk factors for PTSD were having been sexually assaulted by more than one person, suffering from acute stress disorder (ASD) shortly after the assault, having been exposed to several acts during the assault, having been injured, having co-morbid depression, and having a history of more than two earlier traumas. Further, ASD on its own was found to be a poor predictor of PTSD because of the substantial ceiling effect after sexual assaults. Conclusions Development of PTSD is common in the aftermath of sexual assaults. Increased risk of developing PTSD is caused by a combination of victim vulnerability and the extent of the dramatic nature of the current assault. By identifying those women at greatest risk of developing PTSD appropriate therapeutic resources can be directed. PMID:25340763

  4. Resilient But Addicted: The Impact of Resilience on the Relationship between Smoking Withdrawal and PTSD

    PubMed Central

    Asnaani, Anu; Alpert, Elizabeth; McLean, Carmen P.; Foa, Edna B.

    2015-01-01

    Nicotine use is common among people with posttraumatic stress disorder (PTSD). Resilience, which is reflected in one's ability to cope with stress, has been shown to be associated with lower cigarette smoking and posttraumatic stress symptoms, but relationships among these three variables have not been examined. This study investigates the relationships of resilience and nicotine withdrawal with each other and in relation to PTSD symptoms. Participants were 118 cigarette smokers with PTSD seeking treatment for PTSD and nicotine use. Data were randomly cross-sectionally sampled from three time points: week 0, week 12, and week 27 of the study. Hierarchical multiple regression analyses revealed main effects of both resilience and nicotine withdrawal symptoms on PTSD severity, controlling for the sampled time point, negative affect, and expired carbon monoxide concentration. Consistent with prior research, PTSD severity was higher among individuals who were less resilient and for those who had greater nicotine withdrawal. There was an interaction between resilience and nicotine withdrawal on self-reported PTSD severity, such that greater resilience was associated with lower PTSD severity only among participants with low nicotine withdrawal symptoms. Among individuals with high nicotine withdrawal, PTSD severity was high, regardless of resilience level. These results suggest that resilience is a protective factor for PTSD severity for those with low levels of nicotine withdrawal, but at high levels of nicotine withdrawal, the protective function of resilience is mitigated. PMID:25881517

  5. Preliminary Study of Acute Changes in Emotion Processing in Trauma Survivors with PTSD Symptoms

    PubMed Central

    Wang, Xin; Xie, Hong; Cotton, Andrew S.; Duval, Elizabeth R.; Tamburrino, Marijo B.; Brickman, Kristopher R.; Elhai, Jon D.; Ho, S. Shaun; McLean, Samuel A.; Ferguson, Eric J.; Liberzon, Israel

    2016-01-01

    Accumulating evidence suggests traumatic experience can rapidly alter brain activation associated with emotion processing. However, little is known about acute changes in emotion neurocircuits that underlie PTSD symptom development. To examine acute alterations in emotion circuit activation and structure that may be linked to PTSD symptoms, thirty-eight subjects performed a task of appraisal of emotional faces as their brains were functionally and structurally studied with MRI at both two weeks and three months after motor vehicle collision (MVC). As determined by symptoms reported in the PTSD Checklist at three months, sixteen survivors developed probable PTSD, whereas the remaining 22 did not meet criteria for PTSD diagnosis (non-PTSD). The probable PTSD group had greater activation than the non-PTSD group in dorsal and ventral medial prefrontal cortex (dmPFC and vmPFC) while appraising fearful faces within two weeks after MVC and in left insular cortex (IC) three months after MVC. dmPFC activation at two weeks significantly positively correlated with PTSD symptom severity at two weeks (R = 0.462, P = 0.006) and three months (R = 0.418, p = 0.012). Changes over time in dmPFC activation and in PTSD symptom severity were also significantly positively correlated in the probable PTSD group (R = 0.641, P = 0.018). A significant time by group interaction was found for volume changes in left superior frontal gyrus (SFG, F = 6.048, p = 0.019) that partially overlapped dmPFC active region. Between two weeks and three months, left SFG volume decreased in probable PTSD survivors. These findings identify alterations in frontal cortical activity and structure during the early post-trauma period that appear to be associated with development of PTSD symptoms. PMID:27415431

  6. Maternal Age at Holocaust Exposure and Maternal PTSD Independently Influence Urinary Cortisol Levels in Adult Offspring

    PubMed Central

    Bader, Heather N.; Bierer, Linda M.; Lehrner, Amy; Makotkine, Iouri; Daskalakis, Nikolaos P.; Yehuda, Rachel

    2014-01-01

    Background: Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal posttraumatic stress disorder (PTSD) appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression. Method: Ninety-five Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 h urinary cortisol was assayed by RIA. Offspring completed the parental PTSD questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence, or adulthood and examined in relation to offspring psychobiology. Results: Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not. Conclusion: Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased

  7. Latent classes of PTSD symptoms in Vietnam veterans.

    PubMed

    Steenkamp, Maria M; Nickerson, Angela; Maguen, Shira; Dickstein, Benjamin D; Nash, William P; Litz, Brett T

    2012-11-01

    The authors examined heterogeneity in posttraumatic stress disorder (PTSD) symptom presentation among veterans (n = 335) participating in the clinical interview subsample of the National Vietnam Veterans Readjustment Study. Latent class analysis was used to identify clinically homogeneous subgroups of Vietnam War combat veterans. Consistent with previous research, three classes emerged from the analysis, namely, veterans with no disturbance (61.4% of the cohort), intermediate disturbance (25.6%), and pervasive disturbance (12.5%). The authors also examined physical injury, war-zone stressor exposure, peritraumatic dissociation, and general dissociation as predictors of class membership. The findings are discussed in the context of recent conceptual frameworks that posit a range of posttraumatic outcomes and highlight the sizable segment of military veterans who suffer from intermediate (subclinical) PTSD symptoms. PMID:22798638

  8. Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress.

    PubMed

    Gutner, Cassidy A; Galovski, Tara; Bovin, Michelle J; Schnurr, Paula P

    2016-10-01

    Both theoretical and empirical findings have demonstrated similarities across diagnoses, leading to a growing interest in transdiagnostic interventions. Most of the evidence supporting transdiagnostic treatment has accumulated for depression, anxiety, and eating disorders, with minimal attention given to posttraumatic stress disorder and other reactions to traumatic stressors. Although single-diagnosis protocols are effective for posttraumatic stress disorder (PTSD) and other trauma-related disorders, in principle, transdiagnostic approaches may have beneficial applications within a traumatized population. This paper defines different types of transdiagnostic treatments, reviews transdiagnostic approaches used in related disorders, and discusses their applicability to PTSD. Examples are drawn from existing transdiagnostic treatments in order to provide a framework for the application of such interventions to the field of traumatic stress. Implications for implementation and dissemination are also discussed. PMID:27604362

  9. Implementing an Assessment Clinic in a Residential PTSD Program

    PubMed Central

    McDowell, Joan; McManus, Eliza; Rodriguez, Jessica L.

    2014-01-01

    Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD) such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included. PMID:25379280

  10. Principles for developing animal models of military PTSD

    PubMed Central

    Daskalakis, Nikolaos P.; Yehuda, Rachel

    2014-01-01

    The extent to which animal studies can be relevant to military posttraumatic stress disorder (PTSD) continues to be a matter of discussion. Some features of the clinical syndrome are more easily modeled than others. In the animal literature, a great deal of attention is focused on modeling the characteristics of military exposures and their impact on measurable behaviors and biological parameters. There are many issues to consider regarding the ecological validity of predator, social defeat or immobilization stress to combat-related experience. In contrast, less attention has been paid to individual variation following these exposures. Such variation is critical to understand how individual differences in the response to military trauma exposure may result to PTSD or resilience. It is important to consider potential differences in biological findings when comparing extremely exposed to non-exposed animals, versus those that result from examining individual differences. Animal models of military PTSD are also critical in advancing efforts in clinical treatment. In an ideal translational approach to study deployment related outcomes, information from humans and animals, blood and brain, should be carefully considered in tandem, possibly even computed simultaneously, to identify molecules, pathways and networks that are likely to be the key drivers of military PTSD symptoms. With the use novel biological methodologies (e.g., optogenetics) in the animal models, critical genes and pathways can be tuned up or down (rather than over-expressed or ablated completely) in discrete brain regions. Such techniques together with pre-and post-deployment human imaging will accelerate the identification of novel pharmacological and non-pharmacological intervention strategies. PMID:25206946

  11. Interpersonal Psychotherapy (IPT) for PTSD: A Case Study

    PubMed Central

    RAFAELI, ALEXANDRA KLEIN; MARKOWITZ, JOHN C.

    2013-01-01

    Interpersonal Psychotherapy (IPT), a time-limited, evidence-based treatment, has shown efficacy in treating major depressive disorder and other psychiatric conditions. Interpersonal Psychotherapy focuses on the patient’s current life events and social and interpersonal functioning for understanding and treating symptoms. This case report demonstrates the novel use of IPT as treatment for posttraumatic stress disorder (PTSD). Preliminary evidence suggests IPT may relieve PTSD symptoms without focusing on exposure to trauma reminders. Thus IPT may offer an alternative for patients who refuse (or do not respond to) exposure-based approaches. Interpersonal Psychotherapy focuses on two problem areas that specifically affect patients with PTSD: interpersonal difficulties and affect dysregulation. This case report describes a pilot participant from a study comparing 14 weekly sessions of IPT to treatment with two other psychotherapies. We describe the session-by-session IPT protocol, illustrating how to formulate the case, help the patient identify and address problematic affects and interpersonal functioning, and to monitor treatment response. PMID:22032045

  12. The role of PTSD in adjudicating violent crimes.

    PubMed

    Hamner, Mark B

    2014-01-01

    PTSD was formalized as a diagnosis by the American Psychiatric Association in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM), 3rd edition. Since that time, the diagnosis has been widely utilized in the courts including the use in criminal proceedings. PTSD may play a role in the assessment of violent crimes both as a possible contributing factor in the perpetrators as well as a consequence in the victims. There are a number of ethical and clinical considerations in the use of this diagnosis. Importantly, the diagnostic criteria have changed to a degree with subsequent editions of the DSM. This may have an impact on the interpretation of past legal judgments. Moreover, extensive psychiatric comorbidity may complicate the clinical picture, e.g., mood disorders, substance use disorders, or psychosis. The diagnosis of PTSD is still based on clinical, largely subjective criteria, e.g., biological markers are not yet utilized. As such, there may not be consistent agreement about the diagnosis among experts. This paper summarizes some of these relevant issues in adjudicating violent crimes. PMID:25040379

  13. Impact of war, religiosity and ideology on PTSD and psychiatric disorders in adolescents from Gaza Strip and South Lebanon.

    PubMed

    Khamis, Vivian

    2012-06-01

    This study investigated the extent to which differences in the types of war trauma, economic pressure, religiosity and ideology accounted for variation in PTSD and psychiatric disorders among adolescents from Gaza Strip and South Lebanon. Participants were 600 adolescents aged 12-16 years. They were selected from the public school system in the highly war exposed areas. Questionnaires were administered in an interview format with adolescents at school by two trained psychologists. Results indicated that the various types of trauma had differential effects on the psychological status of adolescents in both countries. Economic pressure was more predictive of PTSD and psychological distress in adolescents from Gaza. Differences in religiosity and ideology did not account for similar variation in stress response among adolescents from Gaza and South Lebanon. While higher levels of religiosity evidenced the greatest levels of depression and anxiety in adolescents from Gaza, religiosity had an attenuated effect on adolescents from South Lebanon. Ideology was negatively associated with depression and anxiety in Gaza strip adolescents, whereas it did not play a role for adolescents from South Lebanon. The clinical and research implications of these conclusions are discussed.

  14. Associations Among Disaster Exposure, Intimate Relationship Adjustment, and PTSD Symptoms: Can Disaster Exposure Enhance a Relationship?

    PubMed Central

    Fredman, Steffany J.; Monson, Candice M.; Schumm, Jeremiah A.; Adair, Kathryn C.; Taft, Casey T.; Resick, Patricia A.

    2010-01-01

    This study examined associations among disaster characteristics, relationship adjustment, and posttraumatic stress disorder (PTSD) symptomatology 9 months postdisaster in 205 women exposed to extensive flooding. Bivariately, threat/harm and loss exposure dimensions were related to each other but differentially related to relationship adjustment and PTSD symptoms. Results from structural equation modeling revealed a positive and significant direct association between threat/harm and PTSD symptoms. Conversely, loss was not significantly associated with PTSD symptoms, but was positively and significantly associated with relationship adjustment. Relationship adjustment was negatively and significantly related to PTSD symptoms. These data suggest that some aspects of disaster exposure can have a mobilizing and positive effect on intimate relationships. In turn, positive intimate relationships may buffer individuals against PTSD symptoms. PMID:20623594

  15. A Prospective Study of Trait Anger and PTSD Symptoms in Police

    PubMed Central

    Meffert, Susan M.; Metzler, Thomas J.; Henn-Haase, Clare; McCaslin, Shannon; Inslicht, Sabra; Chemtob, Claude; Neylan, Thomas; Marmar, Charles R.

    2013-01-01

    It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder (PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact. PMID:18720397

  16. Effects of parents' experiential avoidance and PTSD on adolescent disaster-related posttraumatic stress symptomatology.

    PubMed

    Polusny, Melissa A; Ries, Barry J; Meis, Laura A; DeGarmo, David; McCormick-Deaton, Catherine M; Thuras, Paul; Erbes, Christopher R

    2011-04-01

    Despite the importance of family context to adolescents' reactions following disaster, little research has examined the role of parents' functioning on adolescents' disaster-related posttraumatic stress disorder (PTSD) symptoms. Using data from 288 adolescents (ages 12 to 19 years) and 288 parents exposed to a series of severe tornadoes in a rural Midwestern community, this study tested a conceptual model of the interrelationships between individual and parental risk factors on adolescents' disaster-related PTSD symptoms using structural equation modeling. Results showed that the psychological process of experiential avoidance mediated the relationship between family disaster exposure and PTSD for both adolescents and their parents. Parents' PTSD symptoms independently predicted adolescents' PTSD symptoms. Further, parents' postdisaster functioning amplified the effects of adolescent experiential avoidance on adolescents' disaster-related PTSD symptoms. Findings highlight the importance of family context in understanding adolescents' postdisaster reactions. Clinical implications are discussed.

  17. Heart rate response to fear conditioning and virtual reality in subthreshold PTSD.

    PubMed

    Roy, Michael J; Costanzo, Michelle E; Jovanovic, Tanja; Leaman, Suzanne; Taylor, Patricia; Norrholm, Seth D; Rizzo, Albert A

    2013-01-01

    Posttraumatic stress disorder (PTSD) is a significant health concern for U.S. military service members (SMs) returning from Afghanistan and Iraq. Early intervention to prevent chronic disability requires greater understanding of subthreshold PTSD symptoms, which are associated with impaired physical health, mental health, and risk for delayed onset PTSD. We report a comparison of physiologic responses for recently deployed SMs with high and low subthreshold PTSD symptoms, respectively, to a fear conditioning task and novel virtual reality paradigm (Virtual Iraq). The high symptom group demonstrated elevated heart rate (HR) response during fear conditioning. Virtual reality sequences evoked significant HR responses which predicted variance of the PTSD Checklist-Military Version self-report. Our results support the value of physiologic assessment during fear conditioning and combat-related virtual reality exposure as complementary tools in detecting subthreshold PTSD symptoms in Veterans. PMID:23792855

  18. Differences in PTSD Symptomatology Among Latinos with Childhood and Adult Trauma: The Moderating Effect of Acculturation

    PubMed Central

    DiGangi, Julia A.; Goddard, Andrea J.; Miller, Steven A.; Leon, Gabriela; Jason, Leonard A.

    2016-01-01

    The development of PTSD has been shown to be dependent on a variety of factors, including ethnicity, whether the trauma was experienced as a child or adult, and acculturation. Using 104 Latinos who had completed treatment for substance abuse disorder(s), this study compared PTSD symptomatology for individuals reporting their worst traumatic event (WTE) in childhood versus adulthood. The moderating effect of acculturation was also examined. Although many studies have reported on the pernicious effects of childhood trauma, very few have provided direct comparisons of child and adult trauma in terms of PTSD symptoms. Results indicated that those reporting their WTE in childhood had greater PTSD symptomatology than those reporting in adulthood. Acculturation moderated the relationship between timing of the trauma and PTSD symptoms. Specifically, those who reported their WTE in childhood and had the lower levels of acculturation reported the higher number of PTSD symptoms. Implications and future directions are discussed. PMID:27227166

  19. NHMRC guidelines for clinical practice for ASD and PTSD.

    PubMed

    Ladd, Gary

    2008-03-01

    Dear Editor, Recently I described the case of a scuba instructor suffering from acute stress disorder (ASD), a type of post-traumatic stress disorder (PTSD), following the death of one of her students. The treatment described was a combination of eye movement desensitization and reprocessing (EMDR) and cognitive-behavioural therapy (CBT) exposure based exercises. As it happens, in August the Australian Centre for Post Traumatic Mental Health published Australian clinical practice guidelines for ASD and PTSD. These have been endorsed by the National Health and Medical Research Council (NHMRC). The treatment described in the diver injury case is consistent with these guidelines. The NHMRC guidelines suggest that immediately following a traumatic episode (e.g., diver death or serious injury) the most helpful response is to offer psychological first aid. This includes providing information on traumatic stress reactions, encouraging self care and using available social support. It is recommended that the medical practitioner monitor the patient, watching for improvement, plateau or deterioration, and be ready to offer assistance or appropriate referral if needed. The guidelines recommend the use of trauma-focused psychological therapy as the first-line intervention for ASD and PTSD. EMDR, with in vivo exposure included, and CBT are considered the most effective treatments. If medication is required, selective serotonin re-uptake inhibitor antidepressants are considered the best choice. For the benefit and convenience of patients and practitioners, the NHMRC guidelines and a comprehensive set of information guides on ASD and PTSD are available online as pdf file downloads at http://www.acpmh.unimelb.edu.au. An update in Medical Journal of Australia provides traumatic stress information for medical practitioners including screening questions that can be used to identify patients suffering with ASD and PTSD. This article is available online at: http

  20. Post-traumatic Stress Disorder (PTSD) in Children of Conflict Region of Kashmir (India): A Review.

    PubMed

    Mushtaq, Raheel; Shah, Tabindah; Mushtaq, Sahil

    2016-01-01

    Post-traumatic stress disorder (PTSD) occurs due to traumatic events. The last two decades have seen various traumatic events in Kashmiri population, which has led to psychological impact on all population, especially children. PTSD is one of the psychiatric disorders occurring after witnessing of traumatic events. A review of literature regarding PTSD in children of Kashmir (India) has been done to assess the prevalence, causes, neurobiology, risk factors and psychiatric co morbidity associated with it.

  1. Suicidal Ideation Associated with PCL Checklist-Ascertained PTSD among Veterans Treated for Substance Abuse

    PubMed Central

    Cornelius, Jack R.; Haas, Gretchen L.; Appelt, Cathleen J.; Walker, Jon D.; Fox, Lauren J.; Kasckow, John W.; Luther, James F.; Salloum, Ihsan M.

    2013-01-01

    This manuscript begins by reviewing the literature concerning the use of the SCID versus the PCL for diagnosing PTSD, and by reviewing the literature regarding the presence of suicidal ideation as a clinical correlate of PTSD. This manuscript then describes our recent study involving PTSD among Veterans, which assessed the presence of suicidal ideation as a clinical correlate of PTSD, as diagnosed by the SCID versus as diagnosed by the PCL. We hypothesized that the presence of suicidal ideation would be associated with a diagnosis of PTSD. Subjects were 101 Veterans recruited from VA behavioral health and substance use treatment clinics in the VA Pittsburgh Healthcare System. The study compared correlations of suicidal ideation with PTSD as determined with the PTSD Checklist versus the Structured Clinical Interview for DSM-IV, and utilized question 9 of the Beck Depression Inventory for assessing presence of SI. PTSD was diagnosed in 15 subjects using the SCID, and in 15 subjects using the PTSD Checklist. SI were reported by 16 subjects. The presence of SI was significantly associated with the diagnosis of PTSD on the PCL (chi-square=5.73, df=1, p=0.017) but not on the SCID (chi-square=0.08, df=1, p=0.773). These findings suggest that SI associated with the diagnosis of PTSD among Veterans are better ascertained by the PCL as compared to the more elaborate diagnostic algorithm used in the SCID. The current study finding raises the possibility that a less complicated diagnostic assessment instrument such as the PCL may be superior to the SCID, a more complicated instrument for diagnosing PTSD, at least in some populations. PMID:25382964

  2. Post-traumatic Stress Disorder (PTSD) in Children of Conflict Region of Kashmir (India): A Review

    PubMed Central

    Shah, Tabindah; Mushtaq, Sahil

    2016-01-01

    Post-traumatic stress disorder (PTSD) occurs due to traumatic events. The last two decades have seen various traumatic events in Kashmiri population, which has led to psychological impact on all population, especially children. PTSD is one of the psychiatric disorders occurring after witnessing of traumatic events. A review of literature regarding PTSD in children of Kashmir (India) has been done to assess the prevalence, causes, neurobiology, risk factors and psychiatric co morbidity associated with it. PMID:26894159

  3. Memory for trauma-related information in Holocaust survivors with PTSD.

    PubMed

    Golier, Julia A; Yehuda, Rachel; Lupien, Sonia J; Harvey, Philip D

    2003-12-01

    The impact of trauma-related information on memory performance in aging Holocaust survivors with post-traumatic stress disorder (PTSD) was evaluated. Explicit and implicit memory for neutral and Holocaust-related words was assessed in Holocaust survivors with PTSD (PTSD+, n=31), in Holocaust survivors without PTSD (PTSD-, n=17), and in healthy Jewish adults not exposed to the Holocaust (non-exposed, n=34) using the paired associates learning and word-stem completion tests, respectively. The PTSD+ group had significantly poorer paired associate recall than the PTSD- and non-exposed groups, and showed a significantly different response to the introduction of Holocaust-related words. The PTSD+ group recalled significantly more words from the Holocaust-related than the neutral word pairs, whereas word type had little effect on paired associate recall in the other two groups. In contrast, there were no group differences in implicit memory performance or in the effect of Holocaust-related words on implicit memory. Among Holocaust survivors, explicit recall of Holocaust-related word pairs was associated with intrusive PTSD symptoms. These results suggest that aging Holocaust survivors with PTSD preferentially form new associations with trauma-related stimuli as compared with neutral stimuli. The presence of such a disturbance of associative learning decades after the Holocaust may underlie the persistence of psychological symptoms and, in particular, the intrusive symptoms of PTSD. This trauma-related facilitation of explicit memory, together with generally poorer explicit memory, may help to explain the bi-directional nature of the memory impairments in PTSD.

  4. Cognitive processing therapy for veterans with comorbid PTSD and alcohol use disorders.

    PubMed

    Kaysen, Debra; Schumm, Jeremiah; Pedersen, Eric R; Seim, Richard W; Bedard-Gilligan, Michele; Chard, Kathleen

    2014-02-01

    Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidity in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12 months), past AUD (prior to 12 months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting.

  5. Physiological reactivity to nonideographic virtual reality stimuli in veterans with and without PTSD

    PubMed Central

    Webb, Andrea K; Vincent, Ashley L; Jin, Alvin B; Pollack, Mark H

    2015-01-01

    Background Post-traumatic stress disorder (PTSD) currently is diagnosed via clinical interview in which subjective self reports of traumatic events and associated experiences are discussed with a mental health professional. The reliability and validity of diagnoses can be improved with the use of objective physiological measures. Methods In this study, physiological activity was recorded from 58 male veterans (PTSD Diagnosis n = 16; Trauma Exposed/No PTSD Diagnosis: n = 23; No Trauma/No PTSD Diagnosis: n = 19) with and without PTSD and combat trauma exposure in response to emotionally evocative non-idiographic virtual reality stimuli. Results Statistically significant differences among the Control, Trauma, and PTSD groups were present during the viewing of two virtual reality videos. Skin conductance and interbeat interval features were extracted for each of ten video events (five events of increasing severity per video). These features were submitted to three stepwise discriminant function analyses to assess classification accuracy for Control versus Trauma, Control versus PTSD, and Trauma versus PTSD pairings of participant groups. Leave-one-out cross-validation classification accuracy was between 71 and 94%. Conclusions These results are promising and suggest the utility of objective physiological measures in assisting with PTSD diagnosis. PMID:25642387

  6. Effectiveness of brief VR treatment for PTSD in war-fighters: a case study.

    PubMed

    Miyahira, Sarah D; Folen, Raymond A; Hoffman, Hunter G; Garcia-Palacios, Azucena; Schaper, Kim M

    2010-01-01

    War-fighters exposed to combat are at high risk for developing posttraumatic stress disorder (PTSD), a complex and challenging condition to treat. Cognitive behavioral therapies (CBT) have been empirically validated as effective treatments for PTSD resulting from sexual assault, vehicular accidents, and disasters. Exposure, imaginal or in vivo, to the traumatic event is a central component of successful CBT treatment. Early studies indicate that CBT with brief virtual reality exposure (VRE) is beneficial in treating PTSD. The case study examined the effectiveness of brief VRE in treating combat-related PTSD. PMID:20543300

  7. Analysis of prevalence of PTSD and its influencing factors among college students after the Wenchuan earthquake

    PubMed Central

    2013-01-01

    Background This study explored the prevalence and severity of post-traumatic stress disorder (PTSD) in college students who lived in earthquake center one year after the Wenchuan earthquake on May 12, 2008, the factors affecting the prevalence of PTSD was also investigated. Methods 2987 students studying at the senior normal school in Tibetan autonomous region which was one of the most devastated regions were selected for this study. The PTSD Checklist-Civilian Version (PCL-C) was used as a screening instrument. Results A total of 420 cases (14.1%) were diagnosed with PTSD, among which mild, moderate, severe and extreme symptoms were reported in 122, 185, 106 and 7 cases, respectively. The PTSD prevalence in college students lived in the severely affected area was significantly higher than that in the less severe area (P < 0.001). According to the multivariate logistic regression analysis, the students who were injured in the earthquake, those lost their first degree relative, and those confronted with dead bodies were more likely to express PTSD. Male students were more prone than female students to develop PTSD. However, the students who received psychological tutorship were less prone to express PTSD. Conclusions At one year after the earthquake, the PTSD rate in college students in the severely affected area was high. The social support, psychological help and rehabilitation project should be strengthened to improve their ability to cope with the trauma. PMID:23331706

  8. Cognitive predictors and risk factors of PTSD following stillbirth: a short-term longitudinal study.

    PubMed

    Horsch, Antje; Jacobs, Ingo; McKenzie-McHarg, Kirstie

    2015-04-01

    This short-term longitudinal study investigated cognitive predictors and risk factors of posttraumatic stress disorder (PTSD) in mothers following stillbirth. After a stillbirth at ≥ 24 weeks gestational age, 65 women completed structured clinical interviews and questionnaires assessing PTSD symptoms, cognitive predictors (appraisals, dysfunctional strategies), and risk factors (perceived social support, trauma history, obstetric history) at 3 and 6 months. PTSD symptoms decreased between 3 and 6 months (Cohen's d ranged .34-.52). Regression analyses also revealed a specific positive relationship between Rumination and concurrent frequency of PTSD symptoms (β = .45). Negative Self-View and Negative World-View related positively and Self-Blame related negatively to concurrent number of PTSD symptoms (β = .48, .44, -.45, respectively). Suppression and Distraction predicted a decrease and Numbing predicted an increase in time-lagged number of PTSD symptoms (β = -.33, -.28, .30, respectively). Risk factors for PTSD symptoms were younger age (β = -.25), lower income (β = -.29), fewer previous pregnancies (β = -.31), and poorer perceived social support (β = -.26). Interventions addressing negative appraisals, dysfunctional strategies, and social support are recommended for mothers with PTSD following stillbirth. Knowledge of cognitive predictors and risk factors of PTSD may inform the development of a screening instrument. PMID:25820435

  9. THE PANIC ATTACK–PTSD MODEL: APPLICABILITY TO ORTHOSTATIC PANIC AMONG CAMBODIAN REFUGEES

    PubMed Central

    Hinton, Devon E.; Hofmann, Stefan G.; Pitman, Roger K.; Pollack, Mark H.; Barlow, David H.

    2009-01-01

    This article examines the ability of the “Panic Attack–PTSD Model” to predict how panic attacks are generated and how panic attacks worsen posttraumatic stress disorder (PTSD). The article does so by determining the validity of the Panic Attack–PTSD Model in respect to one type of panic attacks among traumatized Cambodian refugees: orthostatic panic (OP) attacks, that is, panic attacks generated by moving from lying or sitting to standing. Among Cambodian refugees attending a psychiatric clinic, we conducted two studies to explore the validity of the Panic Attack–PTSD Model as applied to OP patients, meaning patients with at least one episode of OP in the previous month. In Study 1, the “Panic Attack–PTSD Model” accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis-associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious–depressive distress (SCL subscales), and OP severity significantly mediated the effect of anxious–depressive distress on CAPS severity. In Study 2, as predicted by the Panic Attack–PTSD Model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a CBT study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity. PMID:18470741

  10. Fear of anxiety as a partial mediator of the relation between trauma severity and PTSD symptoms.

    PubMed

    Reuther, Erin T; Davis, Thompson E; Matthews, Russell A; Munson, Melissa S; Grills-Taquechel, Amie E

    2010-08-01

    Fear of anxiety has previously been found to be a predictor of overall symptoms of posttraumatic stress disorder (PTSD). The current exploratory study examines the relationship between fear of anxiety and symptoms of PTSD in a sample of adults exposed to Hurricane Katrina. Fear of anxiety was found to partially mediate the relationship between the severity of trauma and the severity of PTSD. Further, this mediation was found to operate differently by gender, with the mediation holding true for men but not for women. For both men and women, fear of anxiety was positively correlated with PTSD symptoms.

  11. Predictors of PTSD symptoms in adults admitted to a Level I trauma center: a prospective analysis.

    PubMed

    Powers, Mark B; Warren, Ann Marie; Rosenfield, David; Roden-Foreman, Kenleigh; Bennett, Monica; Reynolds, Megan C; Davis, Michelle L; Foreman, Michael L; Petrey, Laura B; Smits, Jasper A J

    2014-04-01

    Trauma centers are an ideal point of intervention in efforts to prevent posttraumatic stress disorder (PTSD). In order to assist in the development of prevention efforts, this study sought to identify early predictors of PTSD symptoms among adults admitted to a Level I trauma center using a novel analytic strategy (Fournier et al., 2009). Upon admission, participants (N=327) were screened for PTSD symptoms and provided information on potential predictor variables. Their PTSD symptoms were assessed again 3 months later (N=227). Participants were classified as symptomatic (positive PTSD screen) or asymptomatic (negative PTSD screen) at the follow-up assessment. Multinomial logistic regression showed that age, depression, number of premorbid psychiatric disorders, gunshot wound, auto vs. pedestrian injury, and alcohol use predicted who had PTSD symptoms at FU with 76.3% accuracy. However, when controlling for PTSD severity at baseline, only age, number of premorbid psychiatric disorders, and gunshot wounds predicted PTSD symptoms at FU but with 78.5% accuracy. These findings suggest that psychological prevention efforts in trauma centers may be best directed toward adults who are young, have premorbid psychiatric disorders, and those admitted with gunshot wounds.

  12. Relaxation processes in administered-rate pricing

    NASA Astrophysics Data System (ADS)

    Hawkins, Raymond J.; Arnold, Michael R.

    2000-10-01

    We show how the theory of anelasticity unifies the observed dynamics and proposed models of administered-rate products. This theory yields a straightforward approach to rate model construction that we illustrate by simulating the observed relaxation dynamics of two administered rate products. We also demonstrate how the use of this formalism leads to a natural definition of market friction.

  13. 22 CFR 196.4 - Administering office.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Administering office. 196.4 Section 196.4 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL COMMERCIAL ARBITRATION THOMAS R. PICKERING FOREIGN AFFAIRS/GRADUATE FOREIGN AFFAIRS FELLOWSHIP PROGRAM § 196.4 Administering office. The Department of...

  14. 22 CFR 196.4 - Administering office.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Administering office. 196.4 Section 196.4 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL COMMERCIAL ARBITRATION THOMAS R. PICKERING FOREIGN AFFAIRS/GRADUATE FOREIGN AFFAIRS FELLOWSHIP PROGRAM § 196.4 Administering office. The Department of...

  15. 22 CFR 196.4 - Administering office.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Administering office. 196.4 Section 196.4 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL COMMERCIAL ARBITRATION THOMAS R. PICKERING FOREIGN AFFAIRS/GRADUATE FOREIGN AFFAIRS FELLOWSHIP PROGRAM § 196.4 Administering office. The Department of...

  16. 22 CFR 196.4 - Administering office.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Administering office. 196.4 Section 196.4 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL COMMERCIAL ARBITRATION THOMAS R. PICKERING FOREIGN AFFAIRS/GRADUATE FOREIGN AFFAIRS FELLOWSHIP PROGRAM § 196.4 Administering office. The Department of...

  17. 22 CFR 196.4 - Administering office.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Administering office. 196.4 Section 196.4 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL COMMERCIAL ARBITRATION THOMAS R. PICKERING FOREIGN AFFAIRS/GRADUATE FOREIGN AFFAIRS FELLOWSHIP PROGRAM § 196.4 Administering office. The Department of...

  18. Decoding the Traumatic Memory among Women with PTSD: Implications for Neurocircuitry Models of PTSD and Real-Time fMRI Neurofeedback.

    PubMed

    Cisler, Josh M; Bush, Keith; James, G Andrew; Smitherman, Sonet; Kilts, Clinton D

    2015-01-01

    Posttraumatic Stress Disorder (PTSD) is characterized by intrusive recall of the traumatic memory. While numerous studies have investigated the neural processing mechanisms engaged during trauma memory recall in PTSD, these analyses have only focused on group-level contrasts that reveal little about the predictive validity of the identified brain regions. By contrast, a multivariate pattern analysis (MVPA) approach towards identifying the neural mechanisms engaged during trauma memory recall would entail testing whether a multivariate set of brain regions is reliably predictive of (i.e., discriminates) whether an individual is engaging in trauma or non-trauma memory recall. Here, we use a MVPA approach to test 1) whether trauma memory vs neutral memory recall can be predicted reliably using a multivariate set of brain regions among women with PTSD related to assaultive violence exposure (N=16), 2) the methodological parameters (e.g., spatial smoothing, number of memory recall repetitions, etc.) that optimize classification accuracy and reproducibility of the feature weight spatial maps, and 3) the correspondence between brain regions that discriminate trauma memory recall and the brain regions predicted by neurocircuitry models of PTSD. Cross-validation classification accuracy was significantly above chance for all methodological permutations tested; mean accuracy across participants was 76% for the methodological parameters selected as optimal for both efficiency and accuracy. Classification accuracy was significantly better for a voxel-wise approach relative to voxels within restricted regions-of-interest (ROIs); classification accuracy did not differ when using PTSD-related ROIs compared to randomly generated ROIs. ROI-based analyses suggested the reliable involvement of the left hippocampus in discriminating memory recall across participants and that the contribution of the left amygdala to the decision function was dependent upon PTSD symptom severity. These

  19. SAFE for PTSD: noncontact psychophysiological measure based on high-resolution thermal imaging to aid in PTSD diagnosis and assessment of treatment

    NASA Astrophysics Data System (ADS)

    Familoni, Babajide O.; Ma, Lein; Hutchinson, J. Andrew; Morgan, C. Andrew, III; Rasmusson, Ann; O'Kane, Barbara L.

    2012-06-01

    Post Traumatic Stress Disorder (PTSD) sometimes develops following exposure to very stressful or traumatic events such as motor vehicle accidents, rape, and war. It is arguably the signature injury of the conflicts in Iraq and Afghanistan. Previous studies have demonstrated that PTSD sufferers exhibit autonomic hyper-responsiveness to both neutral and trauma-related stimuli. In this study, we propose using high resolution thermal imaging of sweat-pores to obtain a noncontact, remote, and quantifiable measure of the sympathetic autonomic nervous reactivity to guide diagnosis, assess response to treatment, and tease out important cues to suicidality as a PTSD comorbidity.

  20. Relations between PTSD and distress dimensions in an Indian child/adolescent sample following the 2008 Mumbai terrorist attacks.

    PubMed

    Contractor, Ateka A; Mehta, Panna; Tiamiyu, Mojisola F; Hovey, Joseph D; Geers, Andrew L; Charak, Ruby; Tamburrino, Marijo B; Elhai, Jon D

    2014-08-01

    Posttraumatic stress disorder's (PTSD) four-factor dysphoria model has substantial empirical support (reviewed in Elhai & Palmieri, Journal of Anxiety Disorders, 25, 849-854, 2011; Yufik & Simms, Journal of Abnormal Psychology, 119, 764-776, 2010). However, debatable is whether the model's dysphoria factor adequately captures all of PTSD's emotional distress (e.g., Marshall et al., Journal of Abnormal Psychology, 119(1), 126-135, 2010), which is relevant to understanding the assessment and psychopathology of PTSD. Thus, the present study assessed the factor-level relationship between PTSD and emotional distress in 818 children/adolescents attending school in the vicinity of the 2008 Mumbai terrorist attacks. The effective sample had a mean age of 12.85 years (SD = 1.33), with the majority being male (n = 435, 53.8 %). PTSD and emotional distress were measured by the UCLA PTSD Reaction Index (PTSD-RI) and Brief Symptom Inventory-18 (BSI-18) respectively. Confirmatory factor analyses (CFA) assessed the PTSD and BSI-18 model fit; Wald tests assessed hypothesized PTSD-distress latent-level relations; and invariance testing examined PTSD-distress parameter differences using age, gender and direct exposure as moderators. There were no moderating effects for the PTSD-distress structural parameters. BSI-18's depression and somatization factors related more to PTSD's dysphoria than PTSD's avoidance factor. The results emphasize assessing for specificity and distress variance of PTSD factors on a continuum, rather than assuming dysphoria factor's complete accountability for PTSD's inherent distress. Additionally, PTSD's dysphoria factor related more to BSI-18's depression than BSI-18's anxiety/somatization factors; this may explain PTSD's comorbidity mechanism with depressive disorders.

  1. Who Should Administer Energy-Efficiency Programs?

    SciTech Connect

    Blumstein, Carl; Goldman, Charles; Barbose, Galen L.

    2003-05-01

    The restructuring of the electric utility industry in the US created a crisis in the administration of ratepayer-funded energy-efficiency programs. Before restructuring, nearly all energy-efficiency programs in the US were administered by utilities and funded from utility rates. Restructuring called these arrangements into question in two ways. First, the separation of generation from transmission and distribution undermined a key rationale for utility administration. This was the Integrated Resource Planning approach in which the vertically integrated utility was given incentives to provide energy services at least cost. Second, questions were raised as to whether funding through utility rates could be sustained in a competitive environment and most states that restructured their electricity industry adopted a system benefits charge. The crisis in administration of energy-efficiency programs produced a variety of responses in the eight years since restructuring in the US began in earn est. These responses have included new rationales for energy-efficiency programs, new mechanisms for funding programs, and new mechanisms for program administration and governance. This paper focuses on issues related to program administration. It describes the administrative functions and some of the options for accomplishing them. Then it discusses criteria for choosing among the options. Examples are given that highlight some of the states that have made successful transitions to new governance and/or administration structures. Attention is also given to California where large-scale energy-efficiency programs have continued to operate, despite the fact that many of the key governance/administration issues remain unresolved. The conclusion attempts to summarize lessons learned.

  2. Scale

    ERIC Educational Resources Information Center

    Schaffhauser, Dian

    2009-01-01

    The common approach to scaling, according to Christopher Dede, a professor of learning technologies at the Harvard Graduate School of Education, is to jump in and say, "Let's go out and find more money, recruit more participants, hire more people. Let's just keep doing the same thing, bigger and bigger." That, he observes, "tends to fail, and fail…

  3. Lifetime and HIV-related PTSD among persons recently diagnosed with HIV.

    PubMed

    Martin, Lindi; Kagee, Ashraf

    2011-01-01

    This cross-sectional study sought to determine the percentage of individuals who met criteria for lifetime PTSD and HIV-related PTSD among 85 recently diagnosed HIV-positive patients attending public health clinics in the Western Cape, South Africa. The PTSD module of the Composite International Diagnostic Interview (CIDI) was used to determine the percentage of those who met criteria for lifetime PTSD and HIV-related PTSD. The rate of lifetime PTSD and incidence of HIV-related PTSD was 54.1% (95% CI: 43.6-64.3%) and 40% (95% CI: 30.2-50.6%), respectively. Findings suggest that receiving an HIV-positive diagnosis and/or being HIV-positive may be considered a stressor that frequently results in HIV-related PTSD. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health of HIV-positive individuals is appropriately addressed.

  4. Spirituality factors in the prediction of outcomes of PTSD treatment for U.S. military veterans.

    PubMed

    Currier, Joseph M; Holland, Jason M; Drescher, Kent D

    2015-02-01

    Spirituality is a multifaceted construct that might affect veterans' recovery from posttraumatic stress disorder (PTSD) in adaptive and maladaptive ways. Using a cross-lagged panel design, this study examined longitudinal associations between spirituality and PTSD symptom severity among 532 U.S. veterans in a residential treatment program for combat-related PTSD. Results indicated that spirituality factors at the start of treatment were uniquely predictive of PTSD symptom severity at discharge, when accounting for combat exposure and both synchronous and autoregressive associations between the study variables, βs = .10 to .16. Specifically, veterans who scored higher on adaptive dimensions of spirituality (daily spiritual experiences, forgiveness, spiritual practices, positive religious coping, and organizational religiousness) at intake fared significantly better in this program. In addition, possible spiritual struggles (operationalized as negative religious coping) at baseline were predictive of poorer PTSD outcomes, β = .11. In contrast to these results, PTSD symptomatology at baseline did not predict any of the spirituality variables at posttreatment. In keeping with a spiritually integrative approach to treating combat-related PTSD, these results suggest that understanding the possible spiritual context of veterans' trauma-related concerns might add prognostic value and equip clinicians to alleviate PTSD symptomatology among those veterans who possess spiritual resources or are somehow struggling in this domain.

  5. Psychopharmacologic treatment of dissociative fugue and PTSD in an Ethiopian refugee.

    PubMed

    Liu-Barbaro, Dorothy; Stein, Murray

    2015-07-01

    Despite widespread awareness of their frequent co-occurrence, little is known about treatment of individuals with comorbid posttraumatic stress disorder (PTSD) and dissociative disorders. Patients with dissociative disorders do not respond well to standard exposure therapy, and few psychopharmacologic trials exist. Fluoxetine proved ineffective for depersonalization disorder, but paroxetine showed efficacy in decreasing dissociative symptoms in PTSD patients. PMID:26115334

  6. Impact of DSM-5 PTSD and gender on impaired eating behaviors in 512 Italian earthquake survivors.

    PubMed

    Carmassi, Claudia; Antonio Bertelloni, Carlo; Massimetti, Gabriele; Miniati, Mario; Stratta, Paolo; Rossi, Alessandro; Dell'Osso, Liliana

    2015-01-30

    Considerable comorbidity rates between Post-traumatic Stress Disorder (PTSD) and eating disorders have been recently reported, as well as increased obesity and underweight conditions. The aim of the present study was to investigate the possible associations between DSM-5 PTSD, gender and impaired eating habits in a sample of 512 Italian earthquake survivors evaluated by the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Mood Spectrum-Self Report (MOODS-SR). Alterations in eating behaviors were assessed by means of four MOODS-SR items: n=150 (…there was no food that appealed to you or tasted good to you?), n=151 (…you constantly craved sweets or carbohydrates?), n=152 (…your appetite or weight decreased?), n=153 (…your appetite or weight increased?). In a Decision Tree procedure subjects with PTSD with respect to those without and, in the No-PTSD subgroup, females with respect to males, had a significantly higher ratio of at least one MOODS-SR eating behavior item (MOODS-SR EB). In the No-PTSD subgroup only, subjects with at least one MOODS-SR EB presented a significantly higher mean TALS-SR symptomatological domains total score with respect to those without MOODS-SR EB. In conclusion, alterations in eating behaviors were associated with PTSD after the L׳Aquila earthquake; among survivors without PTSD significant a correlation emerged between MOODS-SR EB and PTSD symptoms. PMID:25454114

  7. Women Reporting Intimate Partner Violence in India: Associations with PTSD and Depressive Symptoms

    PubMed Central

    Chandra, Prabha S.; Satyanarayana, Veena A.; Carey, Michael P.

    2010-01-01

    Background Intimate Partner Violence (IPV) is prevalent worldwide and often has mental health sequelae. Objectives To describe the prevalence and the nature of PTSD symptoms among Indian women reporting IPV, (b) to study the relationship between symptoms of PTSD and depression, and (c) to examine the relationship between sexual coercion and PTSD symptoms. Methods Consecutive women (n = 105) presenting to an adult psychiatry outpatient unit of National Institute of Mental Health and Neuro Sciences in South India were recruited. These women were assessed for IPV, sexual coercion, PTSD symptoms, and depression. Results Fifty-nine women (56%) reported a history of IPV, of whom 41 (70%) also reported sexual coercion. Among women reporting IPV, seven (14%) exceeded cut-off scores for PTSD and twelve (20%) exceeded cut-off scores for sub-threshold PTSD. The majority of those reporting IPV exceeded cut-off scores for a depressive disorder. Compared to women without a history of IPV, women reporting IPV had higher scores on PTSD and depression. Severity of violence and sexual coercion correlated positively (r = 0.39) with PTSD severity. Conclusions The findings highlight the importance of screening women for IPV and its sequelae, in mental health settings. PMID:19283446

  8. Determinants of altered intracellular endocrine-immune interplay in Bosnian war refugees suffering from PTSD.

    PubMed

    Pitts, Kenneth P; Joksimovic, Ljiljana; Steudte-Schmiedgen, Susann; Rohleder, Nicolas; Wolf, Jutta M

    2016-07-01

    Posttraumatic Stress Disorder (PTSD) has been repeatedly linked to changes in glucocorticoid (GC) sensitivity. To increase our understanding of this phenomenon and its potential relevance for PTSD development and treatment, the current study investigates the interplay between two key moderators, glucocorticoid receptor (GRα) and GR co-chaperone FKBP5, and their relation to GC sensitivity. A GC sensitivity assay was performed in 52 Bosnian war refugees (19m; 40.8±8.7 years) clinically diagnosed with PTSD to divide the patient group into a high (HS) and a low (LS) GC sensitivity group. Expression of GRα and FKBP5 mRNA was quantified by real-time RT-PCR. Links between gene expression and GC sensitivity were driven by the HS group of PTSD patients, which also showed increased expression of GRα but not FKBP5 compared to the LS group. Further, expressions of FKBP5 and GRα were strongly correlated in the HS patient group, while this association was missing in the LS PTSD group. Our findings suggest that PTSD phenotypes may be characterized by differences in intracellular signaling transduction processes. The associations of expression of GRα and FKBP5 in the high-sensitive PTSD subgroup may thereby reflect physiological adaptation to preserve immune-relevant GC signaling. Further research is needed to understand the role and consequences of GRα-FKBP5 dissociation in low GC sensitivity PTSD patients. PMID:27086273

  9. Does Narrative Exposure Therapy Reduce PTSD in Survivors of Mass Violence?

    ERIC Educational Resources Information Center

    McPherson, Jane

    2012-01-01

    Purpose: This review examines the effectiveness of narrative exposure therapy (NET) , a short-term intervention for posttraumatic stress disorder (PTSD) in survivors of mass violence and torture, who have often suffered multiple traumas over several years. Methods: Randomized control trials were reviewed if they measured PTSD outcome and were…

  10. A Memory-Based Model of Posttraumatic Stress Disorder: Evaluating Basic Assumptions Underlying the PTSD Diagnosis

    ERIC Educational Resources Information Center

    Rubin, David C.; Berntsen, Dorthe; Bohni, Malene Klindt

    2008-01-01

    In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed., text rev.; American Psychiatric Association,…

  11. Variations in Criterion A and PTSD Rates in a Community Sample of Women

    PubMed Central

    Anders, Samantha; Frazier, Patricia; Frankfurt, Sheila

    2010-01-01

    We assessed PTSD prevalence and symptoms as a function of whether participants’ worst lifetime event met Criterion A1 for PTSD (DSM-IV-TR; APA, 2000) and whether the event was directly or indirectly experienced in a community sample of adult women (N = 884). Exposure to both non-Criterion A1 and Criterion A1 events was systematically assessed. PTSD was assessed with regard to participants’ self-nominated worst event using the PTSD module of the SCID-I/NP (First, Spitzer, Gibbon, & Williams, 1997). There were no differences in PTSD prevalence rates between Criterion A1 and non-A1 events; however, directly-experienced worst events were significantly more likely to meet PTSD criteria than were indirectly-experienced worst events. Non-Criterion A1 and directly-experienced worst events were associated with significantly more PTSD symptoms than were Criterion A1 or indirectly-experienced events, respectively. Criterion A2 (experiencing fear, helplessness, or horror) had little effect on PTSD rates. PMID:20888184

  12. Threat modulation of visual search efficiency in PTSD: A comparison of distinct stimulus categories.

    PubMed

    Olatunji, Bunmi O; Armstrong, Thomas; Bilsky, Sarah A; Zhao, Mimi

    2015-10-30

    Although an attentional bias for threat has been implicated in posttraumatic stress disorder (PTSD), the cues that best facilitate this bias are unclear. Some studies utilize images and others utilize facial expressions that communicate threat. However, the comparability of these two types of stimuli in PTSD is unclear. The present study contrasted the effects of images and expressions with the same valence on visual search among veterans with PTSD and controls. Overall, PTSD patients had slower visual search speed than controls. Images caused greater disruption in visual search than expressions, and emotional content modulated this effect with larger differences between images and expressions arising for more negatively valenced stimuli. However, this effect was not observed with the maximum number of items in the search array. Differences in visual search speed by images and expressions significantly varied between PTSD patients and controls for only anger and at the moderate level of task difficulty. Specifically, visual search speed did not significantly differ between PTSD patients and controls when exposed to angry expressions. However, PTSD patients displayed significantly slower visual search than controls when exposed to anger images. The implications of these findings for better understanding emotion modulated attention in PTSD are discussed.

  13. Neural correlates of inhibition and contextual cue processing related to treatment response in PTSD.

    PubMed

    van Rooij, Sanne J H; Geuze, Elbert; Kennis, Mitzy; Rademaker, Arthur R; Vink, Matthijs

    2015-02-01

    Thirty to fifty percent of posttraumatic stress disorder (PTSD) patients do not respond to treatment. Understanding the neural mechanisms underlying treatment response could contribute to improve response rates. PTSD is often associated with decreased inhibition of fear responses in a safe environment. Importantly, the mechanism of effective treatment (psychotherapy) relies on inhibition and so-called contextual cue processing. Therefore, we investigate inhibition and contextual cue processing in the context of treatment. Forty-one male war veterans with PTSD and 22 healthy male war veterans (combat controls) were scanned twice with a 6- to 8-month interval, in which PTSD patients received treatment (psychotherapy). We distinguished treatment responders from nonresponders on the base of percentage symptom decrease. Inhibition and contextual cue processing were assessed with the stop-signal anticipation task. Behavioral and functional MRI measures were compared between PTSD patients and combat controls, and between responders and nonresponders using repeated measures analyses. PTSD patients showed behavioral and neural deficits in inhibition and contextual cue processing at both time points compared with combat controls. These deficits were unaffected by treatment; therefore, they likely represent vulnerability factors or scar aspects of PTSD. Second, responders showed increased pretreatment activation of the left inferior parietal lobe (IPL) during contextual cue processing compared with nonresponders. Moreover, left IPL activation predicted percentage symptom improvement. The IPL has an important role in contextual cue processing, and may therefore facilitate the effect of psychotherapy. Hence, increased left IPL activation may represent a potential predictive biomarker for PTSD treatment response.

  14. Cognitive-Behavioral Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Smith, Patrick; Yule, William; Perrin, Sean; Tranah, Troy; Dagleish, Tim; Clark, David M.

    2007-01-01

    Objective: To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people. Method: Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full "DSM-IV" PTSD diagnostic criteria after…

  15. Gender Differences in the Clinical Presentation of PTSD and Its Concomitants in Survivors of Interpersonal Assault

    ERIC Educational Resources Information Center

    Galovski, Tara E.; Mott, Juliette; Young-Xu, Yinong; Resick, Patricia A.

    2011-01-01

    This study compares a sample of PTSD-positive, female survivors of interpersonal assault (n = 162) to a sample of similarly traumatized male counterparts (n = 45) on a number of variables, including PTSD-symptom severity, depressive symptoms, anger, guilt, and health-related concerns. Results indicate that male and female interpersonal assault…

  16. The Driving Behavior Survey as a Measure of Behavioral Stress Responses to MVA-Related PTSD

    PubMed Central

    Baker, Aaron S.; Litwack, Scott D.; Clapp, Joshua D.; Beck, J. Gayle; Sloan, Denise M.

    2014-01-01

    Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n = 40) were racially diverse adults (M age = 40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r = .41–.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials. PMID:24800313

  17. Art Therapy for Combat-Related PTSD: Recommendations for Research and Practice

    ERIC Educational Resources Information Center

    Collie, Kate; Backos, Amy; Malchiodi, Cathy; Spiegel, David

    2006-01-01

    With a new generation of American combat veterans returning from Iraq, the nation has an obligation to do everything possible to improve care for posttraumatic stress disorder (PTSD). Although art therapy has been understudied in this context, it shows promise as a means of treating hard-to-treat symptoms of combat-related PTSD, such as avoidance…

  18. Behavioral Activation for Comorbid PTSD and Major Depression: A Case Study

    ERIC Educational Resources Information Center

    Mulick, Patrick S.; Naugle, Amy E.

    2004-01-01

    The present investigation details the assessment and use of Behavioral Activation (BA) therapy to treat a 37-year-old male police officer/military veteran suffering from posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). This case study is an attempt to expand empirical knowledge regarding BA, comorbid PTSD and MDD, and…

  19. A Couple-Based Approach to the Reduction of PTSD Avoidance Symptoms: Preliminary Findings

    ERIC Educational Resources Information Center

    Sautter, Frederic J.; Glynn, Shirley M.; Thompson, Karin E.; Franklin, Laurel; Han, Xiaotong

    2009-01-01

    This study reports preliminary findings regarding the feasibility and efficacy of a novel couple-based treatment, named Strategic Approach Therapy (SAT), for reducing avoidance symptoms of posttraumatic stress disorder (PTSD). Six male Vietnam combat veterans diagnosed with PTSD and their cohabitating marital partners participated in 10 weeks of…

  20. Sleep variability in military-related PTSD: a comparison to primary insomnia and healthy controls.

    PubMed

    Straus, Laura D; Drummond, Sean P A; Nappi, Carla M; Jenkins, Melissa M; Norman, Sonya B

    2015-02-01

    Sleep disturbances are prevalent in posttraumatic stress disorder (PTSD) and are associated with a number of adverse health consequences. Few studies have used comprehensive assessment methods to characterize sleep in Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OEF/OIF/OND) veterans with PTSD. OEF/OIF/OND veterans with PTSD and sleep disturbance (n = 45) were compared to patients with primary insomnia (n = 25) and healthy control subjects (n = 27). Participants were assessed using questionnaire-based measures as well as daily subjective and objective measures of sleep. The 3 groups were compared with regard to (a) group means, (b) intraindividual (i.e., night-to-night) variability of sleep, and (c) interindividual (i.e., within-group) variability of sleep. In terms of group means, only objective sleep efficiency was significantly worse with PTSD than with primary insomnia (d = 0.54). Those with PTSD differed from those with primary insomnia on measures of intraindividual as well as interindividual variability (d = 0.48-0.73). These results suggested sleep symptoms in OEF/OIF/OND veterans with PTSD are more variable across nights and less consistent across patients relative to sleep symptoms in insomnia patients without PTSD. These findings have implications for research, as well as for personalizing treatment for individuals with PTSD.

  1. Determinants of altered intracellular endocrine-immune interplay in Bosnian war refugees suffering from PTSD.

    PubMed

    Pitts, Kenneth P; Joksimovic, Ljiljana; Steudte-Schmiedgen, Susann; Rohleder, Nicolas; Wolf, Jutta M

    2016-07-01

    Posttraumatic Stress Disorder (PTSD) has been repeatedly linked to changes in glucocorticoid (GC) sensitivity. To increase our understanding of this phenomenon and its potential relevance for PTSD development and treatment, the current study investigates the interplay between two key moderators, glucocorticoid receptor (GRα) and GR co-chaperone FKBP5, and their relation to GC sensitivity. A GC sensitivity assay was performed in 52 Bosnian war refugees (19m; 40.8±8.7 years) clinically diagnosed with PTSD to divide the patient group into a high (HS) and a low (LS) GC sensitivity group. Expression of GRα and FKBP5 mRNA was quantified by real-time RT-PCR. Links between gene expression and GC sensitivity were driven by the HS group of PTSD patients, which also showed increased expression of GRα but not FKBP5 compared to the LS group. Further, expressions of FKBP5 and GRα were strongly correlated in the HS patient group, while this association was missing in the LS PTSD group. Our findings suggest that PTSD phenotypes may be characterized by differences in intracellular signaling transduction processes. The associations of expression of GRα and FKBP5 in the high-sensitive PTSD subgroup may thereby reflect physiological adaptation to preserve immune-relevant GC signaling. Further research is needed to understand the role and consequences of GRα-FKBP5 dissociation in low GC sensitivity PTSD patients.

  2. Overt Social Support Behaviors: Associations With PTSD, Concurrent Depressive Symptoms and Gender

    PubMed Central

    Crevier, Myra G.; Marchand, André; Nachar, Nadim; Guay, Stéphane

    2013-01-01

    Women are twice as likely as men to develop a posttraumatic stress disorder (PTSD). Gender differences in social support after a traumatic event might partially explain this disparity. However, the portrait of the links among PTSD, depression, social support, and gender is still unclear. This study examined behaviors of individuals with PTSD and their significant other in relation to PTSD and concurrent depressive symptoms, and tested gender as a moderator of these associations. Observed overt supportive and countersupportive behaviors of 68 dyads composed of an individual with PTSD and a significant other in a trauma-oriented discussion were coded with a support coding system and analyzed according to gender. Gender was revealed to act as a moderator of the links between interactional behaviors of individuals with PTSD and their concurrent depressive symptoms. More specifically, women were less implicated and less likely to propose positive solutions compared with men. On the other hand, men were more implicated and less likely to criticize their significant other than were women. PTSD and concurrent depressive symptoms were related to poorer interpersonal communication in women. Hence, women and men with PTSD and concurrent depressive symptoms might benefit from gender-tailored interventions targeting symptoms and dyadic behaviors. PMID:26440610

  3. University Counseling Center Use of Prolonged Exposure Therapy: In-Clinic Treatment for Students with PTSD

    ERIC Educational Resources Information Center

    Bonar, Ted C.

    2015-01-01

    Students utilize university counseling center services to address distress related to post-traumatic stress disorder (PTSD). Since counseling centers services such as group work or general psychotherapy may not address specific PTSD-symptom reduction, centers often give community referrals in such cases. Evidence-based therapies (EBTs), including…

  4. PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

    PubMed Central

    Ralevski, Elizabeth; Olivera-Figueroa, Lening A; Petrakis, Ismene

    2014-01-01

    Background Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. PMID:24648794

  5. Duration of Exposure and the Dose-Response Model of PTSD

    ERIC Educational Resources Information Center

    Kaysen, Debra; Rosen, Gerald; Bowman, Marilyn; Resick, Patricia A.

    2010-01-01

    A dose-response model underlies posttraumatic stress disorder (PTSD) and posits a relationship between event magnitude and clinical outcome. The present study examines whether one index of event magnitude--duration of exposure--contributes to risk of PTSD among female victims of sexual assault. Findings support a small but significant contribution…

  6. A Critical Analysis of Approaches To Targeted PTSD Prevention: Current Status and Theoretically Derived Future Directions

    ERIC Educational Resources Information Center

    Feldner, Matthew T.; Monson, Candice M.; Friedman, Matthew J.

    2007-01-01

    Although efforts to prevent posttraumatic stress disorder (PTSD) have met with relatively limited success, theoretically driven preventive approaches with promising efficacy are emerging. The current article critically reviews investigations of PTSD prevention programs that target persons at risk for being exposed to a traumatic event or who have…

  7. Visiting the Muses: Creativity, Coping, and PTSD in Talented Dancer and Athletes

    ERIC Educational Resources Information Center

    Thomson, Paula; Jaque, S. Victoria

    2016-01-01

    Although exposure to traumatic events runs high among Americans, only a few--about 8.7 percent--of those exposed to such events develop symptoms that warrant a diagnosis of Posttraumatic Stress Disorder (PTSD). The authors investigate two groups--dancers and athletes, including some who suffered from PTSD and some who did not--and found a higher…

  8. Treatment of PTSD in Older Adults: Do Cognitive-Behavioral Interventions Remain Viable?

    ERIC Educational Resources Information Center

    Clapp, Joshua D.; Beck, J. Gayle

    2012-01-01

    The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or…

  9. Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors

    PubMed Central

    Lehrner, Amy; Bierer, Linda M.; Passarelli, Vincent; Pratchett, Laura C.; Flory, Janine D.; Bader, Heather; Harris, Iris R.; Bedi, Aarti; Daskalakis, Nikolaos P.; Makotkine, Iouri; Yehuda, Rachel

    2014-01-01

    Intergenerational effects of trauma have been observed clinically in a wide range of populations, and parental PTSD has been associated with an increased risk for psychopathology in offspring. In studies of Holocaust survivor offspring, parental PTSD, and particularly maternal PTSD, has been associated with increased risk for PTSD, low basal urinary cortisol excretion and enhanced cortisol suppression in response to dexamethasone. Such findings implicate maternally derived glucocorticoid programming in the intergenerational transmission of trauma-related consequences, potentially resulting from in utero influences or early life experiences. This study investigated the relative influence of Holocaust exposure and PTSD in mothers and fathers on glucocorticoid sensitivity in offspring. Eighty Holocaust offspring and 15 offspring of non-exposed Jewish parents completed evaluations and provided blood and urine samples. Glucocorticoid sensitivity was evaluated using the lysozyme suppression test (LST), an in vitro measure of glucocorticoid receptor sensitivity in a peripheral tissue, the dexamethasone suppression test (DST), and 24 hour urinary cortisol excretion. Maternal PTSD was associated with greater glucocorticoid sensitivity in offspring across all three measures of glucocorticoid function. An interaction of maternal and paternal PTSD on the DST and 24-hr urinary cortisol showed an effect of decreased glucocorticoid sensitivity in offspring with paternal, but not maternal, PTSD. Although indirect, these findings are consistent with the hypothesis that epigenetic programming may be involved in the intergenerational transmission of trauma-related effects on glucocorticoid regulation. PMID:24485493

  10. Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors.

    PubMed

    Lehrner, Amy; Bierer, Linda M; Passarelli, Vincent; Pratchett, Laura C; Flory, Janine D; Bader, Heather N; Harris, Iris R; Bedi, Aarti; Daskalakis, Nikolaos P; Makotkine, Iouri; Yehuda, Rachel

    2014-02-01

    Intergenerational effects of trauma have been observed clinically in a wide range of populations, and parental PTSD has been associated with an increased risk for psychopathology in offspring. In studies of Holocaust survivor offspring, parental PTSD, and particularly maternal PTSD, has been associated with increased risk for PTSD, low basal urinary cortisol excretion and enhanced cortisol suppression in response to dexamethasone. Such findings implicate maternally derived glucocorticoid programming in the intergenerational transmission of trauma-related consequences, potentially resulting from in utero influences or early life experiences. This study investigated the relative influence of Holocaust exposure and PTSD in mothers and fathers on glucocorticoid sensitivity in offspring. Eighty Holocaust offspring and 15 offspring of non-exposed Jewish parents completed evaluations and provided blood and urine samples. Glucocorticoid sensitivity was evaluated using the lysozyme suppression test (LST), an in vitro measure of glucocorticoid receptor sensitivity in a peripheral tissue, the dexamethasone suppression test (DST), and 24-h urinary cortisol excretion. Maternal PTSD was associated with greater glucocorticoid sensitivity in offspring across all three measures of glucocorticoid function. An interaction of maternal and paternal PTSD on the DST and 24-h urinary cortisol showed an effect of decreased glucocorticoid sensitivity in offspring with paternal, but not maternal, PTSD. Although indirect, these findings are consistent with the hypothesis that epigenetic programming may be involved in the intergenerational transmission of trauma-related effects on glucocorticoid regulation.

  11. Variations in Criterion A and PTSD rates in a community sample of women.

    PubMed

    Anders, Samantha L; Frazier, Patricia A; Frankfurt, Sheila B

    2011-03-01

    We assessed PTSD prevalence and symptoms as a function of whether participants' worst lifetime event met Criterion A1 for PTSD (DSM-IV-TR; APA, 2000) and whether the event was directly or indirectly experienced in a community sample of adult women (N=884). Exposure to both non-Criterion A1 and Criterion A1 events was systematically assessed. PTSD was assessed with regard to participants' self-nominated worst event using the PTSD module of the SCID-I/NP (First, Spitzer, Gibbon, & Williams, 1997). There were no differences in PTSD prevalence rates between Criterion A1 and non-A1 events; however, directly experienced worst events were significantly more likely to meet PTSD criteria than were indirectly experienced worst events. Non-Criterion A1 and directly experienced worst events were associated with significantly more PTSD symptoms than were Criterion A1 or indirectly experienced events, respectively. Criterion A2 (experiencing fear, helplessness, or horror) had little effect on PTSD rates. PMID:20888184

  12. Spirituality factors in the prediction of outcomes of PTSD treatment for U.S. military veterans.

    PubMed

    Currier, Joseph M; Holland, Jason M; Drescher, Kent D

    2015-02-01

    Spirituality is a multifaceted construct that might affect veterans' recovery from posttraumatic stress disorder (PTSD) in adaptive and maladaptive ways. Using a cross-lagged panel design, this study examined longitudinal associations between spirituality and PTSD symptom severity among 532 U.S. veterans in a residential treatment program for combat-related PTSD. Results indicated that spirituality factors at the start of treatment were uniquely predictive of PTSD symptom severity at discharge, when accounting for combat exposure and both synchronous and autoregressive associations between the study variables, βs = .10 to .16. Specifically, veterans who scored higher on adaptive dimensions of spirituality (daily spiritual experiences, forgiveness, spiritual practices, positive religious coping, and organizational religiousness) at intake fared significantly better in this program. In addition, possible spiritual struggles (operationalized as negative religious coping) at baseline were predictive of poorer PTSD outcomes, β = .11. In contrast to these results, PTSD symptomatology at baseline did not predict any of the spirituality variables at posttreatment. In keeping with a spiritually integrative approach to treating combat-related PTSD, these results suggest that understanding the possible spiritual context of veterans' trauma-related concerns might add prognostic value and equip clinicians to alleviate PTSD symptomatology among those veterans who possess spiritual resources or are somehow struggling in this domain. PMID:25624135

  13. Adolescent exposure to the World Trade Center attacks, PTSD symptomatology, and suicidal ideation.

    PubMed

    Chemtob, Claude M; Madan, Anita; Berger, Pinchas; Abramovitz, Robert

    2011-10-01

    This study examined the associations between different types of trauma exposure, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation among New York City adolescents 1 year after the World Trade Center attacks. A sample of 817 adolescents, aged 13-18, was drawn from 2 Jewish parochial high schools (97% participation rate). We assessed 3 types of trauma exposure, current (within the past month) and past (within the past year) suicidal ideation, and current PTSD symptoms. Findings indicated that probable PTSD was associated with increased risk for suicidal ideation. Exposure to attack-related traumatic events increased risk for both suicidal ideation and PTSD. However, specific types of trauma exposure differentially predicted suicidal ideation and PTSD: knowing someone who was killed increased risk for PTSD, but not for suicidal ideation, and having a family member who was hurt but not killed, increased risk for suicidal ideation, but not for PTSD. This study extends findings from the adult literature showing associations between trauma exposure, PTSD, and increased suicidal ideation in adolescents. PMID:21882245

  14. A Cartoon-Based Measure of PTSD Symptomatology in Children Exposed to a Disaster

    ERIC Educational Resources Information Center

    Elklit, Ask; Nielsen, Louise Hjort; Lasgaard, Mathias; Duch, Christina

    2013-01-01

    Research on childhood posttraumatic stress disorder (PTSD) is sparse. This is partly due to the limited availability of empirically validated measures for children who are insecure readers. The present study examined the reliability and validity of a cartoon-based measure of PTSD symptoms in children exposed to a disaster. Cartoons were generated…

  15. Exposure Therapy for Substance Abusers with PTSD: Translating Research to Practice

    ERIC Educational Resources Information Center

    Coffey, Scott F.; Schumacher, Julie A.; Brimo, Marcella L.; Brady, Kathleen T.

    2005-01-01

    Epidemiological research indicates that there is substantial comorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Moreover, there is growing evidence that having a comorbid PTSD diagnosis is associated with greater substance use problem severity and poorer outcomes from SUD treatment. In an attempt to improve…

  16. Integrated and Holistic Treatment Approach to PTSD and SUD: A Synergy

    ERIC Educational Resources Information Center

    Weis, Melanie

    2010-01-01

    Individuals living with posttraumatic stress disorder (PTSD) and addiction experience a complex and dynamic interaction of symptoms from both diagnoses. However, heretofore, each diagnosis has been approached as if it were a separate treatment consideration. Therefore, an individual may be treated for either a substance use disorder (SUD) or PTSD,…

  17. Exposure-Based Cognitive Behavioral Treatment of PTSD in Adults with Schizophrenia or Schizoaffective Disorder

    PubMed Central

    Frueh, B. Christopher; Grubaugh, Anouk L.; Cusack, Karen J.; Kimble, Matthew O.; Elhai, Jon D.; Knapp, Rebecca G.

    2009-01-01

    In an open trial design, adults (n = 20) with posttraumatic stress disorder (PTSD) and either schizophrenia or schizoaffective disorder were treated via an 11-week cognitive-behavioral intervention for PTSD that consisted of education, anxiety management therapy, social skills training, and exposure therapy, provided at community mental health centers. Results offer preliminary hope for effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, especially among treatment completers (n = 13). Data showed significant PTSD symptom improvement, maintained at 3-month follow-up. Further, 12 of 13 completers no longer met criteria for PTSD or were considered treatment responders. Clinical outcomes for other targeted domains (e.g., anger, general mental health) also improved and were maintained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no adverse events. Significant improvements were not noted on depression, general anxiety, or physical health status. Future directions include the need for randomized controlled trials and dissemination efforts. PMID:19342194

  18. PTSD's underlying symptom dimensions and relations with behavioral inhibition and activation.

    PubMed

    Contractor, Ateka A; Elhai, Jon D; Ractliffe, Kendra C; Forbes, David

    2013-10-01

    Reinforcement sensitivity theory (RST) stipulates that individuals have a behavioral activation system (BAS) guiding approach (rewarding) behaviors (Gray, 1971, 1981), and behavioral inhibition system (BIS) guiding conflict resolution between approach and avoidance (punishment) behaviors (Gray & McNaughton, 2000). Posttraumatic stress disorder (PTSD) severity overall relates to both BIS (e.g., Myers, VanMeenen, & Servatius, 2012; Pickett, Bardeen, & Orcutt, 2011) and BAS (Pickett et al., 2011). Using a more refined approach, we assessed specific relations between PTSD's latent factors (Simms, Watson, & Doebbeling, 2002) and observed variables measuring BIS and BAS using 308 adult, trauma-exposed primary care patients. Confirmatory factor analysis and Wald chi-square tests demonstrated a significantly greater association with BIS severity compared to BAS severity for PTSD's dysphoria, avoidance, and re-experiencing factors. Further, PTSD's avoidance factor significantly mediated relations between BIS/BAS severity and PTSD's dysphoria factor.

  19. PTSD's underlying symptom dimensions and relations with behavioral inhibition and activation.

    PubMed

    Contractor, Ateka A; Elhai, Jon D; Ractliffe, Kendra C; Forbes, David

    2013-10-01

    Reinforcement sensitivity theory (RST) stipulates that individuals have a behavioral activation system (BAS) guiding approach (rewarding) behaviors (Gray, 1971, 1981), and behavioral inhibition system (BIS) guiding conflict resolution between approach and avoidance (punishment) behaviors (Gray & McNaughton, 2000). Posttraumatic stress disorder (PTSD) severity overall relates to both BIS (e.g., Myers, VanMeenen, & Servatius, 2012; Pickett, Bardeen, & Orcutt, 2011) and BAS (Pickett et al., 2011). Using a more refined approach, we assessed specific relations between PTSD's latent factors (Simms, Watson, & Doebbeling, 2002) and observed variables measuring BIS and BAS using 308 adult, trauma-exposed primary care patients. Confirmatory factor analysis and Wald chi-square tests demonstrated a significantly greater association with BIS severity compared to BAS severity for PTSD's dysphoria, avoidance, and re-experiencing factors. Further, PTSD's avoidance factor significantly mediated relations between BIS/BAS severity and PTSD's dysphoria factor. PMID:24064333

  20. Pharmacological secondary prevention of PTSD in youth: challenges and opportunities for advancement.

    PubMed

    Maccani, Matthew A; Delahanty, Douglas L; Nugent, Nicole R; Berkowitz, Steven J

    2012-10-01

    Child and adolescent posttraumatic stress disorder (PTSD) is associated with an increased risk for a number of deleterious mental and physical health outcomes that if untreated may persist throughout the life course. Efficacious interventions applied soon after trauma exposure have the potential to reduce or prevent the development of PTSD symptoms and their associated impact on behavior and physical health. We review extant research related to treatment-modifiable peritraumatic predictors of pediatric PTSD, which have informed an emerging field of pharmacologic secondary prevention (i.e., occurring shortly following trauma exposure) of PTSD. Challenges and opportunities for early posttrauma PTSD prevention are described. Finally, we offer new models for biologically informed integration of pharmacologic and psychosocial secondary prevention intervention strategies for children and adolescents.

  1. Ethnoracial Variations in Acute PTSD Symptoms Among Hospitalized Survivors of Traumatic Injury

    PubMed Central

    Stephens, Kari A.; Sue, Stanley; Roy-Byrne, Peter; Unützer, Jürgen; Wang, Jin; Rivara, Frederick P.; Jurkovich, Gregory J.; Zatzick, Douglas F.

    2011-01-01

    Ethnoracial minority status contributes to an increased risk for posttraumatic stress disorder (PTSD) after trauma exposure, beyond other risk factors. A population-based sampling frame was used to examine the associations between ethnoracial groups and early PTSD symptoms while adjusting for relevant clinical and demographic characteristics. Acutely injured trauma center inpatients (N = 623) were screened with the PTSD Checklist. American Indian and African American patients reported the highest levels of posttraumatic stress and preinjury cumulative trauma burden. African American heritage was independently associated with an increased risk of higher acute PTSD symptom levels. Disparities in trauma history, PTSD symptoms, and event related factors emphasize the need for acute care services to incorporate culturally competent approaches for treating these diverse populations. PMID:20564368

  2. Mild traumatic brain injury and treatment response in prolonged exposure for PTSD.

    PubMed

    Sripada, Rebecca K; Rauch, Sheila A M; Tuerk, Peter W; Smith, Erin; Defever, Andrew M; Mayer, Rebecca A; Messina, Michael; Venners, Margaret

    2013-06-01

    A proportion of U.S. veterans returning from Iraq and Afghanistan have experienced mild traumatic brain injury (mTBI), which is associated with increased risk for developing posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) has proven effectiveness in the treatment of PTSD; however, some clinicians have reservations about using PE with individuals with a history of mTBI. We examined the impact of PE for veterans with PTSD and with or without a history of mTBI in a naturalistic sample of 51 veterans who received PE at a Veterans Health Administration PTSD clinic. We also analyzed previously collected data from a controlled trial of 22 veterans randomly assigned to PE or present centered therapy. For both sets of data, we found that PE reduced symptom levels and we also did not detect an effect for mTBI, suggesting that PE may be helpful for individuals with PTSD and a history of mTBI. PMID:23696427

  3. Involuntary Memories and Dissociative Amnesia: Assessing Key Assumptions in PTSD Research.

    PubMed

    Berntsen, Dorthe; Rubin, David C

    2014-03-01

    Autobiographical memories of trauma victims are often described as disturbed in two ways. First, the trauma is frequently re-experienced in the form of involuntary, intrusive recollections. Second, the trauma is difficult to recall voluntarily (strategically); important parts may be totally or partially inaccessible-a feature known as dissociative amnesia. These characteristics are often mentioned by PTSD researchers and are included as PTSD symptoms in the DSM-IV-TR (American Psychiatric Association, 2000). In contrast, we show that both involuntary and voluntary recall are enhanced by emotional stress during encoding. We also show that the PTSD symptom in the diagnosis addressing dissociative amnesia, trouble remembering important aspects of the trauma is less well correlated with the remaining PTSD symptoms than the conceptual reversal of having trouble forgetting important aspects of the trauma. Our findings contradict key assumptions that have shaped PTSD research over the last 40 years.

  4. Military Beliefs and PTSD in Active Duty U.S. Army Soldiers

    PubMed Central

    Loew, Benjamin; Carter, Sarah; Allen, Elizabeth; Markman, Howard; Stanley, Scott; Rhoades, Galena

    2014-01-01

    Post-traumatic distress after military combat is a major cost of war. One under-investigated factor potentially associated with PTSD symptoms is specific beliefs about one’s military service. This study examined post-deployment self-reports from 272 active-duty U.S. Army soldiers, to investigate potential associations between military-related PTSD symptom severity and three beliefs about the military: the importance and value ascribed to one’s own work in the Army, to current military operations in Iraq and Afghanistan, and to military service in general. Higher scores on these three beliefs were negatively correlated with military-related PTSD symptom severity. However, in a combined regression model that controlled for recent combat exposure, only the belief about current military operations had a significant, unique association with PTSD symptom severity. That is, more positive beliefs about the value of operations in Iraq or Afghanistan were associated with lower PTSD symptoms. PMID:25530729

  5. Involuntary Memories and Dissociative Amnesia: Assessing Key Assumptions in PTSD Research

    PubMed Central

    Berntsen, Dorthe; Rubin, David C.

    2014-01-01

    Autobiographical memories of trauma victims are often described as disturbed in two ways. First, the trauma is frequently re-experienced in the form of involuntary, intrusive recollections. Second, the trauma is difficult to recall voluntarily (strategically); important parts may be totally or partially inaccessible—a feature known as dissociative amnesia. These characteristics are often mentioned by PTSD researchers and are included as PTSD symptoms in the DSM-IV-TR (American Psychiatric Association, 2000). In contrast, we show that both involuntary and voluntary recall are enhanced by emotional stress during encoding. We also show that the PTSD symptom in the diagnosis addressing dissociative amnesia, trouble remembering important aspects of the trauma is less well correlated with the remaining PTSD symptoms than the conceptual reversal of having trouble forgetting important aspects of the trauma. Our findings contradict key assumptions that have shaped PTSD research over the last 40 years. PMID:25309832

  6. PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: a latent class analysis.

    PubMed

    Hruska, Bryce; Irish, Leah A; Pacella, Maria L; Sledjeski, Eve M; Delahanty, Douglas L

    2014-10-01

    We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA. PMID:25124501

  7. Psychotherapies for PTSD: what do they have in common?

    PubMed Central

    Schnyder, Ulrich; Ehlers, Anke; Elbert, Thomas; Foa, Edna B.; Gersons, Berthold P. R.; Resick, Patricia A.; Shapiro, Francine; Cloitre, Marylène

    2015-01-01

    Over the past three decades, research and clinical practice related to the field of traumatic stress have developed tremendously. In parallel with the steady accumulation of basic knowledge, therapeutic approaches have been developed to treat people suffering from posttraumatic stress disorder (PTSD) and other trauma-related psychological problems. Today, a number of evidence-based treatments are available. They differ in various ways; however, they also have a number of commonalities. Given this situation, clinicians may wonder which treatment program to use, or more specifically, which treatment components are critical for a successful therapy. In this article, seven pioneers who have developed empirically supported psychotherapies for trauma-related disorders were asked to compose an essay of three parts: first, to provide a brief summary of the treatment they have developed; second, to identify three key interventions that are common and critical in treating PTSD; and third, to suggest important topics and future directions for research. The paper ends with a summary highlighting the identified commonalities (psychoeducation; emotion regulation and coping skills; imaginal exposure; cognitive processing, restructuring, and/or meaning making; emotions; and memory processes), pointing to future directions such as trying to better understand the underlying mechanisms of action, and developing treatments that are tailored to the needs of different patient groups. PMID:26290178

  8. Dopamine Rebound-Excitation Theory: Putting Brakes on PTSD

    PubMed Central

    Lee, Jason C.; Wang, Lei Philip; Tsien, Joe Z.

    2016-01-01

    It is not uncommon for humans or animals to experience traumatic events in their lifetimes. However, the majority of individuals are resilient to long-term detrimental changes turning into anxiety and depression, such as post-traumatic stress disorder (PTSD). What underlying neural mechanism accounts for individual variability in stress resilience? Hyperactivity in fear circuits, such as the amygdalar system, is well-known to be the major pathophysiological basis for PTSD, much like a “stuck accelerator.” Interestingly, increasing evidence demonstrates that dopamine (DA) – traditionally known for its role in motivation, reward prediction, and addiction – is also crucial in regulating fear learning and anxiety. Yet, how dopaminergic (DAergic) neurons control stress resilience is unclear, especially given that DAergic neurons have multiple subtypes with distinct temporal dynamics. Here, we propose the Rebound-Excitation Theory, which posits that DAergic neurons’ rebound-excitation at the termination of fearful experiences serves as an important “brake” by providing intrinsic safety-signals to fear-processing neural circuits in a spatially and temporally controlled manner. We discuss how DAergic neuron rebound-excitation may be regulated by genetics and experiences, and how such physiological properties may be used as a brain-activity biomarker to predict and confer individual resilience to stress and anxiety. PMID:27729874

  9. Searching for non-genetic molecular and imaging PTSD risk and resilience markers: Systematic review of literature and design of the German Armed Forces PTSD biomarker study.

    PubMed

    Schmidt, Ulrike; Willmund, Gerd-Dieter; Holsboer, Florian; Wotjak, Carsten T; Gallinat, Jürgen; Kowalski, Jens T; Zimmermann, Peter

    2015-01-01

    Biomarkers allowing the identification of individuals with an above average vulnerability or resilience for posttraumatic stress disorder (PTSD) would especially serve populations at high risk for trauma exposure like firefighters, police officers and combat soldiers. Aiming to identify the most promising putative PTSD vulnerability markers, we conducted the first systematic review on potential imaging and non-genetic molecular markers for PTSD risk and resilience. Following the PRISMA guidelines, we systematically screened the PubMed database for prospective longitudinal clinical studies and twin studies reporting on pre-trauma and post-trauma PTSD risk and resilience biomarkers. Using 25 different combinations of search terms, we retrieved 8151 articles of which we finally included and evaluated 9 imaging and 27 molecular studies. In addition, we briefly illustrate the design of the ongoing prospective German Armed Forces (Bundeswehr) PTSD biomarker study (Bw-BioPTSD) which not only aims to validate these previous findings but also to identify novel and clinically applicable molecular, psychological and imaging risk, resilience and disease markers for deployment-related psychopathology in a cohort of German soldiers who served in Afghanistan.

  10. Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino Youth: Results from the Hispanic Family Study

    PubMed Central

    Vásquez, Desi Alonzo; de Arellano, Michael A.; Reid-Quiñones, Kathryn; Bridges, Ana J.; Rheingold, Alyssa A.; Stocker, Ryan P.J.; Danielson, Carla Kmett

    2012-01-01

    This is the first study to examine peritraumatic dissociation and peritraumatic emotions as they predict PTSD symptoms and diagnosis in Latino youth. Our aim was to test the hypothesis that degree of peritraumatic dissociation would predict of number of PTSD symptoms and PTSD clinical diagnosis when the influences of other salient factors were statistically controlled. We also explored the possible contributions of peritraumatic emotional responses to PTSD symptomatology and PTSD diagnosis. We expected that peritraumatic dissociation would emerge as a significant predictor of PTSD. A total of 204 Latino youth (mean age = 12.37) completed semi-structured, individual clinical interviews with bilingual research assistants. These interviews assessed trauma exposure, peritraumatic responses, and current psychopathology. A linear regression analysis demonstrated significant relationships between lifetime number of traumatic events, peritraumatic dissociation, shame, and number of PTSD symptoms endorsed. Significant inverse (protective) relationships were demonstrated between anger and guilt and current PTSD symptomatology. Logistic regression analysis demonstrated significant relationships between peritraumatic dissociation, shame, lifetime number of traumatic events experienced, and PTSD diagnosis. The analyses examined both number of PTSD symptoms, as well as diagnosis of PTSD, while simultaneously controlling for age, lifetime exposure to traumatic events, time residing in the United States, and gender. These results support an increasingly robust body of empirical literature suggesting that the peritraumatic dissociative and emotional responses to trauma are important predictors of future PTSD diagnosis. Possible cultural factors contributing to the dissociative responses in Latino youth and clinical implications are discussed. PMID:22989240

  11. MMPI-2 Profiles in Civilian PTSD: An Examination of Differential Responses between Victims of Crime and Industrial Accidents

    ERIC Educational Resources Information Center

    Shercliffe, Regan Jeffery; Colotla, Victor

    2009-01-01

    The authors studied MMPI-2 profiles of workers (N = 83) diagnosed with posttraumatic stress disorder (PTSD) and a control group comprising workers with chronic pain (N = 40). Significant differences were seen in profiles between the PTSD groups and the control group, and the authors compared the PTSD profiles according to exposure to two different…

  12. Have You Lived through a Very Scary and Dangerous Event? A Real Illness: Post-Traumatic Stress Disorder (PTSD).

    ERIC Educational Resources Information Center

    National Inst. of Mental Health (DHHS), Bethesda, MD.

    A description of post-traumatic stress disorder (PTSD) is presented to help bring to light the symptoms that may occur after a traumatic event. The paper's question and answer format provides an easy way to share information about PTSD. Following the definition, an explanation is given of how PTSD starts and how long it lasts. Information is…

  13. Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino youth: results from the Hispanic family study.

    PubMed

    Vásquez, Desi Alonzo; de Arellano, Michael A; Reid-Quiñones, Kathryn; Bridges, Ana J; Rheingold, Alyssa A; Stocker, Ryan P J; Danielson, Carla Kmett

    2012-01-01

    This is the 1st study to examine peritraumatic dissociation and peritraumatic emotions as they predict symptoms and diagnosis of posttraumatic stress disorder (PTSD) in Latino youth. Our aim was to test the hypothesis that the degree of peritraumatic dissociation would predict the number of PTSD symptoms and PTSD clinical diagnosis when the influences of other salient factors were statistically controlled. We also explored the possible contributions of peritraumatic emotional responses to PTSD symptomatology and PTSD diagnosis. We expected that peritraumatic dissociation would emerge as a significant predictor of PTSD. A total of 204 Latino youth (mean age = 12.37 years) completed semistructured individual clinical interviews with bilingual research assistants. These interviews assessed trauma exposure, peritraumatic responses, and current psychopathology. A linear regression analysis demonstrated significant relationships between lifetime number of traumatic events, peritraumatic dissociation, shame, and number of PTSD symptoms endorsed. Significant inverse (protective) relationships were demonstrated between anger and guilt and current PTSD symptomatology. Logistic regression analysis demonstrated significant relationships between peritraumatic dissociation, shame, lifetime number of traumatic events experienced, and PTSD diagnosis. The analyses examined both the number of PTSD symptoms as well as diagnosis of PTSD while simultaneously controlling for age, lifetime exposure to traumatic events, time residing in the United States, and gender. These results support an increasingly robust body of empirical literature suggesting that the peritraumatic dissociative and emotional responses to trauma are important predictors of future PTSD diagnosis. Possible cultural factors contributing to the dissociative responses in Latino youth and clinical implications are discussed.

  14. Attention-Deficit/Hyperactivity Disorder in Adult Patients with Posttraumatic Stress Disorder (PTSD): Is ADHD a Vulnerability Factor?

    ERIC Educational Resources Information Center

    Adler, L. A.; Kunz, M.; Chua, H. C.; Rotrosen, J.; Resnick, S. G.

    2004-01-01

    Objective: There is limited evidence suggesting a link between posttraumatic stress disorder (PTSD) and Attention-Deficit/Hyperactivity Disorder (ADHD). This study examined the association between PTSD and ADHD using retrospective and current clinical evaluations. Method: Twenty-five male veterans with PTSD and 22 male veterans with panic …

  15. Ecological momentary assessment of PTSD symptoms and alcohol use in combat veterans.

    PubMed

    Possemato, Kyle; Maisto, Stephen A; Wade, Michael; Barrie, Kimberly; McKenzie, Shannon; Lantinga, Larry J; Ouimette, Paige

    2015-12-01

    Despite high rates of comorbid hazardous alcohol use and posttraumatic stress disorder (PTSD), the nature of the functional relationship between these problems is not fully understood. Insufficient evidence exists to fully support models commonly used to explain the relationship between hazardous alcohol use and PTSD including the self-medication hypothesis and the mutual maintenance model. Ecological momentary assessment (EMA) can monitor within-day fluctuations of symptoms and drinking to provide novel information regarding potential functional relationships and symptom interactions. This study aimed to model the daily course of alcohol use and PTSD symptoms and to test theory-based moderators, including avoidance coping and self-efficacy to resist drinking. A total of 143 recent combat veterans with PTSD symptoms and hazardous drinking completed brief assessments of alcohol use, PTSD symptoms, mood, coping, and self-efficacy 4 times daily for 28 days. Our results support the finding that increases in PTSD are associated with more drinking within the same 3-hr time block, but not more drinking within the following time block. Support for moderators was found: Avoidance coping strengthened the relationship between PTSD and later drinking, while self-efficacy to resist drinking weakened the relationship between PTSD and later drinking. An exploratory analysis revealed support for self-medication occurring in certain times of the day: Increased PTSD severity in the evening predicted more drinking overnight. Overall, our results provide mixed support for the self-medication hypothesis. Also, interventions that seek to reduce avoidance coping and increase patient self-efficacy may help veterans with PTSD decrease drinking.

  16. Scales

    SciTech Connect

    Murray Gibson

    2007-04-27

    Musical scales involve notes that, sounded simultaneously (chords), sound good together. The result is the left brain meeting the right brain — a Pythagorean interval of overlapping notes. This synergy would suggest less difference between the working of the right brain and the left brain than common wisdom would dictate. The pleasing sound of harmony comes when two notes share a common harmonic, meaning that their frequencies are in simple integer ratios, such as 3/2 (G/C) or 5/4 (E/C).

  17. Scales

    ScienceCinema

    Murray Gibson

    2016-07-12

    Musical scales involve notes that, sounded simultaneously (chords), sound good together. The result is the left brain meeting the right brain — a Pythagorean interval of overlapping notes. This synergy would suggest less difference between the working of the right brain and the left brain than common wisdom would dictate. The pleasing sound of harmony comes when two notes share a common harmonic, meaning that their frequencies are in simple integer ratios, such as 3/2 (G/C) or 5/4 (E/C).

  18. The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: Posttraumatic Stress Disorder Enters the Age of Large-Scale Genomic Collaboration.

    PubMed

    Logue, Mark W; Amstadter, Ananda B; Baker, Dewleen G; Duncan, Laramie; Koenen, Karestan C; Liberzon, Israel; Miller, Mark W; Morey, Rajendra A; Nievergelt, Caroline M; Ressler, Kerry J; Smith, Alicia K; Smoller, Jordan W; Stein, Murray B; Sumner, Jennifer A; Uddin, Monica

    2015-09-01

    The development of posttraumatic stress disorder (PTSD) is influenced by genetic factors. Although there have been some replicated candidates, the identification of risk variants for PTSD has lagged behind genetic research of other psychiatric disorders such as schizophrenia, autism, and bipolar disorder. Psychiatric genetics has moved beyond examination of specific candidate genes in favor of the genome-wide association study (GWAS) strategy of very large numbers of samples, which allows for the discovery of previously unsuspected genes and molecular pathways. The successes of genetic studies of schizophrenia and bipolar disorder have been aided by the formation of a large-scale GWAS consortium: the Psychiatric Genomics Consortium (PGC). In contrast, only a handful of GWAS of PTSD have appeared in the literature to date. Here we describe the formation of a group dedicated to large-scale study of PTSD genetics: the PGC-PTSD. The PGC-PTSD faces challenges related to the contingency on trauma exposure and the large degree of ancestral genetic diversity within and across participating studies. Using the PGC analysis pipeline supplemented by analyses tailored to address these challenges, we anticipate that our first large-scale GWAS of PTSD will comprise over 10 000 cases and 30 000 trauma-exposed controls. Following in the footsteps of our PGC forerunners, this collaboration-of a scope that is unprecedented in the field of traumatic stress-will lead the search for replicable genetic associations and new insights into the biological underpinnings of PTSD.

  19. The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: Posttraumatic Stress Disorder Enters the Age of Large-Scale Genomic Collaboration

    PubMed Central

    Logue, Mark W; Amstadter, Ananda B; Baker, Dewleen G; Duncan, Laramie; Koenen, Karestan C; Liberzon, Israel; Miller, Mark W; Morey, Rajendra A; Nievergelt, Caroline M; Ressler, Kerry J; Smith, Alicia K; Smoller, Jordan W; Stein, Murray B; Sumner, Jennifer A; Uddin, Monica

    2015-01-01

    The development of posttraumatic stress disorder (PTSD) is influenced by genetic factors. Although there have been some replicated candidates, the identification of risk variants for PTSD has lagged behind genetic research of other psychiatric disorders such as schizophrenia, autism, and bipolar disorder. Psychiatric genetics has moved beyond examination of specific candidate genes in favor of the genome-wide association study (GWAS) strategy of very large numbers of samples, which allows for the discovery of previously unsuspected genes and molecular pathways. The successes of genetic studies of schizophrenia and bipolar disorder have been aided by the formation of a large-scale GWAS consortium: the Psychiatric Genomics Consortium (PGC). In contrast, only a handful of GWAS of PTSD have appeared in the literature to date. Here we describe the formation of a group dedicated to large-scale study of PTSD genetics: the PGC-PTSD. The PGC-PTSD faces challenges related to the contingency on trauma exposure and the large degree of ancestral genetic diversity within and across participating studies. Using the PGC analysis pipeline supplemented by analyses tailored to address these challenges, we anticipate that our first large-scale GWAS of PTSD will comprise over 10 000 cases and 30 000 trauma-exposed controls. Following in the footsteps of our PGC forerunners, this collaboration—of a scope that is unprecedented in the field of traumatic stress—will lead the search for replicable genetic associations and new insights into the biological underpinnings of PTSD. PMID:25904361

  20. The dimensionality of trauma: a multidimensional scaling comparison of police officers with and without posttraumatic stress disorder.

    PubMed

    Carlier, I V; Lamberts, R D; Gersons, B P

    2000-12-01

    This study assesses the multidimensional structure of traumatic events as perceived by police officers and investigates individual differences in the scaling of such perceptions. Forty-two police officers with posttraumatic stress disorder (PTSD) and 40 officers without PTSD were given descriptions of critical incidents they were likely to encounter at work. They sorted these on the basis of similarity and rated them on 15 descriptive scales. The two groups were comparable in terms of relevant background characteristics. PTSD was diagnosed with the Structured Interview (SI-PTSD). The similarity data were subjected to individual differences multidimensional scaling analysis [Carroll and Chang, Psychometrika 35 (1970) 283]. The objective was, first, to identify the basic cognitive dimensions of psychological trauma that police officers use in discriminating between common critical incidents and, second, to test whether officers with and without PTSD apply such dimensions differently when interpreting critical incidents. The same three-dimensional solution was obtained for both groups: (1) emotional reactivity; (2) vulnerability and physical integrity; and (3) moral responsibility. Significant differences were found between the PTSD and non-PTSD groups in the salience of Dimension 2. Results are discussed with reference to other studies that address the meaning and interpretation of traumatic events. Implications for the conceptualization and assessment of trauma and PTSD are outlined. PMID:11104855

  1. Mental health and functional impairment outcomes following a 6-week intensive treatment programme for UK military veterans with post-traumatic stress disorder (PTSD): a naturalistic study to explore dropout and health outcomes at follow-up

    PubMed Central

    Murphy, Dominic; Hodgman, Georgina; Carson, Carron; Spencer-Harper, Lucy; Hinton, Mark; Wessely, Simon; Busuttil, Walter

    2015-01-01

    Objective Combat Stress, a UK national charity for veterans with mental health problems, has been funded by the National Health Service (NHS) to provide a national specialist service to deliver treatment for post-traumatic stress disorder (PTSD). This paper reports the efficacy of a PTSD treatment programme for UK veterans at 6 months follow-up. Design A within subject design. Setting UK veterans with a diagnosis of PTSD who accessed Combat Stress. Participants 246 veterans who received treatment between late 2012 and early 2014. Intervention An intensive 6-week residential treatment programme, consisting of a mixture of individual and group sessions. Participants were offered a minimum of 15 individual trauma-focused cognitive behavioural therapy sessions. In addition, participants were offered 55 group sessions focusing on psychoeducational material and emotional regulation. Main outcome measures Clinicians completed measures of PTSD and functional impairment and participants completed measures of PTSD, depression, anger and functional impairment. Results We observed significant reductions in PTSD scores following treatment on both clinician completed measures (PSS-I: −13.0, 95% CI −14.5 to −11.5) and self-reported measures (Revised Impact of Events Scale (IES-R): −16.5, 95% CI −19.0 to −14.0). Significant improvements in functional impairment were also observed (eg, Health of the Nation Outcome Scales (HONOS): −6.85, 95% CI −7.98 to −5.72). There were no differences in baseline outcomes between those who completed and those who did not complete the programme, or post-treatment outcomes between those we were able to follow-up at 6 months and those lost to follow-up. Conclusions In a naturalistic study we observed a significant reduction in PTSD scores and functional impairment following treatment. These improvements were maintained at 6 month follow-up. Our findings suggest it may be helpful to take a closer look at combining individual

  2. Molecular Mechanisms of Posttraumatic Stress Disorder (PTSD) as a Basis for Individualized and Personalized Therapy: Rationale, Design and Methods of the South Eastern Europe (SEE)-PTSD study.

    PubMed

    Kulenovic, Alma Dzubur; Agani, Ferid; Avdibegovic, Esmina; Jakovljevic, Miro; Babic, Dragan; Kucukalic, Abdulah; Kucukalic, Sabina; Dzananovic, Emina Sabic; Mehmedbasic, Alma Bravo; Uka, Aferdita Goci; Haxhibeqiri, Shpend; Haxhibeqiri, Valdete; Hoxha, Blerina; Sinanovic, Osman; Kravic, Nermina; Muminovic, Mirnesa; Aukst-Margetic, Branka; Jaksic, Nenad; Franc, Ana Cima; Rudan, Dusko; Pavlovic, Marko; Babic, Romana; Bojic, Elma Feric; Marjanovic, Damir; Bozina, Nada; Ziegler, Christiane; Wolf, Christiane; Warrings, Bodo; Domschke, Katharina; Deckert, Jürgen

    2016-06-01

    Posttraumatic Stress Disorder (PTSD) is a major health problem in South Eastern Europe (SEE). Available treatment options are not efficient enough and the course is often chronic. Little is known about molecular mediators and moderators of pathogenesis and therapy. Genetic and epigenetic variation may be one central molecular mechanism. We therefore established a consortium combining clinical expertise on PTSD from SEE countries Bosnia-Herzegovina (Sarajevo, Tuzla and Mostar), Kosovo (Prishtina) and Croatia (Zagreb) with genetic and epigenetic competence from Germany (Würzburg) in 2011 within the framework of the DAAD (Deutscher Akademischer Austauschdienst)-funded Stability Pact for South Eastern Europe. After obtaining ethical votes and performing rater trainings as well as training in DNA extraction from EDTA blood between 2011 and 2013, we recruited 747 individuals who had experienced war-related trauma in the SEE conflicts between 1991 and 1999. 236 participants had current PTSD, 161 lifetime PTSD and 350 did not have and never had PTSD. Demographic and clinical data are currently merged together with genetic and epigenetic data in a single database to allow for a comprehensive analysis of the role of genetic and epigenetic variation in the pathogenesis and therapy of PTSD. Analyses will be done to a great degree by PhD students from participating SEE centers who in addition to participation in the project had an opportunity to take part in spring and summer schools of the DFG (Deutsche Forschungsgemeinschaft) funded Research Training Group (RTG) 1253 and thus meet PhD students from Germany and other countries We are confident that our project will not only contribute to a better understanding of genetic and epigenetic mechanisms of PTSD as a basis for future individualized and personalized therapies, but also to the academic development of South Eastern Europe. PMID:27287790

  3. REPETITIVE TMS COMBINED WITH EXPOSURE THERAPY FOR PTSD: A PRELIMINARY STUDY

    PubMed Central

    Osuch, Elizabeth A.; Benson, Brenda E.; Luckenbaugh, David A.; Geraci, Marilla; Post, Robert M.; McCann, Una

    2009-01-01

    Treatment for anxiety and posttraumatic stress disorder (PTSD) includes exposure therapy and medications, but some patients are refractory. Few studies of repetitive transcranial magnetic stimulation (rTMS) for anxiety or PTSD exist. In this preliminary report, rTMS was combined with exposure therapy for PTSD. Nine subjects with chronic, treatment-refractory PTSD were studied in a placebo controlled, cross-over design of imaginal exposure therapy with rTMS (1Hz) versus sham. PTSD symptoms, serum and twenty-four hour urine were obtained and analyzed. Effect sizes for PTSD symptoms were determined using Cohen’s d. Active rTMS showed a larger effect size of improvement for hyperarousal symptoms compared to sham; 24-hour urinary norepinephrine and serum T4 increased; serum prolactin decreased. Active rTMS with exposure may have symptomatic and physiological effects. Larger studies are needed to confirm these preliminary findings and verify whether rTMS plus exposure therapy has a role in the treatment of PTSD. PMID:18455908

  4. Comorbidity of PTSD in anxiety and depressive disorders: prevalence and shared risk factors.

    PubMed

    Spinhoven, Philip; Penninx, Brenda W; van Hemert, Albert M; de Rooij, Mark; Elzinga, Bernet M

    2014-08-01

    The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18-65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.

  5. Developmental trauma, complex PTSD, and the current proposal of DSM-5

    PubMed Central

    Sar, Vedat

    2011-01-01

    This paper evaluates representation of clinical consequences of developmental psychological trauma in the current proposal of DSM-5. Despite intensive efforts by its proponents for two decades, it is not known yet if Complex PTSD will take a place in the final version of DSM-5. Recognition of dissociative character of several symptom dimensions and introduction of items about negative affects such as shame and guilt imply an indirect improvement toward better coverage of the consequences of developmental trauma in the existing category of PTSD. As disorders with highest prevalence of chronic traumatization in early years of life, dissociative disorders and personality disorder of borderline type are maintained as DSM-5 categories; however, recognition of a separate type of trauma-related personality disorder is unlikely. While a preschooler age variant of PTSD is under consideration, the proposed diagnosis of Developmental Trauma Disorder (child version of Complex PTSD) has not secured a place in the DSM-5 yet. We welcome considerations of subsuming Adjustment Disorders, Acute Stress Disorder, PTSD, and Dissociative Disorders under one rubric, i.e., Section of Trauma, Stress, or Event Related Disorders. Given the current conceptualization of DSM-5, this paper proposes Complex PTSD to be a subtype of the DSM-5 PTSD. Composition of a trauma-related disorders section would facilitate integration of knowledge and expertise about interrelated and overlapping consequences of trauma. PMID:22893823

  6. A Test of Whether Coping Styles Moderate the Effect of PTSD Symptoms on Alcohol Outcomes

    PubMed Central

    Grosso, Justine A.; Kimbrel, Nathan A.; Dolan, Sara; Meyer, Eric C.; Kruse, Marc I.; Gulliver, Suzy B.; Morissette, Sandra B.

    2016-01-01

    Coping style may partially account for the frequent co-occurrence of posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD). We hypothesized that PTSD symptom severity, avoidant coping, and action-oriented coping would interact, such that veterans high on PTSD symptoms and avoidant coping and low on action-oriented coping would report more negative alcohol-related consequences and drinking a greater number of drinks per week compared to veterans without all three risk factors. The sample (N = 128) of veterans (85.2% male, M = 37.8 years old, 63.3% Caucasian) completed a diagnostic assessment and self-report measures assessing PTSD, alcohol use disorders, coping styles, and alcohol outcomes. Consistent with the main hypothesis, a three-way interaction among PTSD symptom severity, avoidant coping, and action-oriented coping was found in the predicted direction. In addition, post-hoc descriptive analyses indicated that Veterans with a current PTSD diagnosis, low action-oriented coping, and high avoidant coping had worse alcohol outcomes and were twice as likely to meet criteria for current AUD compared with Veterans with two or fewer risk factors. These findings suggest that the combination of PTSD and maladaptive coping styles may be more important for understanding alcohol-related outcomes than the presence of any of these variables in isolation. PMID:25158641

  7. Prevalence and duration of PTSD in survivors 6 years after a natural disaster.

    PubMed

    Arnberg, Filip K; Bergh Johannesson, Kerstin; Michel, Per-Olof

    2013-04-01

    The present study aimed to examine the prevalence of posttraumatic stress disorder (PTSD) in survivors with low levels of risk factors for PTSD. The sample included 142 adults (58% women, 54% university education, 93% employed/students/retired) on vacation in Southeast Asia during the 2004 Indian Ocean disaster. Semi-structured clinical interviews (SCID-I) were performed after 6 years including PTSD, depression, specific phobia, and alcohol abuse. The 6-year prevalence of PTSD was 11.3% and the current prevalence was 4.2%, with onset mainly within 1 month and remission within 3 years post-disaster. Suicidal ideation and comorbidity were common in PTSD cases. Lifetime prevalence of depression was 19%, specific phobia 7%, and alcohol abuse 4%. The findings suggest elevated levels of PTSD but not other disorders as compared with general population samples, but still lower levels than other disaster samples. Despite benign circumstances, however, the course and burden of PTSD were comparable to similar studies.

  8. Lower stress-reactive cortisol in female veterans associated with military status but not PTSD.

    PubMed

    Pierce, Meghan E; Pritchard, Laurel M

    2016-09-01

    Female veterans are a growing yet understudied population. Currently, 14.6% of all troops deployed to Afghanistan and Iraq are female. Military service is associated with an increased risk for trauma exposure and subsequent development of posttraumatic stress disorder (PTSD). Dysregulation of the hypothalamic-pituitary-adrenal axis is frequently associated with PTSD. Few studies have examined females diagnosed with PTSD and only one study, to our knowledge, has examined HPA-axis dysregulation in female veterans. This study examined salivary cortisol in 52 female veterans and civilians both with and without PTSD. We collected saliva samples at bedtime and awakening, as well as in response to the Trier social stress test (TSST). We found that female veterans had blunted cortisol concentrations at all time points during the TSST compared to female civilians, regardless of PTSD status. Even though all groups showed the expected diurnal decline in cortisol, the difference between awakening and bedtime samples were significant only in civilians without PTSD. The results of our study suggest that stressors specific to the military may lead to lower than normal cortisol, which may not be associated with the expressions of PTSD.

  9. PTSD Symptoms Among Police Officers: Associations With Frequency, Recency, And Types Of Traumatic Events

    PubMed Central

    Hartley, Tara A.; Sarkisian, Khachatur; Violanti, John M.; Andrew, Michael E.; Burchfiel, Cecil M.

    2016-01-01

    Policing necessitates exposure to traumatic, violent and horrific events, which can lead to an increased risk for developing post-traumatic stress disorder (PTSD). The purpose of this study was to determine whether the frequency, recency, and type of police-specific traumatic events were associated with PTSD symptoms. Participants were 359 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004–2009). Traumatic police events were measured using the Police Incident Survey (PIS); PTSD was measured using the PTSD Checklist-Civilian Version (PCL-C). Associations between PIS and PTSD symptoms were evaluated using ANCOVA. Contrast statements were used to test for linear trends. Increased frequency of specific types of events were associated with an increase in the PCL-C score in women, particularly women with no history of prior trauma and those who reported having a high workload (p < 0.05). More recent exposure to seeing severely assaulted victims was associated with higher PCL-C scores in men (p < 0.02). In summary, the frequency of several traumatic events was associated with higher PTSD scores in women, while the recency of seeing victims of assault was associated with higher PTSD scores in men. These results may be helpful in developing intervention strategies to reduce the psychological effects following exposure and these strategies may be different for men and women. PMID:24707587

  10. Civilian PTSD symptoms and risk for involvement in the criminal justice system.

    PubMed

    Donley, Sachiko; Habib, Leah; Jovanovic, Tanja; Kamkwalala, Asante; Evces, Mark; Egan, Glenn; Bradley, Bekh; Ressler, Kerry J

    2012-01-01

    Posttraumatic stress disorder (PTSD) has received considerable attention with regard to the ongoing wars in Iraq and Afghanistan. In studies of veterans, behavioral sequelae of PTSD can include hostile and violent behavior. Rates of PTSD found in impoverished, high-risk urban populations within U.S. inner cities are as high as in returning veterans. The objective of this study was to determine whether civilian PTSD is associated with increased risk of incarceration and charges related to violence in a low-income, urban population. Participants (n = 4,113) recruited from Grady Memorial Hospital in Atlanta, Georgia, completed self-report measures assessing history of trauma, PTSD symptoms, and incarceration. Both trauma exposure and civilian PTSD remained strongly associated with increased risk of involvement in the criminal justice system and charges of a violent offense, even after adjustment for sex, age, race, education, employment, income, and substance abuse in a regression model. Trauma and PTSD have important implications for public safety and recidivism.

  11. Lower stress-reactive cortisol in female veterans associated with military status but not PTSD.

    PubMed

    Pierce, Meghan E; Pritchard, Laurel M

    2016-09-01

    Female veterans are a growing yet understudied population. Currently, 14.6% of all troops deployed to Afghanistan and Iraq are female. Military service is associated with an increased risk for trauma exposure and subsequent development of posttraumatic stress disorder (PTSD). Dysregulation of the hypothalamic-pituitary-adrenal axis is frequently associated with PTSD. Few studies have examined females diagnosed with PTSD and only one study, to our knowledge, has examined HPA-axis dysregulation in female veterans. This study examined salivary cortisol in 52 female veterans and civilians both with and without PTSD. We collected saliva samples at bedtime and awakening, as well as in response to the Trier social stress test (TSST). We found that female veterans had blunted cortisol concentrations at all time points during the TSST compared to female civilians, regardless of PTSD status. Even though all groups showed the expected diurnal decline in cortisol, the difference between awakening and bedtime samples were significant only in civilians without PTSD. The results of our study suggest that stressors specific to the military may lead to lower than normal cortisol, which may not be associated with the expressions of PTSD. PMID:27460501

  12. Healing Touch with Guided Imagery for PTSD in returning active duty military: a randomized controlled trial.

    PubMed

    Jain, Shamini; McMahon, George F; Hasen, Patricia; Kozub, Madelyn P; Porter, Valencia; King, Rauni; Guarneri, Erminia M

    2012-09-01

    Post-traumatic stress disorder (PTSD) remains a significant problem in returning military and warrants swift and effective treatment. We conducted a randomized controlled trial to determine whether a complementary medicine intervention (Healing Touch with Guided Imagery [HT+GI]) reduced PTSD symptoms as compared to treatment as usual (TAU) returning combat-exposed active duty military with significant PTSD symptoms. Active duty military (n = 123) were randomized to 6 sessions (within 3 weeks) of HT+GI vs. TAU. The primary outcome was PTSD symptoms; secondary outcomes were depression, quality of life, and hostility. Repeated measures analysis of covariance with intent-to-treat analyses revealed statistically and clinically significant reduction in PTSD symptoms (p < 0.0005, Cohen's d = 0.85) as well as depression (p < 0.0005, Cohen's d = 0.70) for HT+GI vs. TAU. HT+GI also showed significant improvements in mental quality of life (p = 0.002, Cohen's d = 0.58) and cynicism (p = 0.001, Cohen's d = 0.49) vs. TAU. Participation in a complementary medicine intervention resulted in a clinically significant reduction in PTSD and related symptoms in a returning, combat-exposed active duty military population. Further investigation of GT and biofield therapy approaches for mitigating PTSD in military populations is warranted.

  13. Effect of virtual reality PTSD treatment on mood and neurocognitive outcomes.

    PubMed

    McLay, Robert; Ram, Vasudha; Murphy, Jennifer; Spira, James; Wood, Dennis P; Wiederhold, Mark D; Wiederhold, Brenda K; Johnston, Scott; Reeves, Dennis

    2014-07-01

    Virtual reality (VR) is an emerging tool to help treat posttraumatic stress disorder (PTSD). Previously published studies have shown that VR graded exposure therapy (VR-GET) treatment can result in improvements in PTSD symptoms. Less is known about the impact on depression, general anxiety, and neuropsychological functioning in patients with PTSD. This study examined changes in self-reports of PTSD, depression, and anxiety before and after treatment, and also examined neuropsychological functioning as assessed by a computerized test of simple reaction time, procedural reaction time, and performance on the congruent, incongruent, emotional, and neutral (match the color of the "nonsense word") Stroop tests. Results showed that subjects treated with VR-GET showed significant reductions in PTSD and anxiety severity and significant improvements on the emotional Stroop test. Changes in depression and other measures of neuropsychological function were not significant. Change scores on the emotional Stroop test did not correlate with changes in self-report measures of PTSD. Overall, these findings support the use of VR-GET as a treatment for PTSD but indicate that benefits may be narrowly focused. Additional treatments may be needed after or alongside VR-GET for service members with neuropsychological impairments.

  14. Combat-related PTSD in military court: a diagnosis in search of a defense.

    PubMed

    Sparr, Landy F

    2015-01-01

    As more veterans return from Iraq and Afghanistan, Posttraumatic Stress Disorder (PTSD) often returns with them. As a result, PTSD has quickly become the most prevalent mental disorder diagnosis among active duty United States (U.S.) military. Although numerous studies have not only validated PTSD but have chronicled its negative behavioral impact, it remains a controversial diagnosis. It is widely diagnosed by all types of mental health professionals for even minimal trauma, and DSM-IV PTSD criteria have wide overlap with other mood and anxiety disorders. This, however, has not stopped PTSD from being used in civilian courts in the U.S. as a mental disorder to establish grounds for mental status defenses, such as insanity, diminished capacity, and self-defense, or as a basis for sentencing mitigation. Not surprisingly, PTSD has recently found its way into military courts, where some defense attorneys are eager to draw upon its understandable and linear etiology to craft some type of mental incapacity defense for their clients. As in the civilian sphere, this has met with mixed success due to relevance considerations. A recent court-martial, U.S. v. Lawrence Hutchins III, has effectively combined all the elemental nuances of PTSD in military court.

  15. The Strongest Correlates of PTSD for Firefighters: Number, Recency, Frequency, or Perceived Threat of Traumatic Events?

    PubMed

    Pinto, Ricardo J; Henriques, Sandra P; Jongenelen, Inês; Carvalho, Cláudia; Maia, Ângela C

    2015-10-01

    Firefighters experience a wide range of traumatic events while on duty and are at risk to develop psychopathology and posttraumatic stress disorder (PTSD). According to cognitive models, the person's interpretation of the traumatic event is responsible for the development of PTSD rather than the traumatic event itself. This cross-sectional study aimed to explore the contribution of perceived threat to explain PTSD symptoms in Portuguese firefighters, after adjusting for potential confounding factors. A sample of 397 firefighters completed self-report measures of exposure to traumatic events, psychopathology, and PTSD. Perceived threat explained unique variance in PTSD symptoms, R(2) = .40, ΔR(2) = .02, F(10, 367) = 24.55, p < .001, Cohen's f(2) =.03, after adjusting for psychopathology, number, recency, and frequency of the events, and other potential confounding variables. The association between psychopathology and PTSD was also moderated by perceived threat, R(2) = .43, ΔR(2) = .03, F(11, 366) = 25.33, p < .001, Cohen's f(2) =.05. Firefighters may benefit from interventions that focus on perceived threat to prevent PTSD symptoms.

  16. PTSD symptoms among police officers: associations with frequency, recency, and types of traumatic events.

    PubMed

    Hartley, Tara A; Violanti, John M; Sarkisian, Khachatur; Andrew, Michael E; Burchfiel, Cecil M

    2013-01-01

    Policing necessitates exposure to traumatic, violent and horrific events, which can lead to an increased risk for developing post-traumatic stress disorder (PTSD). The purpose of this study was to determine whether the frequency, recency, and type of police-specific traumatic events were associated with PTSD symptoms. Participants were 359 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2009). Traumatic police events were measured using the Police Incident Survey (PIS); PTSD was measured using the PTSD Checklist-Civilian Version (PCL-C). Associations between PIS and PTSD symptoms were evaluated using ANCOVA. Contrast statements were used to test for linear trends. Increased frequency of specific types of events were associated with an increase in the PCL-C score in women, particularly women with no history of prior trauma and those who reported having a high workload (p < 0.05). More recent exposure to seeing severely assaulted victims was associated with higher PCL-C scores in men (p < 0.02). In summary, the frequency of several traumatic events was associated with higher PTSD scores in women, while the recency of seeing victims of assault was associated with higher PTSD scores in men. These results may be helpful in developing intervention strategies to reduce the psychological effects following exposure and these strategies may be different for men and women.

  17. Combat-related PTSD in military court: a diagnosis in search of a defense.

    PubMed

    Sparr, Landy F

    2015-01-01

    As more veterans return from Iraq and Afghanistan, Posttraumatic Stress Disorder (PTSD) often returns with them. As a result, PTSD has quickly become the most prevalent mental disorder diagnosis among active duty United States (U.S.) military. Although numerous studies have not only validated PTSD but have chronicled its negative behavioral impact, it remains a controversial diagnosis. It is widely diagnosed by all types of mental health professionals for even minimal trauma, and DSM-IV PTSD criteria have wide overlap with other mood and anxiety disorders. This, however, has not stopped PTSD from being used in civilian courts in the U.S. as a mental disorder to establish grounds for mental status defenses, such as insanity, diminished capacity, and self-defense, or as a basis for sentencing mitigation. Not surprisingly, PTSD has recently found its way into military courts, where some defense attorneys are eager to draw upon its understandable and linear etiology to craft some type of mental incapacity defense for their clients. As in the civilian sphere, this has met with mixed success due to relevance considerations. A recent court-martial, U.S. v. Lawrence Hutchins III, has effectively combined all the elemental nuances of PTSD in military court. PMID:25697713

  18. [Untreated PTSD in schizophrenia - unrecognized risk factor for recovery and course of illness?].

    PubMed

    Vauth, R; Nyberg, E

    2007-08-01

    More recently research has focused on post-traumatic stress disorder (PTSD) as comorbide condition of schizophrenia. Current literature focussing the relationship between PTSD and schizophrenia is reviewed. Evidence is found in support of psychosis as a precondition for development of PTSD, PTSD as vulnerability factor for psychosis as well as psychosis and PTSD both as part of a spectrum of responses to a traumatic event. PTSD may be regarded as risk factor for worse outcome in schizophrenia: Internal stress of reexperiencing the trauma may enhance vulnerability to relapse of illness and proneness to anxiety avoiding coping style with psychosis by adoption of a "sealing over" style, lowering service utilization and compliance. Risk for development of alcohol misuse, cannabis misuse or benzodiazepine misuse and depression may be higher, also worsening the course of schizophrenia. Methodological shortcomings of current studies, ongoing debates on extending DSM-IV criterion A1 definition to psychotic or treatment experiences and implications for clinical assessment and cognitive-behavioural treatment of PTSD in schizophrenia are discussed. PMID:17380464

  19. Do PTSD Symptoms and Course Predict Continued Substance Use for Homeless Individuals in Contingency Management for Cocaine Dependence?

    PubMed Central

    Burns, Michelle Nicole; Lehman, Kenneth A.; Milby, Jesse B.; Wallace, Dennis; Schumacher, Joseph E.

    2010-01-01

    Homeless individuals (n = 187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD. PMID:20363465

  20. Normative life events and PTSD in children: how easy stress can affect children's brain.

    PubMed

    Kousha, Maryam; Mehdizadeh Tehrani, Shervin

    2013-01-01

    Exposure to traumatic events is common in children and adolescent. Post traumatic stress disorder (PTSD) is an emotional reaction to traumatic events, which is increasingly recognized to be a prevalent and disabling disorder. The aim of this study is to determine the distribution of normative life events which predicts PTSD in youth who referred to an outpatient clinic in Rasht, Iran. This study is a cross-sectional descriptive study. The samples of children and adolescents ranging from 1-18 yr old who were diagnosed PTSD based on DSM-IV criteria in psychiatric interview and K-SADS (Kiddie-schedule for affective disorder and schizophrenia for school age children) semi-structured diagnostic interview, from 2005 until 2008.The information consist of: age, sex, comorbidity with PTSD, events accompanying with PTSD, and time interval between events and visit. Eighty four youth who met the diagnosis of PTSD and their parents participated in the survey. Half of PTSD youth were 6-11 years old and admitted to clinic in the first 3 months after events. The most common events were witnessing violent or fearful scenes on TV followed by witnessing someone's death or funeral ceremony. The most comorbidity with PTSD included: attention deficit hyperactivity disorder, depression and anxiety. Our results indicate that youth exposure to violent or fearful scenes on TV could be very traumatic for them. Informing parents about the potential effect of low-magnitude stressors such as violent or fearful scenes on TV and funeral ceremony can decrease the prevalence of PTSD in youth. PMID:23456584

  1. Normative life events and PTSD in children: how easy stress can affect children's brain.

    PubMed

    Kousha, Maryam; Mehdizadeh Tehrani, Shervin

    2013-01-01

    Exposure to traumatic events is common in children and adolescent. Post traumatic stress disorder (PTSD) is an emotional reaction to traumatic events, which is increasingly recognized to be a prevalent and disabling disorder. The aim of this study is to determine the distribution of normative life events which predicts PTSD in youth who referred to an outpatient clinic in Rasht, Iran. This study is a cross-sectional descriptive study. The samples of children and adolescents ranging from 1-18 yr old who were diagnosed PTSD based on DSM-IV criteria in psychiatric interview and K-SADS (Kiddie-schedule for affective disorder and schizophrenia for school age children) semi-structured diagnostic interview, from 2005 until 2008.The information consist of: age, sex, comorbidity with PTSD, events accompanying with PTSD, and time interval between events and visit. Eighty four youth who met the diagnosis of PTSD and their parents participated in the survey. Half of PTSD youth were 6-11 years old and admitted to clinic in the first 3 months after events. The most common events were witnessing violent or fearful scenes on TV followed by witnessing someone's death or funeral ceremony. The most comorbidity with PTSD included: attention deficit hyperactivity disorder, depression and anxiety. Our results indicate that youth exposure to violent or fearful scenes on TV could be very traumatic for them. Informing parents about the potential effect of low-magnitude stressors such as violent or fearful scenes on TV and funeral ceremony can decrease the prevalence of PTSD in youth.

  2. Male veterans with PTSD exhibit aberrant neural dynamics during working memory processing: an MEG study

    PubMed Central

    McDermott, Timothy J.; Badura-Brack, Amy S.; Becker, Katherine M.; Ryan, Tara J.; Khanna, Maya M.; Heinrichs-Graham, Elizabeth; Wilson, Tony W.

    2016-01-01

    Background Posttraumatic stress disorder (PTSD) is associated with executive functioning deficits, including disruptions in working memory. In this study, we examined the neural dynamics of working memory processing in veterans with PTSD and a matched healthy control sample using magnetoencephalography (MEG). Methods Our sample of recent combat veterans with PTSD and demographically matched participants without PTSD completed a working memory task during a 306-sensor MEG recording. The MEG data were preprocessed and transformed into the time-frequency domain. Significant oscillatory brain responses were imaged using a beamforming approach to identify spatiotemporal dynamics. Results Fifty-one men were included in our analyses: 27 combat veterans with PTSD and 24 controls. Across all participants, a dynamic wave of neural activity spread from posterior visual cortices to left frontotemporal regions during encoding, consistent with a verbal working memory task, and was sustained throughout maintenance. Differences related to PTSD emerged during early encoding, with patients exhibiting stronger α oscillatory responses than controls in the right inferior frontal gyrus (IFG). Differences spread to the right supramarginal and temporal cortices during later encoding where, along with the right IFG, they persisted throughout the maintenance period. Limitations This study focused on men with combat-related PTSD using a verbal working memory task. Future studies should evaluate women and the impact of various traumatic experiences using diverse tasks. Conclusion Posttraumatic stress disorder is associated with neurophysiological abnormalities during working memory encoding and maintenance. Veterans with PTSD engaged a bilateral network, including the inferior prefrontal cortices and supramarginal gyri. Right hemispheric neural activity likely reflects compensatory processing, as veterans with PTSD work to maintain accurate performance despite known cognitive deficits

  3. Factor structure of PTSD, and relation with gender in trauma survivors from India

    PubMed Central

    Charak, Ruby; Armour, Cherie; Elklit, Ask; Angmo, Disket; Elhai, Jon D.; Koot, Hans M.

    2014-01-01

    Background The factor structure of posttraumatic stress disorder (PTSD) has been extensively studied in Western countries. Some studies have assessed its factor structure in Asia (China, Sri Lanka, and Malaysia), but few have directly assessed the factor structure of PTSD in an Indian adult sample. Furthermore, in a largely patriarchal society in India with strong gender roles, it becomes imperative to assess the association between the factors of PTSD and gender. Objective The purpose of the present study was to assess the factor structure of PTSD in an Indian sample of trauma survivors based on prevailing models of PTSD defined in the DSM-IV-TR (APA, 2000), and to assess the relation between PTSD factors and gender. Method The sample comprised of 313 participants (55.9% female) from Jammu and Kashmir, India, who had experienced a natural disaster (N=200) or displacement due to cross-border firing (N=113). Results Three existing PTSD models—two four-factor models (Emotional Numbing and Dysphoria), and a five-factor model (Dysphoric Arousal)—were tested using Confirmatory Factor Analysis with addition of gender as a covariate. The three competing models had similar fit indices although the Dysphoric Arousal model fit significantly better than Emotional Numbing and Dysphoria models. Gender differences were found across the factors of Re-experiencing and Anxious arousal. Conclusions Findings indicate that the Dysphoric Arousal model of PTSD was the best model; albeit the fit indices of all models were fairly similar. Compared to males, females scored higher on factors of Re-experiencing and Anxious arousal. Gender differences found across two factors of PTSD are discussed in light of the social milieu in India. PMID:25413575

  4. Methylphenidate and desipramine combined treatment improves PTSD symptomatology in a rat model

    PubMed Central

    Aga-Mizrachi, S; Cymerblit-Sabba, A; Gurman, O; Balan, A; Shwam, G; Deshe, R; Miller, L; Gorodetsky, N; Heinrich, N; Tzezana, O; Zubedat, S; Grinstein, D; Avital, A

    2014-01-01

    Antidepressant medication constitutes the first line pharmacological treatment for posttraumatic stress disorder (PTSD), however, because many patients display no beneficial drug effects it has been suggested that combinations of antidepressants with additional drugs may be necessary. The defining symptoms of PTSD include re-experiencing, avoidance and hyperarousal. In addition, PTSD patients were shown to become easily distracted and often suffer from poor concentration together with indications of comorbidity with attention-deficit hyperactivity disorder (ADHD). Methylphenidate (MPH) is the most common and effective drug treatment for ADHD, thus we aimed to investigate the effects of MPH treatment, by itself or in combination with the antidepressants fluoxetine (FLU) or desipramine (DES). We modified an animal model of PTSD by exposing rats to chronic stress and evaluating the subsequent development of behavioral PTSD-like symptoms, as well as the effects on proinflammatory cytokines, which were implicated in PTSD. We report that while FLU or DES had a beneficial effect on avoidance and hyperarousal symptoms, MPH improved all three symptoms. Moreover, the combination of MPH with DES produced the most dramatic beneficial effects. Serum levels of interleukin-1β (IL-1β) and IL-6 were elevated in the PTSD-like group compared with the control group, and were decreased by MPH, FLU, DES or the combination drug treatments, with the combination of DES+MPH producing the most complete rescue of the inflammatory response. Considering the versatile symptoms of PTSD, our results suggest a new combined treatment for PTSD comprising the antidepressant DES and the psychostimulant MPH. PMID:25247592

  5. PTSD symptoms and pain in Canadian military veterans: the mediating roles of anxiety, depression, and alcohol use.

    PubMed

    Irwin, Kara C; Konnert, Candace; Wong, May; O'Neill, Thomas A

    2014-04-01

    Symptoms of posttraumatic stress disorder (PTSD) and pain are often comorbid among veterans. The purpose of this study was to investigate to what extent symptoms of anxiety, depression, and alcohol use mediated the relationship between PTSD symptoms and pain among 113 treated male Canadian veterans. Measures of PTSD, pain, anxiety symptoms, depression symptoms, and alcohol use were collected as part of the initial assessment. The bootstrapped resampling analyses were consistent with the hypothesis of mediation for anxiety and depression, but not alcohol use. The confidence intervals did not include zero and the indirect effect of PTSD on pain through anxiety was .04, CI [.03, .07]. The indirect effect of PTSD on pain through depression was .04, CI [.02, .07]. These findings suggest that PTSD and pain symptoms among veterans may be related through the underlying symptoms of anxiety and depression, thus emphasizing the importance of targeting anxiety and depression symptoms when treating comorbid PTSD and pain patients.

  6. Race-related PTSD: the Asian American Vietnam veteran.

    PubMed

    Loo, C M

    1994-10-01

    This article presents a conceptual framework by which to understand race-related post-traumatic stress disorder (PTSD) for the Asian American Vietnam veteran. The framework draws from cognitive schema theory, social behaviorism, the notion of cumulative racism as trauma, and the assumption that bifurcation and negation of one's bicultural identity is injurious. Classifications of race-related stress or trauma that may be experienced by Asian American Vietnam veterans, with exemplifying clinical case material, are presented. These types of stressors include being mistaken for Vietnamese, verbal and physical assaults that are race-related, death and near-death experiences that are race-related, racial stigmatization, dissociation from one's Asian identity, and marginalization. As studies of combat trauma and sexual assault forced the psychological stresses attendant to war and sexist oppression into public consciousness, so this article addresses psychological stress and trauma attendant to racism.

  7. Psychometric Properties of the Life Events Checklist

    ERIC Educational Resources Information Center

    Gray, Matt J.; Litz, Brett T.; Hsu, Julie L.; Lombardo, Thomas W.

    2004-01-01

    The Life Events Checklist (LEC), a measure of exposure to potentially traumatic events, was developed at the National Center for Posttraumatic Stress Disorder (PTSD) concurrently with the Clinician Administered PTSD Scale (CAPS) to facilitate the diagnosis of PTSD. Although the CAPS is recognized as the gold standard in PTSD symptom assessment,…

  8. Epigenetic Mechanisms in Learned Fear: Implications for PTSD

    PubMed Central

    Zovkic, Iva B; Sweatt, J David

    2013-01-01

    One of the most exciting discoveries in the learning and memory field in the past two decades is the observation that active regulation of gene expression is necessary for experience to trigger lasting functional and behavioral change, in a wide variety of species, including humans. Thus, as opposed to the traditional view of ‘nature' (genes) being separate from ‘nurture' (environment and experience), it is now clear that experience actively drives alterations in central nervous system (CNS) gene expression in an ongoing fashion, and that the resulting transcriptional changes are necessary for experience to trigger altered long-term behavior. In parallel over the past decade, epigenetic mechanisms, including regulation of chromatin structure and DNA methylation, have been shown to be potent regulators of gene transcription in the CNS. In this review, we describe data supporting the hypothesis that epigenetic molecular mechanisms, especially DNA methylation and demethylation, drive long-term behavioral change through active regulation of gene transcription in the CNS. Specifically, we propose that epigenetic molecular mechanisms underlie the formation and stabilization of context- and cue-triggered fear conditioning based in the hippocampus and amygdala, a conclusion reached in a wide variety of studies using laboratory animals. Given the relevance of cued and contextual fear conditioning to post-traumatic stress, by extension we propose that these mechanisms may contribute to post-traumatic stress disorder (PTSD) in humans. Moreover, we speculate that epigenetically based pharmacotherapy may provide a new avenue of drug treatment for PTSD-related cognitive and behavioral function. PMID:22692566

  9. TPM: cloud-based tele-PTSD monitor using multi-dimensional information.

    PubMed

    Xu, Roger; Mei, Gang; Zhang, Guangfan; Gao, Pan; Pepe, Aaron; Li, Jiang

    2013-01-01

    An automated system that can remotely and non-intrusively screen individuals at high risk for Post-Traumatic Stress Disorder (PTSD) and monitor their progress during treatment would be desired by many Veterans Affairs (VAs) as well as other PTSD treatment and research organizations. In this paper, we present an automated, cloud-based Tele-PTSD Monitor (TPM) system based on the fusion of multiple sources of information. The TPM system can be hosted in a cloud environment and accessed through landline or cell phones, or on the Internet through a web portal or mobile application (app).

  10. Is maternal PTSD associated with greater exposure of very young children to violent media?

    PubMed

    Schechter, Daniel S; Gross, Anna; Willheim, Erica; McCaw, Jaime; Turner, J Blake; Myers, Michael M; Zeanah, Charles H; Gleason, Mary Margaret

    2009-12-01

    This study examined media viewing by mothers with violence-related posttraumatic stress disorder (PTSD) and related media exposure of their preschool-age children. Mothers (N = 67) recruited from community pediatric clinics participated in a protocol involving a media-preference survey. Severity of maternal PTSD and dissociation were significantly associated with child exposure to violent media. Family poverty and maternal viewing behavior were also associated. Maternal viewing behavior mediated the effects specifically of maternal PTSD severity on child exposure. Clinicians should assess maternal and child media viewing practices in families with histories of violent trauma exposure and related psychopathology.

  11. Teaching Students to Administer the WISC

    ERIC Educational Resources Information Center

    Ritter, Kathleen Yost

    1977-01-01

    A college level psychology course is described in which students were trained by both traditional and experimental methods to administer individual intelligence tests. Comparative analysis of performance by each group indicates that student motivation and performance is not greatly influenced by teaching method and that videotape demonstrations…

  12. Changes in Medications Administered in Schools

    ERIC Educational Resources Information Center

    McCarthy, Ann Marie; Kelly, Michael W.; Johnson, Shella; Roman, Jaclyn; Zimmerman, M. Bridget

    2006-01-01

    The purpose of this descriptive, cross-sectional study was to determine if there have been changes in the type and number of attention deficit/hyperactivity disorder (AD/HD) medications administered in schools since the introduction of long-acting stimulants. A survey was sent to 1,000 school nurses randomly selected from the National Association…

  13. Treatment of PTSD in older adults: Do cognitive-behavioral interventions remain viable?

    PubMed Central

    Clapp, Joshua D.; Beck, J. Gayle

    2011-01-01

    The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitive-behavioral group intervention. Observations from this case series suggests that cognitive-behavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed. PMID:22383863

  14. PTSD in psychiatric nurses and other mental health providers: a review of the literature.

    PubMed

    Jacobowitz, William

    2013-11-01

    Psychiatric nurses are subject to a high rate of assault by patients. The stress of exposure to assault and the potential for assault appear to impact nurses' emotional states in the form of post-traumatic stress and post-traumatic stress disorder (PTSD). Most studies report a prevalence rate of PTSD in this population of between 9-10%. Training in the management of aggressive patients, participating in Critical Incident Debriefing, and having routine structured debriefing meetings may play a role in facilitating the development of resilience in nurses with respect to the risk of PTSD. Knowledge about the state of the science regarding aggression and PTSD is necessary for clinicians and researchers to develop and test effective strategies. This article presents a review of the current literature on this topic. PMID:24131410

  15. PTSD in psychiatric nurses and other mental health providers: a review of the literature.

    PubMed

    Jacobowitz, William

    2013-11-01

    Psychiatric nurses are subject to a high rate of assault by patients. The stress of exposure to assault and the potential for assault appear to impact nurses' emotional states in the form of post-traumatic stress and post-traumatic stress disorder (PTSD). Most studies report a prevalence rate of PTSD in this population of between 9-10%. Training in the management of aggressive patients, participating in Critical Incident Debriefing, and having routine structured debriefing meetings may play a role in facilitating the development of resilience in nurses with respect to the risk of PTSD. Knowledge about the state of the science regarding aggression and PTSD is necessary for clinicians and researchers to develop and test effective strategies. This article presents a review of the current literature on this topic.

  16. The consistency of combat exposure reporting and course of PTSD in Vietnam War veterans.

    PubMed

    Koenen, K C; Stellman, S D; Dohrenwend, B P; Sommer, J F; Stellman, J M

    2007-02-01

    Self-reports of traumatic events are often used in clinical and epidemiologic studies. Nevertheless, research suggests combat exposure reports may be biased by posttraumatic stress disorder (PTSD) symptom severity, leading to an inflated dose-response relation between combat exposure and PTSD. The authors examined the consistency in combat exposure reports and their relation to PTSD symptoms in Vietnam Veteran American Legionnaires who responded to two mailed surveys (1984, 1998; N = 1,462). Combat exposure reports were highly reliable (test-retest correlation = 0.87). However, changes in exposure reporting were related to changes in PTSD symptoms, specifically reexperiencing symptoms. The effect size of the dose-response relation attributable to changes in reporting was smaller for continuous than categorical measures. Findings are discussed in relation to recent controversies over veterans' combat exposure reports.

  17. Efficacy of Narrative Writing as an Intervention for PTSD: Does the Evidence Support Its Use?

    PubMed Central

    Sawyer, Alice T.; Lowmaster, Sara E.; Wernick, Jeremy; Marx, Brian P.

    2015-01-01

    Although a number of effective psychotherapies for posttraumatic stress disorder (PTSD) are available, there is a need to develop alternative treatments for those who may not respond optimally to these treatments or who may not have access to clinicians who can competently deliver them. Narrative writing, which involves repeated recounting about a traumatic event in writing, is one treatment that deserves further examination as a potential alternative. In this paper, we describe the most commonly used narrative writing treatment protocols for those with either a diagnosis of PTSD or probable PTSD and discuss the available efficacy data for each of these protocols. We conclude with recommendations for using narrative writing to treat those with PTSD and offer recommendations for future work in this area. PMID:26640295

  18. PTSD Treatment Programs in the U.S. Department of Veterans Affairs

    MedlinePlus

    ... the bottom of the page. Share this page Search PTSD Site Choose Section Enter Term and Search ... Coach Online Tools to help you manage stress. Search Pilots Search PILOTS *, the largest citation database on ...

  19. Real-Time fMRI Neurofeedback with War Veterans with Chronic PTSD: A Feasibility Study

    PubMed Central

    Gerin, Mattia I.; Fichtenholtz, Harlan; Roy, Alicia; Walsh, Christopher J.; Krystal, John H.; Southwick, Steven; Hampson, Michelle

    2016-01-01

    Many patients with post-traumatic stress disorder (PTSD), especially war veterans, do not respond to available treatments. Here, we describe a novel neurofeedback (NF) intervention using real-time functional magnetic resonance imaging for treating and studying PTSD. The intervention involves training participants to control amygdala activity after exposure to personalized trauma scripts. Three combat veterans with chronic PTSD participated in this feasibility study. All three participants tolerated well the NF training. Moreover, two participants, despite the chronicity of their symptoms, showed clinically meaningful improvements, while one participant showed a smaller symptom reduction. Examination of changes in resting-state functional connectivity patterns revealed a normalization of brain connectivity consistent with clinical improvement. These preliminary results support feasibility of this novel intervention for PTSD and indicate that larger, well-controlled studies of efficacy are warranted. PMID:27445868

  20. Real-Time fMRI Neurofeedback with War Veterans with Chronic PTSD: A Feasibility Study.

    PubMed

    Gerin, Mattia I; Fichtenholtz, Harlan; Roy, Alicia; Walsh, Christopher J; Krystal, John H; Southwick, Steven; Hampson, Michelle

    2016-01-01

    Many patients with post-traumatic stress disorder (PTSD), especially war veterans, do not respond to available treatments. Here, we describe a novel neurofeedback (NF) intervention using real-time functional magnetic resonance imaging for treating and studying PTSD. The intervention involves training participants to control amygdala activity after exposure to personalized trauma scripts. Three combat veterans with chronic PTSD participated in this feasibility study. All three participants tolerated well the NF training. Moreover, two participants, despite the chronicity of their symptoms, showed clinically meaningful improvements, while one participant showed a smaller symptom reduction. Examination of changes in resting-state functional connectivity patterns revealed a normalization of brain connectivity consistent with clinical improvement. These preliminary results support feasibility of this novel intervention for PTSD and indicate that larger, well-controlled studies of efficacy are warranted. PMID:27445868

  1. Treatment Options for Individuals with PTSD and Concurrent TBI: A Literature Review and Case Presentation.

    PubMed

    Watson, Hans R; Ghani, Musammar; Correll, Terry

    2016-07-01

    Posttraumatic stress disorder (PTSD) is a well-studied mental health condition with existing guidelines and algorithms for treatment of PTSD. Those guidelines, while acknowledging an increased complexity, fail to provide clear PTSD treatment guidelines when an individual has a concurrent traumatic brain injury (TBI) diagnosis. Therefore, a literature review along with an accompanying case presentation is presented to demonstrate the minimum necessary considerations for approaching treatment of this complex population. Treatment approaches must be lead by providers that have the expertise and training necessary to consider all facets of the patient and their potential options. The provider must consider the pathophysiology of PTSD and TBI and be capable of leading a team to identify the patient's source(s) of dysfunction, current cognitive abilities, and potential indications for psychotropic medications and/or other types of therapeutic intervention. PMID:27222137

  2. Development of a VR therapy application for Iraq war military personnel with PTSD.

    PubMed

    Rizzo, Albert; Pair, Jarrell; McNerney, Peter J; Eastlund, Ernie; Manson, Brian; Gratch, Jon; Hill, Randy; Swartout, Bill

    2005-01-01

    Post Traumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experiences including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that 1 out of 6 returning Iraq War military personnel are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) exposure therapy has been used in previous treatments of PTSD patients with reports of positive outcomes. The aim of the current paper is to specify the rationale, design and development of an Iraq War PTSD VR application that is being created from the virtual assets that were initially developed for theX-Box game entitled Full Spectrum Warrior which was inspired by a combat tactical training simulation, Full Spectrum Command. PMID:15718769

  3. 76 FR 16039 - Agency Information Collection (Statement in Support of Claim for Service Connection for PTSD...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-22

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Statement in Support of Claim for Service Connection for PTSD) Under OMB Review AGENCY: Veterans Benefits Administration, Department of Veterans Affairs....

  4. Pharmacological enhancement of exposure-based treatment in PTSD: a qualitative review

    PubMed Central

    de Kleine, Rianne A.; Rothbaum, Barbara O.; van Minnen, Agnes

    2013-01-01

    There is a good amount of evidence that exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD). Notwithstanding its efficacy, there is room for improvement, since a large proportion of patients does not benefit from treatment. Recently, an interesting new direction in the improvement of exposure therapy efficacy for PTSD emerged. Basic research found evidence of the pharmacological enhancement of the underlying learning and memory processes of exposure therapy. The current review aims to give an overview of clinical studies on pharmacological enhancement of exposure-based treatment for PTSD. The working mechanisms, efficacy studies in PTSD patients, and clinical utility of four different pharmacological enhancers will be discussed: d-cycloserine, MDMA, hydrocortisone, and propranolol. PMID:24147208

  5. Treatment of active duty military with PTSD in primary care: A follow-up report.

    PubMed

    Cigrang, Jeffrey A; Rauch, Sheila A M; Mintz, Jim; Brundige, Antoinette; Avila, Laura L; Bryan, Craig J; Goodie, Jeffrey L; Peterson, Alan L

    2015-12-01

    First-line trauma-focused therapies offered in specialty mental health clinics do not reach many veterans and active duty service members with posttraumatic stress disorder (PTSD). Primary care is an ideal environment to expand access to mental health care. Several promising clinical case series reports of brief PTSD therapies adapted for primary care have shown positive results, but the long-term effectiveness with military members is unknown. The purpose of this study was to determine the long-term outcome of an open trial of a brief cognitive-behavioral primary care-delivered protocol developed specifically for deployment-related PTSD in a sample of 24 active duty military (15 men, 9 women). Measures of PTSD symptom severity showed statistically and clinically significant reductions from baseline to posttreatment that were maintained at the 6-month and 1-year follow-up assessments. Similar reductions were maintained in depressive symptoms and ratings of global mental health functioning. PMID:26519833

  6. Vietnam Vets with PTSD More Than Twice As Likely to Have Heart Disease

    MedlinePlus

    ... Emory University and chair of the department of epidemiology at the Rollins School of Public Health. “For ... 7.7 million U.S. adults, PTSD is an anxiety disorder that develops in a minority of people ...

  7. The role of the dopamine transporter (DAT) in the development of PTSD in preschool children.

    PubMed

    Drury, Stacy S; Theall, Katherine P; Keats, Bronya J B; Scheeringa, Michael

    2009-12-01

    Population-based association studies have supported the heritability of posttraumatic stress disorder (PTSD). This study explored the influence of genetic variation in the dopamine transporter (DAT) 3' untranslated region variable number tandem repeat on the development of PTSD in preschool children exposed to Hurricane Katrina, diagnosed using a developmentally appropriate semistructured interview. A diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , (DSM-IV; American Psychiatric Association, 1994), total symptoms, and specifically Criterion D symptoms were significantly more likely to be found in children with the 9 allele. This study replicates a previous finding in adults with PTSD. The specificity of this finding to the increased arousal symptoms of Criterion D suggests that dopamine and the DAT allele may contribute to one heritable path in a multifinality model of the development of PTSD.

  8. Treatment of active duty military with PTSD in primary care: A follow-up report.

    PubMed

    Cigrang, Jeffrey A; Rauch, Sheila A M; Mintz, Jim; Brundige, Antoinette; Avila, Laura L; Bryan, Craig J; Goodie, Jeffrey L; Peterson, Alan L

    2015-12-01

    First-line trauma-focused therapies offered in specialty mental health clinics do not reach many veterans and active duty service members with posttraumatic stress disorder (PTSD). Primary care is an ideal environment to expand access to mental health care. Several promising clinical case series reports of brief PTSD therapies adapted for primary care have shown positive results, but the long-term effectiveness with military members is unknown. The purpose of this study was to determine the long-term outcome of an open trial of a brief cognitive-behavioral primary care-delivered protocol developed specifically for deployment-related PTSD in a sample of 24 active duty military (15 men, 9 women). Measures of PTSD symptom severity showed statistically and clinically significant reductions from baseline to posttreatment that were maintained at the 6-month and 1-year follow-up assessments. Similar reductions were maintained in depressive symptoms and ratings of global mental health functioning.

  9. Effects of Cognitive–Behavioral Conjoint Therapy for PTSD on Partners’ Psychological Functioning

    PubMed Central

    Shnaider, Philippe; Pukay-Martin, Nicole D.; Fredman, Steffany J.; Macdonald, Alexandra; Monson, Candice M.

    2015-01-01

    A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in “one” partner are negatively associated with their intimate partner’s psychological functioning. The present study investigated intimate partners’ mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive–behavioral conjoint therapy for PTSD (Monson & Fredman, 2012). There were no significant differences between active treatment and waitlist in intimate partners’ psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive–behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress. PMID:24706354

  10. DSM-5 Criteria and Its Implications for Diagnosing PTSD in Military Service Members and Veterans.

    PubMed

    Guina, Jeffrey; Welton, Randon S; Broderick, Pamela J; Correll, Terry L; Peirson, Ryan P

    2016-05-01

    This review addresses how changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 posttraumatic stress disorder (PTSD) criteria has the potential to affect the care and careers of those who have served in the military, where the diagnosis often determines fitness for duty and veterans' benefits. PTSD criteria changes were intended to integrate new knowledge acquired since previous DSM editions. Many believe the changes will improve diagnosis and treatment, but some worry these could have negative clinical, occupational, and legal consequences. We analyze the changes in classification, trauma definition, symptoms, symptom clusters, and subtypes and possible impacts on the military (e.g., over- and under-diagnosis, "drone" video exposure, subthreshold PTSD, and secondary PTSD). We also discuss critiques and proposals for future changes. Our objectives are to improve the screening, diagnosis, and treatment of those service members who have survived trauma and to improve policies related to the military mental healthcare and disability systems. PMID:26971499

  11. DSM-5 Criteria and Its Implications for Diagnosing PTSD in Military Service Members and Veterans.

    PubMed

    Guina, Jeffrey; Welton, Randon S; Broderick, Pamela J; Correll, Terry L; Peirson, Ryan P

    2016-05-01

    This review addresses how changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 posttraumatic stress disorder (PTSD) criteria has the potential to affect the care and careers of those who have served in the military, where the diagnosis often determines fitness for duty and veterans' benefits. PTSD criteria changes were intended to integrate new knowledge acquired since previous DSM editions. Many believe the changes will improve diagnosis and treatment, but some worry these could have negative clinical, occupational, and legal consequences. We analyze the changes in classification, trauma definition, symptoms, symptom clusters, and subtypes and possible impacts on the military (e.g., over- and under-diagnosis, "drone" video exposure, subthreshold PTSD, and secondary PTSD). We also discuss critiques and proposals for future changes. Our objectives are to improve the screening, diagnosis, and treatment of those service members who have survived trauma and to improve policies related to the military mental healthcare and disability systems.

  12. Combat veterans with comorbid PTSD and mild TBI exhibit a greater inhibitory processing ERP from the dorsal anterior cingulate cortex.

    PubMed

    Shu, I-Wei; Onton, Julie A; O'Connell, Ryan M; Simmons, Alan N; Matthews, Scott C

    2014-10-30

    Posttraumatic stress disorder (PTSD) is common among combat personnel with mild traumatic brain injury (mTBI). While patients with either PTSD or mTBI share abnormal activation of multiple frontal brain areas, anterior cingulate cortex (ACC) activity during inhibitory processing may be particularly affected by PTSD. To further test this hypothesis, we recorded electroencephalography from 32 combat veterans with mTBI-17 of whom were also comorbid for PTSD (mTBI+PTSD) and 15 without PTSD (mTBI-only). Subjects performed the Stop Task, a validated inhibitory control task requiring inhibition of initiated motor responses. We observed a larger inhibitory processing eventrelated potential (ERP) in veterans with mTBI+PTSD, including greater N200 negativity. Furthermore, greater N200 negativity correlated with greater PTSD severity. This correlation was most dependent on contributions from the dorsal ACC. Support vector machine analysis demonstrated that N200 and P300 amplitudes objectively classified veterans into mTBI-only or mTBI+PTSD groups with 79.4% accuracy. Our results support a model where, in combat veterans with mTBI, larger ERPs from cingulate areas are associated with greater PTSD severity and likely related to difficulty controlling ongoing brain processes, including trauma-related thoughts and feelings.

  13. Applicability of the ICD-11 proposal for PTSD: a comparison of prevalence and comorbidity rates with the DSM-IV PTSD classification in two post-conflict samples

    PubMed Central

    Stammel, Nadine; Abbing, Eva M.; Heeke, Carina; Knaevelsrud, Christine

    2015-01-01

    Background The World Health Organization recently proposed significant changes to the posttraumatic stress disorder (PTSD) diagnostic criteria in the 11th edition of the International Classification of Diseases (ICD-11). Objective The present study investigated the impact of these changes in two different post-conflict samples. Method Prevalence and rates of concurrent depression and anxiety, socio-demographic characteristics, and indicators of clinical severity according to ICD-11 in 1,075 Cambodian and 453 Colombian civilians exposed to civil war and genocide were compared to those according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Results Results indicated significantly lower prevalence rates under the ICD-11 proposal (8.1% Cambodian sample and 44.4% Colombian sample) compared to the DSM-IV (11.2% Cambodian sample and 55.0% Colombian sample). Participants meeting a PTSD diagnosis only under the ICD-11 proposal had significantly lower rates of concurrent depression and a lower concurrent total score (depression and anxiety) compared to participants meeting only DSM-IV diagnostic criteria. There were no significant differences in socio-demographic characteristics and indicators of clinical severity between these two groups. Conclusions The lower prevalence of PTSD according to the ICD-11 proposal in our samples of persons exposed to a high number of traumatic events may counter criticism of previous PTSD classifications to overuse the PTSD diagnosis in populations exposed to extreme stressors. Also another goal, to better distinguish PTSD from comorbid disorders could be supported with our data. PMID:25989951

  14. Combining Seeking Safety with Sertraline for PTSD and Alcohol Use Disorders: A Randomized Controlled Trial

    PubMed Central

    Hien, Denise; Levin, Frances Rudnick; Ruglass, Lesia; López-Castro, Teresa; Papini, Santiago; Hu, Mei Chen; Cohen, Lisa; Herron, Abigail

    2015-01-01

    Objective The current study marks the first randomized controlled trial to test the benefit of combining Seeking Safety (SS), a present-focused cognitive behavioral therapy for co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), with sertraline, a front-line medication for PTSD shown to also impact drinking outcomes. Method Sixty-nine participants (81% female; 59% African American) with primarily childhood sexual (46%) and physical (39%) trauma exposure, and drug dependence in addition to AUD were randomized to receive a partial-dose (12 sessions) of SS with either sertraline (n = 32; M = 7 sessions) or placebo (n = 37; M = 6 sessions). Assessments conducted at baseline, end-of-treatment, 6- and 12-months posttreatment measured PTSD and AUD symptom severity. Results Both groups demonstrated significant improvement in PTSD symptoms. The SS plus sertraline group exhibited a significantly greater reduction in PTSD symptoms than the SS plus placebo group at end-of-treatment (M difference = −16.15, p = .04, d = 0.83), which was sustained at 6- and 12-month follow-up (M difference = −13.81, p = .04, d = 0.71, and M difference = −12.72, p = .05, d = 0.65, respectively). Both SS groups improved significantly on AUD severity at all posttreatment time points with no significant differences between SS plus sertraline and SS plus placebo. Conclusion Results support the combining of a cognitive behavioral therapy and sertraline for PTSD/AUD. Clinically significant reductions in both PTSD and AUD severity were achieved and sustained through 12-months follow-up, Moreover, greater mean improvement in PTSD symptoms was observed across all follow-up assessments in the SS plus sertraline group. PMID:25622199

  15. Prospective Prediction of PTSD Symptoms Using Fear Potentiated Auditory Startle Responses

    PubMed Central

    Pole, Nnamdi; Neylan, Thomas C.; Otte, Christian; Henn-Hasse, Clare; Metzler, Thomas J.; Marmar, Charles R.

    2009-01-01

    Background PTSD has been most consistently associated with exaggerated physiological reactivity to startling sounds when such sounds occur in threatening contexts. There is conflicting evidence about whether startle hyperreactivity is a pre-existing vulnerability factor for PTSD or an acquired result of post-trauma neural sensitization. Until now, there have been no prospective studies of physiological reactivity to startling sounds in threatening contexts as predictors of PTSD symptoms. Methods One hundred and thirty-eight police academy cadets without current psychopathology were exposed to repeated 106 dB startling sounds under increasing (low, medium, or high) threat of mild electric shock while their eyeblink electromyogram, skin conductance, heart rate, and subjective fear responses were recorded. Measures of response habituation were also calculated. Following one year of exposure to police-related trauma, these participants were assessed for PTSD symptom severity. Results After accounting for other baseline variables that were predictive of PTSD symptom severity (age and general psychiatric distress), more severe PTSD symptoms were prospectively and independently predicted by the following startle measures: greater subjective fear under low threat, greater skin conductance under high threat, and slower skin conductance habituation. Conclusions These results imply that hypersensitivity to contextual threat (indexed by greater fear under low threat), elevated sympathetic nervous system reactivity to explicit threat (indexed by larger responses under high threat), and failure to adapt to repeated aversive stimuli (evidenced by slower habituation) are all unique pre-existing vulnerability factors for greater PTSD symptom severity following traumatic stress exposure. These measures may eventually prove useful for preventing PTSD. PMID:18722593

  16. Worry, worry attacks, and PTSD among Cambodian refugees: a path analysis investigation.

    PubMed

    Hinton, Devon E; Nickerson, Angela; Bryant, Richard A

    2011-06-01

    Among traumatized Cambodian refugees, this article investigates worry (e.g., the types of current life concerns) and how worry worsens posttraumatic stress disorder (PTSD). To explore how worry worsens PTSD, we examine a path model of worry to see whether certain key variables (e.g., worry-induced somatic arousal and worry-induced trauma recall) mediate the relationship between worry and PTSD. Survey data were collected from March 2010 until May 2010 in a convenience sample of 201 adult Cambodian refugees attending a psychiatric clinic in Massachusetts, USA. We found that worry was common in this group (65%), that worry was often about current life concerns (e.g., lacking financial resources, children not attending school, health concerns, concerns about relatives in Cambodia), and that worry often induced panic attacks: in the entire sample, 41% (83/201) of the patients had "worry attacks" (i.e., worry episodes that resulted in a panic episode) in the last month. "Worry attacks" were highly associated with PTSD presence. In the entire sample, generalized anxiety disorder was also very prevalent, and was also highly associated with PTSD. Path analysis revealed that the effect of worry on PTSD severity was mediated by worry-induced somatic arousal, worry-induced catastrophic cognitions, worry-induced trauma recall, inability to stop worry, and irritability. The final model accounted for 75% of the variance in PTSD severity among patients with worry. The public health and treatment implications of the study's findings that worry may have a potent impact on PTSD severity in severely traumatized populations are discussed: worry and daily concerns are key areas of intervention for these worry-hypersensitive (and hence daily-stressor-hypersensitive) populations. PMID:21663803

  17. Accounting for sex differences in PTSD: A multi-variable mediation model

    PubMed Central

    Christiansen, Dorte M.; Hansen, Maj

    2015-01-01

    Background Approximately twice as many females as males are diagnosed with posttraumatic stress disorder (PTSD). However, little is known about why females report more PTSD symptoms than males. Prior studies have generally focused on few potential mediators at a time and have often used methods that were not ideally suited to test for mediation effects. Prior research has identified a number of individual risk factors that may contribute to sex differences in PTSD severity, although these cannot fully account for the increased symptom levels in females when examined individually. Objective The present study is the first to systematically test the hypothesis that a combination of pre-, peri-, and posttraumatic risk factors more prevalent in females can account for sex differences in PTSD severity. Method The study was a quasi-prospective questionnaire survey assessing PTSD and related variables in 73.3% of all Danish bank employees exposed to bank robbery during the period from April 2010 to April 2011. Participants filled out questionnaires 1 week (T1, N=450) and 6 months after the robbery (T2, N=368; 61.1% females). Mediation was examined using an analysis designed specifically to test a multiple mediator model. Results Females reported more PTSD symptoms than males and higher levels of neuroticism, depression, physical anxiety sensitivity, peritraumatic fear, horror, and helplessness (the A2 criterion), tonic immobility, panic, dissociation, negative posttraumatic cognitions about self and the world, and feeling let down. These variables were included in the model as potential mediators. The combination of risk factors significantly mediated the association between sex and PTSD severity, accounting for 83% of the association. Conclusions The findings suggest that females report more PTSD symptoms because they experience higher levels of associated risk factors. The results are relevant to other trauma populations and to other trauma-related psychiatric disorders

  18. Sleep disturbances as the hallmark of PTSD: where are we now?

    PubMed

    Germain, Anne

    2013-04-01

    The hypothesis that rapid eye movement (REM) sleep disturbances are the hallmark of posttraumatic stress disorder (PTSD), proposed by Ross and colleagues in 1989, has stimulated a wealth of clinical, preclinical, and animal studies on the role of sleep in the pathophysiology of PTSD. The present review revisits this influential hypothesis in light of clinical and experimental findings that have since accumulated. Polysomnographic studies conducted in adults with PTSD have yielded mixed findings regarding REM sleep disturbances, and they generally suggest modest and nonspecific sleep disruptions. Prospective and treatment studies have provided more robust evidence for the relationship between sleep disturbances and psychiatric outcomes and symptoms. Experimental animal and human studies that have probed the relationship between REM sleep and fear responses, as well as studies focused more broadly on sleep-dependent affective and memory processes, also provide strong support for the hypothesis that sleep plays an important role in PTSD-relevant processes. Overall, the literature suggests that disturbed REM or non-REM sleep can contribute to maladaptive stress and trauma responses and may constitute a modifiable risk factor for poor psychiatric outcomes. Clinicians need to consider that the chronic sleep disruption associated with nightmares may affect the efficacy of first-line PTSD treatments, but targeted sleep treatments may accelerate recovery from PTSD. The field is ripe for prospective and longitudinal studies in high-risk groups to clarify how changes in sleep physiology and neurobiology contribute to increased risk of poor psychiatric outcomes.

  19. Reduced heart rate responding to trauma reliving in trauma survivors with PTSD: correlates and consequences.

    PubMed

    Halligan, Sarah L; Michael, Tanja; Wilhelm, Frank H; Clark, David M; Ehlers, Anke

    2006-10-01

    The authors investigated whether heart rate (HR) responses to voluntary recall of trauma memories (a) are related to posttraumatic stress disorder (PTSD), and (b) predict recovery 6 months later. Sixty-two assault survivors completed a recall task modeled on imaginal reliving in the initial weeks postassault. Possible cognitive modulators of HR responsivity were assessed; dissociation, rumination, trauma memory disorganization. Individuals with PTSD showed a reduced HR response to reliving compared to those without PTSD, but reported greater distress. Notably, higher HR response but not self-reported distress during reliving predicted greater symptom reduction at follow-up in participants with PTSD. Engagement in rumination was the only cognitive factor that predicted lower HR response. The data are in contrast to studies using trauma reminders to trigger memories, which have found greater physiological reactivity in PTSD. The authors' observations are consistent with models of PTSD that highlight differences between cued or stimulus-driven retrieval and intentional trauma recall, and with E. B. Foa and M. J. Kozak's (1986) hypothesis that full activation of trauma memories facilitates emotional processing. PMID:17075909

  20. Predictors of the new criteria for probable PTSD among older adults.

    PubMed

    Palgi, Yuval

    2015-12-30

    The definition of post-traumatic stress disorder (PTSD) changed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) and it is yet unclear how these changes affect the diagnosis of PTSD among older adults. The present study examined the contribution of demographic characteristics, functioning status, health related factors, as well as exposure to rocket attacks to prediction of probable PTSD in older adults. Three-hundred and thirty-nine community-dwelling adults (age range 50-90; M=65.44, SD=9.77) were sampled through random dialing to Jewish residents in the south of Israel. Participants completed a phone-questionnaire that collected background information and reports of relevant symptoms. Analyses showed that self-rated health, incidence of depression episodes, and exposure to rocket attacks predicted the DSM-5 definition of PTSD as well as the subscale of negative alternations in cognition and mood. The current study delineates the unique set of predictors of probable PTSD in older adults, with an emphasis on negative alternations in cognition and mood. Greater attention to unique predictors of PTSD in the second half of life is called for.

  1. Gene Expression and Methylation Signatures of MAN2C1 are Associated with PTSD

    PubMed Central

    Uddin, Monica; Galea, Sandro; Chang, Shun-Chiao; Aiello, Allison E.; Wildman, Derek E.; de los Santos, Regina; Koenen, Karestan C.

    2011-01-01

    As potential regulators of DNA accessibility and activity, epigenetic modifications offer a mechanism by which the environment can moderate the effects of genes. To date, however, there have been relatively few studies assessing epigenetic modifications associated with post-traumatic stress disorder (PTSD). Here we investigate PTSD-associated methylation differences in 33 genes previously shown to differ in whole blood-derived gene expression levels between those with vs. without the disorder. Drawing on DNA samples similarly obtained from whole blood in 100 individuals, 23 with and 77 without lifetime PTSD, we used methylation microarray data to assess whether these 33 candidate genes showed epigenetic signatures indicative of increased risk for, or resilience to, PTSD. Logistic regression analyses were performed to assess the main and interacting effects of candidate genes’ methylation values and number of potentially traumatic events (PTEs), adjusting for age and other covariates. Results revealed that only one candidate gene–MAN2C1–showed a significant methylation x PTE interaction, such that those with both higher MAN2C1 methylation and greater exposure to PTEs showed a marked increase in risk of lifetime PTSD (OR 4.35, 95% CI: 1.07, 17.77, p = 0.04). These results indicate that MAN2C1 methylation levels modify cumulative traumatic burden on risk of PTSD, and suggest that both gene expression and epigenetic changes at specific loci are associated with this disorder. PMID:21508515

  2. Interindividual Variability in Stress Susceptibility: A Role for Epigenetic Mechanisms in PTSD

    PubMed Central

    Zovkic, Iva B.; Meadows, Jarrod P.; Kaas, Garrett A.; Sweatt, J. David

    2013-01-01

    Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by intrusive and persistent memories of a psychologically traumatic event that leads to significant functional and social impairment in affected individuals. The molecular bases underlying persistent outcomes of a transient traumatic event have remained elusive for many years, but recent studies in rodents have implicated epigenetic modifications of chromatin structure and DNA methylation as fundamental mechanisms for the induction and stabilization of fear memory. In addition to mediating adaptations to traumatic events that ultimately cause PTSD, epigenetic mechanisms are also involved in establishing individual differences in PTSD risk and resilience by mediating long-lasting effects of genes and early environment on adult function and behavior. In this review, we discuss the current evidence for epigenetic regulation of PTSD in human studies and in animal models and comment on ways in which these models can be expanded. In addition, we identify key outstanding questions in the study of epigenetic mechanisms of PTSD in the context of rapidly evolving technologies that are constantly updating and adjusting our understanding of epigenetic modifications and their functional roles. Finally, we discuss the potential application of epigenetic approaches in identifying markers of risk and resilience that can be utilized to promote early intervention and develop therapeutic strategies to combat PTSD after symptom onset. PMID:23805109

  3. Firearm ownership in veterans entering residential PTSD treatment: Associations with suicide ideation, attempts, and combat exposure.

    PubMed

    Smith, Phillip N; Currier, Joseph; Drescher, Kent

    2015-09-30

    This study aimed to describe the frequency of firearm ownership in veterans entering residential treatment for posttraumatic stress disorder (PTSD) and examine the association of firearm ownership with suicide ideation and suicide attempt history, combat exposure, and PTSD symptom severity. Two samples of veterans entering residential PTSD treatment were assessed at intake using self-report measures. Approximately one third of participants endorsed firearm ownership across the two samples. Analyses with a sample predominantly comprised of Vietnam Veterans found that those who endorsed both suicide ideation and prior suicide attempts were less likely to own a firearm compared to suicide ideators and non-suicidal participants. In addition, more frequent combat exposure, but not PTSD symptom severity, was associated with firearm ownership in both samples and most participants endorsed using safe storage practices. These lower rates of firearm ownership generally, and in those with suicide ideation and prior attempts in particular, may reflect an increased focused on means restriction in treatment for combat-related PTSD. Means restriction counseling among PTSD treatment seeking veterans should target those with combat exposure.

  4. Temporal Associations Among Chronic PTSD Symptoms in U.S. Combat Veterans.

    PubMed

    Doron-LaMarca, Susan; Niles, Barbara L; King, Daniel W; King, Lynda A; Pless Kaiser, Anica; Lyons, Michael J

    2015-10-01

    The present study examined fluctuation over time in symptoms of posttraumatic stress disorder (PTSD) among 34 combat veterans (28 with diagnosed PTSD, 6 with subclinical symptoms) assessed every 2 weeks for up to 2 years (range of assessments = 13-52). Temporal relationships were examined among four PTSD symptom clusters (reexperiencing, avoidance, emotional numbing, and hyperarousal) with particular attention to the influence of hyperarousal. Multilevel cross-lagged random coefficients autoregression for intensive time series data analyses were used to model symptom fluctuation decades after combat experiences. As anticipated, hyperarousal predicted subsequent fluctuations in the 3 other PTSD symptom clusters (reexperiencing, avoidance, emotional numbing) at subsequent 2-week intervals (rs = .45, .36, and .40, respectively). Additionally, emotional numbing influenced later reexperiencing and avoidance, and reexperiencing influenced later hyperarousal (rs = .44, .40, and .34, respectively). These findings underscore the important influence of hyperarousal. Furthermore, results indicate a bidirectional relationship between hyperarousal and reexperiencing as well as a possible chaining of symptoms (hyperarousal → emotional numbing → reexperiencing → hyperarousal) and establish potential internal, intrapersonal mechanisms for the maintenance of persistent PTSD symptoms. Results suggested that clinical interventions targeting hyperarousal and emotional numbing symptoms may hold promise for PTSD of long duration.

  5. Trauma Exposure, PTSD, and HIV Sexual Risk Behaviors among Labor Migrants from Tajikistan

    PubMed Central

    Weine, Stevan; Bahromov, Mahbat; Loue, Sana; Owens, Linda

    2012-01-01

    Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g. more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention. PMID:22261829

  6. Risk factors for DSM 5 PTSD symptoms in Israeli civilians during the Gaza war

    PubMed Central

    Gil, Sharon; Weinberg, Michael; Or-Chen, Keren; Harel, Hila

    2015-01-01

    Background In light of the current modifications presented in the diagnostic criteria of posttraumatic stress disorder (PTSD) in the DSM 5, this study aimed at revalidating well-known PTSD risk factors, including gender, peritraumatic dissociation, social support, level of threat, and trait tendency for forgiveness. Method Five hundred and one Israeli civilians were assessed during real-time exposure to missile and rocket fire at the eruption of the Gaza war. Assessments took place approximately one to 2 weeks after the beginning of this military operation, relying on web administration of the study, which allowed simultaneous data collection from respondents in the three regions in Israel that were under attack. Results A structural equation model design revealed that higher levels of forgiveness toward situations were associated with fewer PTSD symptoms, whereas peritraumatic dissociation and high levels of objective and subjective threat were positively associated with PTSD symptoms. Additionally, females were at higher risk for PTSD symptoms than males. Conclusions The findings of this study provide further evidence for the importance of directing preventive attention to those vulnerable to the development of elevated levels of PTSD symptoms. Theoretical and clinical implications of the findings are discussed. PMID:25905028

  7. EMDR therapy for PTSD after motor vehicle accidents: meta-analytic evidence for specific treatment

    PubMed Central

    Boccia, Maddalena; Piccardi, Laura; Cordellieri, Pierluigi; Guariglia, Cecilia; Giannini, Anna Maria

    2015-01-01

    Motor vehicle accident (MVA) victims may suffer both acute and post-traumatic stress disorders (PTSD). With PTSD affecting social, interpersonal and occupational functioning, clinicians as well as the National Institute of Health are very interested in identifying the most effective psychological treatment to reduce PTSD. From research findings, eye movement desensitization and reprocessing (EMDR) therapy is considered as one of the effective treatment of PTSD. In this paper, we present the results of a meta-analysis of fMRI studies on PTSD after MVA through activation likelihood estimation. We found that PTSD following MVA is characterized by neural modifications in the anterior cingulate cortex (ACC), a cerebral structure involved in fear-conditioning mechanisms. Basing on previous findings in both humans and animals, which demonstrate that desensitization techniques and extinction protocols act on the limbic system, the effectiveness of EMDR and of cognitive behavioral therapies (CBT) may be related to the fact that during these therapies the ACC is stimulated by desensitization. PMID:25954183

  8. Predictors of the new criteria for probable PTSD among older adults.

    PubMed

    Palgi, Yuval

    2015-12-30

    The definition of post-traumatic stress disorder (PTSD) changed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) and it is yet unclear how these changes affect the diagnosis of PTSD among older adults. The present study examined the contribution of demographic characteristics, functioning status, health related factors, as well as exposure to rocket attacks to prediction of probable PTSD in older adults. Three-hundred and thirty-nine community-dwelling adults (age range 50-90; M=65.44, SD=9.77) were sampled through random dialing to Jewish residents in the south of Israel. Participants completed a phone-questionnaire that collected background information and reports of relevant symptoms. Analyses showed that self-rated health, incidence of depression episodes, and exposure to rocket attacks predicted the DSM-5 definition of PTSD as well as the subscale of negative alternations in cognition and mood. The current study delineates the unique set of predictors of probable PTSD in older adults, with an emphasis on negative alternations in cognition and mood. Greater attention to unique predictors of PTSD in the second half of life is called for. PMID:26586141

  9. A Risk Assessment Tool to Predict Sustained PTSD Symptoms Among Women Reporting Abuse

    PubMed Central

    Maddoux, John; McFarlane, Judith; Pennings, Jacquelyn

    2016-01-01

    Abstract Background: Nationally and worldwide, 30% or more of women are likely to have experienced intimate partner violence. Maternal mental health symptoms predict child function. When mothers have sustained posttraumatic stress disorder (PTSD), their children at are risk for growth and developmental delays and poor behavioral outcomes that may adversely affect the course of their lives. While many who experience trauma will recover without intervention, a significant proportion will experience PTSD, with negative consequences for their personal lives and the lives of their families. Early identification of those at high risk for PTSD symptoms will support early interventions to prevent PTSD and its negative consequences. Methods: This paper describes the development of a tool that can predict PTSD symptoms at 8 months in mothers who are primarily of low socioeconomic status and primarily members of underrepresented groups. The tool consists of four key measures. Conclusions: Using this tool to identify mothers at high risk for sustained PTSD and entering them into early intervention programs may protect mothers and their children from negative outcomes and promote their health and wellbeing. PMID:26267645

  10. How the neurocircuitry and genetics of fear inhibition may inform our understanding of PTSD.

    PubMed

    Jovanovic, Tanja; Ressler, Kerry J

    2010-06-01

    Exposure to traumatic events that produce extreme fear and horror is all too common in both military and civilian populations, but not all individuals develop posttraumatic stress disorder (PTSD) as a result of the exposure. What mediates risk and resilience in the development of PTSD and other stress-related psychopathology is of paramount importance to our further understanding of trauma-related psychopathology as well as the development of new treatment approaches. Biological factors, such as genotype and neurobiology, interact with environmental factors, such as childhood background and trauma load, to affect vulnerability and resilience in the aftermath of trauma exposure. One of the core symptoms of PTSD is the inability to control fear, which has led some investigators and clinicians to conceptualize PTSD as a disorder of fear or, more importantly, its inhibition. This review focuses on translational methods that have been used to examine fear conditioning and inhibition of fear in PTSD and summarizes genetic and neurobiological factors related to fear inhibition. The authors also discuss different pharmacological approaches that enhance fear inhibition and may improve treatment outcomes for patients with PTSD. PMID:20231322

  11. Neural, psychophysiological, and behavioral markers of fear processing in PTSD: a review of the literature.

    PubMed

    Shvil, Erel; Rusch, Heather L; Sullivan, Gregory M; Neria, Yuval

    2013-05-01

    As presently defined, post-traumatic stress disorder (PTSD) is an amalgam of symptoms falling into: re-experiencing of the trauma, avoidance of reminders of it, emotional numbing and hyperarousal. PTSD has a well-known proximate cause, commonly occurring after a life-threatening event that induces a response of intense fear, horror, and helplessness. Much of the advancement in understanding of the neurobiology of PTSD has emerged from conceptualizing the disorder as one that involves substantial dysfunction in fear processing. This article reviews recent knowledge of fear processing markers in PTSD. A systematic search was performed of reports within the specific three-year publication time period of January 2010 to December 2012. We identified a total of 31 studies reporting fear processing markers in PTSD. We further categorized them according to the following classification: (1) neural-activation markers (n=10), (2) psychophysiological markers (n=14), and (3) behavioral markers (n=7). Across most studies reviewed here, significant differences between individuals with PTSD and healthy controls were shown. Methodological, theoretical and clinical implications were discussed. PMID:23619614

  12. Volumetric Analysis of Amygdala, Hippocampus, and Prefrontal Cortex in Therapy-Naive PTSD Participants

    PubMed Central

    Radojicic, Zoran; Milovanovic, Srdjan; Ilankovic, Andrej; Dimitrijevic, Ivan; Damjanovic, Aleksandar; Aksić, Milan; Radonjic, Vidosava

    2014-01-01

    Objective. In our study we have hypothesized that volume changes of amygdala, hippocampus, and prefrontal cortex are more pronounced in male posttraumatic stress disorder participants. Material and Methods. We have conducted a study of 79 male participants who underwent MRI brain scanning. PTSD diagnosis was confirmed in 49 participants. After MRI was taken all scans were software based volume computed and statistically processed. Results. We found that left amygdala is the most significant parameter for distinction between PTSD participants and participants without PTSD. There were no significant differences in volumes of hippocampi and prefrontal cortices. Roc curve method outlined left amygdala AUC = 0.898 (95% CI = 0.830–0.967) and right amygdala AUC = 0.882 (95% CI = 0.810–0.954) in the group of PTSD participants which makes both variables highly statistically significant. Conclusion. The present investigation revealed significant volume decrease of left amygdala in PTSD patients. Concerning important functions of the amygdala and her neuroanatomical connections with other brain structures, we need to increase number of participants to clarify the correlation between impared amygdala and possible other different brain structures in participants with PTSD. PMID:24745028

  13. Increased anterior cingulate cortex and hippocampus activation in Complex PTSD during encoding of negative words.

    PubMed

    Thomaes, Kathleen; Dorrepaal, Ethy; Draijer, Nel; de Ruiter, Michiel B; Elzinga, Bernet M; Sjoerds, Zsuzsika; van Balkom, Anton J; Smit, Johannes H; Veltman, Dick J

    2013-02-01

    Post-traumatic stress disorder (PTSD) is associated with impaired memory performance coupled with functional changes in brain areas involved in declarative memory and emotion regulation. It is not yet clear how symptom severity and comorbidity affect neurocognitive functioning in PTSD. We performed a functional magnetic resonance imaging (fMRI) study with an emotional declarative memory task in 28 Complex PTSD patients with comorbid depressive and personality disorders, and 21 healthy non-trauma-exposed controls. In Complex PTSD patients--compared to controls--encoding of later remembered negative words vs baseline was associated with increased blood oxygenation level dependent (BOLD) response in the left ventral anterior cingulate cortex (ACC) and dorsal ACC extending to the dorsomedial prefrontal cortex (dmPFC) together with a trend for increased left hippocampus activation. Patients tended to commit more False Alarms to negative words compared to controls, which was associated with enhanced left ventrolateral prefrontal and orbitofrontal cortex (vlPFC/OFC) responses. Severity of child abuse was positively correlated with left ventral ACC activity and severity of depression with (para) hippocampal and ventral ACC activity. Presented results demonstrate functional abnormalities in Complex PTSD in the frontolimbic brain circuit also implicated in fear conditioning models, but generally in the opposite direction, which may be explained by severity of the trauma and severity of comorbid depression in Complex PTSD.

  14. Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan.

    PubMed

    Weine, Stevan; Bahromov, Mahbat; Loue, Sana; Owens, Linda

    2012-08-01

    Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.

  15. Predicting posttraumatic growth among Hurricane Katrina survivors living with HIV: the role of self-efficacy, social support, and PTSD symptoms.

    PubMed

    Cieslak, Roman; Benight, Charles; Schmidt, Norine; Luszczynska, Aleksandra; Curtin, Erin; Clark, Rebecca A; Kissinger, Patricia

    2009-07-01

    The study tested the model of adaptation after trauma by Benight and Bandura (2004) indicating that posttraumatic recovery may be predicted directly by coping self-efficacy (CSE) and indirectly by social support. These relations were investigated in the context of posttraumatic growth (PTG) among Hurricane Katrina survivors living with HIV. Additionally, it was hypothesized that among individuals with more intensive Posttraumatic Stress Disorder (PTSD) symptoms, those with strong CSE would experience the strongest PTG. Cross-sectional data were collected among 90 patients with HIV who reinitiated care at the HIV outpatient clinic. Questionnaires were administered approximately 14 months after the hurricane. Higher CSE was related to higher PTG among the survivors who suffered from more intensive PTSD symptoms. Received social support was directly related to only one index of PTG, relating to others. Furthermore, although there was a significant relationship between social support and CSE, the indirect conditional effect of received social support on PTG was not confirmed. Similar results were obtained across the indices of PTG, controlling for the level of exposure to hurricane-related trauma. Cross-sectional design and convenience character of the sample warrants replications.

  16. Brief report: Self-blame and PTSD symptoms in adolescents exposed to terrorism: is school connectedness a mediator?

    PubMed

    Moscardino, Ughetta; Scrimin, Sara; Capello, Fabia; Altoè, Gianmarco

    2014-01-01

    Previous research has shown that self-blame predicts increased risk of posttraumatic stress disorder (PTSD) in youth exposed to terrorism, but little is known about the factors mediating such relationship. This study aimed to explore whether school connectedness (SC) mediates the effect of self-blame on PTSD in 60 adolescents (aged 14-18 years) who survived the 2004 terrorist attack against school no. 1 in Beslan, Russia. Participants completed measures of coping, SC, and PTSD three years after the traumatic event. Endorsement of self-blaming behaviors was found to be significantly positively related to the presence of PTSD; self-blame was negatively associated with SC, which in turn was negatively related to PTSD. The mediation hypothesis was supported, with SC partially mediating the link between self-blame and PTSD. Adolescents affected by terrorism may benefit from school-based interventions aimed at fostering students' sense of belonging and emotional bonding to teachers, peers, and the school environment.

  17. Food restriction does not relieve PTSD-like anxiety.

    PubMed

    Hendriksen, Hendrikus; Bink, Diewertje I; Vergoossen, Dana L E; Suzet van Slobbe, E; Olivier, Berend; Oosting, Ronald S

    2015-04-15

    We used the inescapable foot shock paradigm (IFS) in rats as an animal model for post-traumatic stress disorder (PTSD). Previously we showed that exercise reversed the enhanced stress sensitivity induced by IFS. From literature it is known that food restriction has antidepressant and anxiolytic effects. Since both treatments influence energy expenditure, we questioned whether food restriction reduces anxiety in the IFS model via a comparable, NPY dependent mechanism as enrichment. Anxiety of IFS-exposed animals was measured as change in locomotion and freezing after sudden silence in an open field test, before and after two weeks of food restriction. In addition a forced swim test (FST) was performed. Next, using qPCR, the expression of neuropeptide Y (NPY) and the neuropeptide Y1 receptor (Y1 receptor) was measured in the amygdala. Food restriction increased locomotion and decreased freezing behavior both in control and IFS animals. These effects were small. IFS-induced anxiety was not abolished after two weeks of food restriction. IFS did not influence immobility or the duration of swimming in the FST of animals fed ad libitum. However, food restriction increased swimming and decreased the duration of immobility in IFS-exposed animals. Y1 receptor expression in the basolateral amygdala decreased after both IFS and food restriction. Although food restriction seems to induce a general anxiolytic effect, it does not operate via enhanced Y1 receptor expression and has no effect on the more pathogenic anxiety induced by IFS. PMID:25460029

  18. Negative Trauma Appraisals and PTSD Symptoms in Sri Lankan Adolescents.

    PubMed

    Ponnamperuma, Thyagi; Nicolson, Nancy A

    2016-02-01

    The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

  19. Validation of a Spanish language version of the pain self-perception scale in patients with fibromyalgia

    PubMed Central

    2010-01-01

    Background The Pain Self-Perception Scale (PSPS) is a 24-item questionnaire used to assess mental defeat in chronic pain patients. The aim of this study was to develop a Spanish language version of the PSPS (PSPS-Spanish), to assess the instrument's psychometric properties in a sample of patients with fibromyalgia and to confirm a possible overlapping between mental defeat and pain catastrophizing. Methods The PSPS was translated into Spanish by three bilingual content and linguistic experts, and then back-translated into English to assess for equivalence. The final Spanish version was administered, along with the Hospital Anxiety Depression Scale (HADS), Pain Visual Analogue Scale (PVAS), Pain Catastrophizing Scale (PCS) and Fibromyalgia Impact Questionnaire (FIQ), to 250 Spanish patients with fibromyalgia. Results PSPS-Spanish was found to have high internal consistency (Cronbach's α = 0.90 and the item-total r correlation coefficients ranged between 0.68 and 0.86). Principal components analysis revealed a one-factor structure which explained 61.4% of the variance. The test-retest correlation assessed with the intraclass correlation coefficient, over a 1-2 weeks interval, was 0.78. The total PSPS score was significantly correlated with all the questionnaires assessed (HADS, PVAS, PCS, and FIQ). Conclusions The Spanish version of the PSPS appears to be a valid tool in assessing mental defeat in patients with fibromyalgia. In patients with fibromyalgia and Post-Traumatic Stress Disorder (PTSD), PSPS-Spanish correlates more intensely with FIQ than in patients without PTSD. Mental defeat seems to be a psychological construct different to pain catastrophizing. PMID:21050485

  20. Treatment of Infertility in Men with Post-traumatic Stress Disorder (PTSD) with the Method of Intrauterine Insemination

    PubMed Central

    Elezaj, Shkelzen; Gashi, Zafer; Zeqiraj, Afrim; Grabanica, Driton; Shllaku, Anton; Gruda, Bujar; Musaj, Vesel

    2015-01-01

    Objective: Our objective was to determine the effect of PTSD on changing the quality of sperm in veterans with PTSD, and the percentage of successful procedures intrauterine insemination (IUI) as a first-line treatment of male infertility patients with post-traumatic stress disorder (PTSD). Patients and methods: The study is designed as a prospective observational study. The study was started from February 2013 until May of 2014. Our study included a total of 51 patients who were treatment for infertility in private Hospital for gynecology, endocrinology and infertility, IVF Center in Peja, and those who were outpatients treated for chronic PTSD in the Polyclinic, Biolab-Zafi, in Klina the Republic of Kosovo. All subjects divide into two groups; The first, consisting of 21 respondents to the participants of the war in Kosovo, which was established diagnosis of PTSD. The second group of 30 who have not lived in Kosovo for the time War, and without signs of PTSD. Results: Subjects with PTSD were somewhat older than the control group (p = 0.235) but it was not a significant difference (44.5 ± 5.6 vs 43.8 ± 2.3). When the question of type of infertility, secondary infertility is significantly higher in patients with PTSD (62% vs 20%). The total number of sperm and semen volume no significant differences between the two groups (p > 0.05). Sperm motility showed a significant reduction in cases of PTSD (p <0.0001), from observation semen parameters were found more abnormal forms of spermatozoa in the ejaculate cases with PSD (p < 0.0001) (Table 2). The percentage of pregnancies IUI procedure was slightly higher in patients with PTSD than the control group without PTSD (19% vs. 16.6%). Conclusion: A combination of analytical oriented psychotherapy techniques and assisted reproductive techniques (ART) such as IUI procedures, increases the chances for healing infertility in patients with PTSD. PMID:26622087

  1. Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring

    PubMed Central

    Desarnaud, Frank; Bader, Heather N.; Makotkine, Iouri; Flory, Janine D.; Bierer, Linda M.; Meaney, Michael J.

    2014-01-01

    Objective Differential effects of maternal and paternal PTSD have been observed in adult offspring of Holocaust survivors in both glucocorticoid receptor sensitivity and vulnerability to psychiatric disorder. The current study examined the relative influences of maternal and paternal PTSD on DNA methylation of the exon 1F promoter of the glucocorticoid receptor gene (NR3C1) in peripheral blood mononuclear cells (PBMCs), and its relationship to glucocorticoid receptor sensitivity, in Holocaust offspring. Method Adult offspring with at least one Holocaust survivor parent (n=80), and demographically similar participants without parental Holocaust exposure or PTSD (n=15) completed clinical interviews, self-report measures, and biological procedures. Blood samples were collected for analysis of glucocorticoid receptor gene exon 1F (GR-1F) promoter methylation and cortisol levels in response to low-dose dexamethasone, and two-way analysis of covariance was performed using maternal and paternal PTSD as main effects. Hierarchical-clustering analysis was used to permit visualization of maternal vs. paternal PTSD effects on clinical variables. Results A significant interaction demonstrated that in the absence of maternal PTSD, offspring with paternal PTSD showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation. Lower GR-1F promoter methylation was significantly associated with greater post-dexamethasone cortisol suppression. The clustering analysis confirmed that maternal and paternal PTSD effects were differentially associated with clinical indicators. Conclusions This is the first study to demonstrate alterations of GR-1F promoter methylation in relation to parental PTSD and neuroendocrine outcomes. The moderation of paternal PTSD effects by maternal PTSD suggests different mechanisms for the intergenerational transmission of trauma-related vulnerabilities. PMID:24832930

  2. PTSD and re-offending risk: the mediating role of worry and a negative perception of other people's support

    PubMed Central

    Ardino, Vittoria; Milani, Luca; Di Blasio, Paola

    2013-01-01

    Background Studies of posttraumatic stress disorder (PTSD) are mainly focused on victims of trauma. Very few studies explored the links between PTSD symptoms and re-offending risk in perpetrators of violence. Objective The aim of the study was to assess the effect of PTSD symptoms on re-offending risk in prisoner populations with a focus on indirect effects of worry and a negative perception of other people’s support on the relationship between PTSD and re-offending risk. Methods 75 prisoners (25 females, mean age: 44.36 years; 50 males, mean age: 34.7 years) were assessed for exposure to child abuse and neglect, PTSD symptoms, worry, a negative perception of other people’s support and re-offending risk. Mediation analyses tested the indirect effects of worry and a negative perception of other people’s support on the relationship between PTSD and re-offending risk. Results 72% participants presented PTSD symptoms and 30.7% were at risk of re-offending. Mediation analyses supported the hypothesis of a mediation pathway from PTSD to worry and a negative perception of other people’s support to an increased risk of re-offending. Conclusions The results indicate that prisoners report high rates of PTSD symptoms; furthermore, they highlight an important relationship between PTSD and re-offending risk. Findings suggest that future research should test further the indirect effects of negative cognitive and emotional states on the relationship of PTSD and re-offending risk and explore more in depth the role of PTSD to assess and treat prisoners. PMID:24371516

  3. Trials of intranasally administered rubella vaccine.

    PubMed

    Hillary, I B

    1971-12-01

    No evidence of vaccine virus transmission was found in two studies where Wistar RA 27/3 rubella vaccine was administered intranasally. Vaccine was immunogenic in all of 23 vaccinated children in one study, while in the other only 5 of the 11 vaccinees developed antibody. The reduced seroconversion rate in the latter study appears to have been caused by one or a combination of factors, including the vaccination technique, the presence of infective nasal conditions in vaccinees and the titre of vaccine used.

  4. Cognitive behavioral therapy (CBT) in a Patient with Implantable Cardioverter Defibrillator (ICD) and Posttraumatic stress disorder(PTSD).

    PubMed

    Ansari, Sahar; Arbabi, Mohammad

    2014-07-01

    The implantable cardioverter defibrillator (ICD) has currently become the standard treatment for preventing sudden cardiac death. There are some psychological consequences in patients with ICD such as posttraumatic stress disorder (PTSD) after the shocks induced by ICD. This report aimed to present the case of a 54-year-old man with ICD who had developed PTSD; his PTSD was treated, using cognitive-behavioral psychotherapy consisting of relaxation, mindfulness and problem solving techniques. In patients with ICD who are experiencing PTSD using cognitive behavioral interventions may be helpful to reduce their psychological sufferings.

  5. Psychological effects following the Iran nuclear deal: Iranian nuclear threat salience moderates the relationship between PTSD symptoms and sleep problems.

    PubMed

    Grossman, Ephraim S; Hoffman, Yaakov; Bodner, Ehud; Palgi, Yuval; Gottlieb, Merav; Mesika, Ofra; Ben-Ezra, Menachem; Shrira, Amit

    2016-09-30

    Following the July-14th, 2015 Iranian agreement, we examined if preoccupation with the threat of a nuclear Iran moderates the relationship between posttraumatic stress disorder (PTSD) symptoms and reported sleep problems in individuals exposed to the 2014 Israel-Gaza conflict. While sleep problems were evident in individuals suffering from PTSD symptoms, they were especially pronounced when PTSD symptoms were coupled with increased Iranian nuclear threat salience. Preoccupation with future national threats may increase PTSD-related sleep problems. Therefore, it may be useful if such threats are accounted for in interventions aiming to ameliorate trauma-related sleep problems arising in the context of security situation.

  6. Psychological effects following the Iran nuclear deal: Iranian nuclear threat salience moderates the relationship between PTSD symptoms and sleep problems.

    PubMed

    Grossman, Ephraim S; Hoffman, Yaakov; Bodner, Ehud; Palgi, Yuval; Gottlieb, Merav; Mesika, Ofra; Ben-Ezra, Menachem; Shrira, Amit

    2016-09-30

    Following the July-14th, 2015 Iranian agreement, we examined if preoccupation with the threat of a nuclear Iran moderates the relationship between posttraumatic stress disorder (PTSD) symptoms and reported sleep problems in individuals exposed to the 2014 Israel-Gaza conflict. While sleep problems were evident in individuals suffering from PTSD symptoms, they were especially pronounced when PTSD symptoms were coupled with increased Iranian nuclear threat salience. Preoccupation with future national threats may increase PTSD-related sleep problems. Therefore, it may be useful if such threats are accounted for in interventions aiming to ameliorate trauma-related sleep problems arising in the context of security situation. PMID:27428082

  7. Proximal Relationships Between PTSD Symptoms and Drinking among Female College Students: Results from a Daily Monitoring Study

    PubMed Central

    Kaysen, Debra; Atkins, David C.; Simpson, Tracy L.; Stappenbeck, Cynthia A.; Blayney, Jessica A.; Lee, Christine M.; Larimer, Mary E.

    2013-01-01

    The self-medication hypothesis has been proposed to explain comorbidity between PTSD and drinking, whereupon problem drinking develops as an attempt to modulate negative affect and ameliorate PTSD symptoms. Studies have begun utilizing daily monitoring methodologies to refine our understanding of proximal relations between PTSD, affect, and alcohol use. 136 female college drinkers with a past history of sexual victimization and 38 female college drinkers with no past trauma history, completed electronic monitoring of PTSD symptoms, affect, alcohol use, and alcohol cravings, daily for 4 weeks. A two-part mixed hurdle model was used to examine likelihood of drinking and amount of alcohol consumed on drinking days. We did find significant relationships between daily PTSD symptoms, affect, and drinking. On days women experienced more intrusive and behavioral avoidance symptoms of PTSD they experienced stronger urges to drink and were more likely to drink on that day. On days where women experienced more negative affect than their average, they experienced stronger urges to drink whereas on days where women experienced more of the dysphoric symptoms associated with PTSD than their average, they drank less. On days with higher positive affect women reported stronger urges to drink and were more likely to drink. Results suggest the need to examine both aspects of affect and specific PTSD symptoms as they may differentially predict drinking behavior. Differences in the ways in which PTSD symptoms and affect influence drinking suggest that interventions more specifically address the function of drinking behaviors in reducing alcohol use among college women. PMID:23915369

  8. White Matter and Cognitive Changes in Veterans Diagnosed with Alcoholism and PTSD

    PubMed Central

    Maksimovskiy, Arkadiy L; McGlinchey, Regina E; Fortier, Catherine B; Salat, David H; Milberg, William P; Oscar-Berman, Marlene

    2014-01-01

    Alcoholism frequently occurs in returning U.S. Veterans, and is often comorbid with Post Traumatic Stress Disorder (PTSD). The goal of this study was to investigate the relationship between white matter changes and neuropsychological alterations in Operation Enduring Freedom, and/or Operation Iraqi Freedom (OEF/OIF) alcoholic Veterans with two primary aims: (1) to examine the relationship of alcoholism to brain structure and function while controlling for the potential effects of comorbid PTSD, and (2) to examine whether the effects of alcoholism are moderated by the quantity of lifetime alcohol consumption. Our sample consisted of 71 deployed OEF/OIF Veterans stratified into four groups: alcoholics without PTSD, alcoholics with PTSD, participants with PTSD without comorbid alcoholism, and control participants without alcoholism or PTSD. Participants were given an extensive neuropsychological and psychiatric assessment battery, as well as Magnetic Resonance Diffusion Tensor Imaging (DT-MRI) scans. Results showed that disruption of executive functioning, and abnormal fractional anisotropy (FA; a measure of axonal integrity) within the frontal subcortical and dorsolateral frontal-parietal regions, occurred independently of the effects of PTSD. Furthermore, these cognitive and neuronal alterations were unique to the most severe subgroup of alcoholics who consumed the greatest amount of alcohol over the course of their lifetime, as compared to the rest of the sample. Axonal integrity within this subgroup, in regions underlying the frontal subcortical area, was shown to be decreased independently of cognitive changes. Integrity of axons underlying the dorsolateral frontal-parietal region, however, was increased. We hypothesized that this is a compensatory mechanism for executive dysfunction. PMID:24855633

  9. Longitudinal Examination of PTSD Symptoms and Problematic Alcohol Use As Risk Factors for Adolescent Victimization

    PubMed Central

    McCart, Michael R; Zajac, Kristyn; Kofler, Michael J; Smith, Daniel W; Saunders, Benjamin E; Kilpatrick, Dean G

    2013-01-01

    Objectives The current study examined associations between PTSD symptoms and future interpersonal victimization among adolescents, after accounting for the impact of early victimization exposure, gender, ethnicity, and household income. In addition, problematic alcohol use was tested as a mediator of the relation between PTSD symptoms and subsequent victimization. Method Participants included a national longitudinal sample of adolescents (N = 3,604) who were ages 12 to 17 at the initial assessment; 50% were male; and 67% were white, 16% African American, and 12% Hispanic. Cohort-sequential latent growth curve modeling was used to examine associations among the study variables. Results Baseline PTSD symptoms significantly predicted age-related increases in interpersonal victimization, even after accounting for the effects of earlier victimization experiences. In addition, alcohol problems emerged as a partial mediator of this relation, such that one-quarter to one-third of the effect of PTSD symptoms on future victimization was attributable to the impact of PTSD symptoms on alcohol problems (which in turn predicted additional victimization risk). Collectively, the full model accounted for more than half of the variance in age-related increases in interpersonal victimization among youth. Conclusion Results indicate that PTSD symptoms serve as a risk factor for subsequent victimization among adolescents, over and above the risk conferred by prior victimization. This increased risk occurred both independently and through the impact of PTSD symptoms on problematic alcohol use. Based on these findings, it is hypothesized that the likelihood of repeated victimization among youth might be reduced through early detection and treatment of these clinical problems. PMID:22963207

  10. Changes in Temporal Attention Inhibition Following Prolonged Exposure and Sertraline in the Treatment of PTSD

    PubMed Central

    Echiverri-Cohen, Aileen; Zoellner, Lori A.; Gallop, Robert; Feeny, Norah; Jaeger, Jeffrey; Bedard-Gilligan, Michele

    2016-01-01

    Objective Attentional inhibitory deficits expressed as difficulty ignoring irrelevant stimuli in the pursuit of goal-directed behavior may serve as a fundamental mechanism of posttraumatic stress disorder (PTSD). Evidence of inhibitory processes as central to extinction suggests that exposure-based treatments may act more directly on the inhibitory deficits implicated in PTSD, whereas, in facilitating serotonergic neurotransmission, selective serotonin reuptake inhibitors (SSRIs) may be less direct and bring about general neurochemical changes in the fear circuitry. If these inhibitory deficits underlie PTSD, then inhibition should improve with successful treatment, with those treated with prolonged exposure (PE) potentially resulting in greater changes in inhibition than those treated with sertraline. Method Changes in temporal attentional inhibition, using an attentional blink (AB) paradigm, were examined at pre-and post-treatment in 49 individuals (74.5% female, 66.7% Caucasian, age M = 37.69, SD = 12.8 years) with chronic PTSD. Participants completed 10 weeks of either PE or sertraline. Results Individuals who made greater improvements with PE showed faster improvements in temporal inhibition on the critical inhibitory lag of AB than those who made greater improvements with sertraline (d = 0.94). These changes could not be accounted for by basic attention. Conclusions Greater improvement in fundamental attentional inhibitory processes with better treatment response to PE, compared to sertraline, suggests potential specificity in how PTSD treatments normalize inhibitory processes, such that exposure-based treatments like PE may target inhibitory processes and improve basic inhibitory functioning. Public Health Significance Statement Inhibitory processes, particularly related to temporal attention, may play a critical role in response to exposure therapy for PTSD. The main finding that individuals with PTSD who made more clinical improvement showed faster

  11. Deployment-Related TBI, Persistent Postconcussive Symptoms, PTSD, and Depression in OEF/OIF Veterans

    PubMed Central

    Morissette, Sandra B.; Woodward, Matthew; Kimbrel, Nathan A.; Meyer, Eric C.; Kruse, Marc I.; Dolan, Sara; Gulliver, Suzy Bird

    2016-01-01

    Objective A substantial proportion of the more than 2 million service members who have served in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the non-specific nature of postconcussive symptoms (PCS) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCS, and symptoms of PTSD and depression among returning OEF/OIF Veterans. Design Two-hundred and thirteen OEF/OIF Veterans (87% male) completed a semi-structured screening interview assessing deployment-related TBI and current, persistent PCS. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression. Results Nearly half (46%) of sampled Veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCS that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of three models of the relationships among TBI, combat exposure, persistent PCS, PTSD, and depression. Consistent with hypotheses, the best fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by non-overlapping persistent PCS. Implications These findings highlight the importance of addressing persistent PCS in order to facilitate the functional recovery of returning war Veterans. PMID:22121940

  12. Personality and neuroimaging measures differentiate PTSD from mTBI in veterans.

    PubMed

    Davenport, Nicholas D; Lim, Kelvin O; Sponheim, Scott R

    2015-09-01

    Mild traumatic brain injury (mTBI) is common among recent veterans and often is associated with chronic post-concussive symptoms (PCS). Elevated PCS may also be a consequence of post-traumatic stress disorder (PTSD) which shares symptoms with PCS. Identification of personality, biological, and psychopathology factors that contribute to the relationship between mTBI and PCS could help isolate the sources of chronic post concussive syndrome in veterans. Clinician rated diagnoses (PTSD, Major Depression, Alcohol Dependence), personality characteristics (Multidimensional Personality Questionnaire [MPQ] subscales), white matter brain imaging measures (Mean Diffusivity, Generalized Fractional Anisotropy), and diagnoses of mTBI were collected from 125 American military veterans of Iraq or Afghanistan. Linear and logistic regression models were tested to determine contributions to PCS and whether there were similar contributors to PTSD and mTBI. PCS score was associated with personality characteristics of high Stress Reaction and Traditionalism and low Control as well as mTBI. A diagnosis of PTSD was associated with low Social Closeness, PCS, Alcohol Dependence, and abnormal white matter mean diffusivity. Diagnosis of mTBI was associated with fewer white matter mean diffusivity abnormalities, PCS, and number of deployments. As commonly observed clinically, both PTSD and mTBI were associated with higher rates of PCS, though the contribution of PTSD appears to be secondary to personality traits, particularly Stress Reaction. Furthermore, the observation of factors that are uniquely associated with Blast mTBI (number of deployments) or with PTSD (Lifetime Alcohol Dependence and low Social Closeness), as well as a factor (region of abnormal MD) that had opposite effects on the likelihood of each diagnosis, indicates that the complex relationships between personality, psychopathology, and nature of mTBI need to be considered when interpreting chronic post-concussive symptoms.

  13. Personality and neuroimaging measures differentiate PTSD from mTBI in veterans.

    PubMed

    Davenport, Nicholas D; Lim, Kelvin O; Sponheim, Scott R

    2015-09-01

    Mild traumatic brain injury (mTBI) is common among recent veterans and often is associated with chronic post-concussive symptoms (PCS). Elevated PCS may also be a consequence of post-traumatic stress disorder (PTSD) which shares symptoms with PCS. Identification of personality, biological, and psychopathology factors that contribute to the relationship between mTBI and PCS could help isolate the sources of chronic post concussive syndrome in veterans. Clinician rated diagnoses (PTSD, Major Depression, Alcohol Dependence), personality characteristics (Multidimensional Personality Questionnaire [MPQ] subscales), white matter brain imaging measures (Mean Diffusivity, Generalized Fractional Anisotropy), and diagnoses of mTBI were collected from 125 American military veterans of Iraq or Afghanistan. Linear and logistic regression models were tested to determine contributions to PCS and whether there were similar contributors to PTSD and mTBI. PCS score was associated with personality characteristics of high Stress Reaction and Traditionalism and low Control as well as mTBI. A diagnosis of PTSD was associated with low Social Closeness, PCS, Alcohol Dependence, and abnormal white matter mean diffusivity. Diagnosis of mTBI was associated with fewer white matter mean diffusivity abnormalities, PCS, and number of deployments. As commonly observed clinically, both PTSD and mTBI were associated with higher rates of PCS, though the contribution of PTSD appears to be secondary to personality traits, particularly Stress Reaction. Furthermore, the observation of factors that are uniquely associated with Blast mTBI (number of deployments) or with PTSD (Lifetime Alcohol Dependence and low Social Closeness), as well as a factor (region of abnormal MD) that had opposite effects on the likelihood of each diagnosis, indicates that the complex relationships between personality, psychopathology, and nature of mTBI need to be considered when interpreting chronic post-concussive symptoms

  14. Childhood maltreatment in adult offspring of Portuguese war veterans with and without PTSD

    PubMed Central

    Dias, Aida; Sales, Luisa; Cardoso, Rui M.; Kleber, Rolf

    2014-01-01

    Background The colonial war that Portugal was involved in between 1961 and 1974 had a significant impact on veterans and their families. However, it is unclear what the consequences of this war are, in particular with regard to levels of childhood maltreatment (CM) in offspring. Objective Our study aims to analyze the influences of fathers’ war exposure and posttraumatic stress disorder (PTSD) on the offspring's CM and simultaneously test the hypothesis of the intergenerational transmission of father–child CM. Method Cross-sectional data were collected, using the Childhood Trauma Questionnaire—Short Form, from 203 adult children and 117 fathers. Subjects were distributed according to three conditions based on the father's war exposure status: did not participate in war, or non-war-exposed (NW); participated in war, or war-exposed (W); and war-exposed with PTSD diagnosis (WP). The data were examined using correlations, variance/covariance, and regression analyses. Results Children of war veterans with PTSD reported more emotional and physical neglect, while their fathers reported increased emotional and physical abuse exposure during their own childhood. Significant father–child CM correlations were found in the war veteran group but less in the war veteran with PTSD group. Father CM predicted 16% of offspring CM of children of war veterans. Conclusions The father's war-related PTSD might be a risk factor for offspring neglect but potentially a protective one for the father–child abuse transmission. War-exposed fathers without PTSD did transmit their own CM experiences more often. Therefore, father's war exposure and father's war PTSD may each be important variables to take into account in the study of intergenerational transmission of CM. PMID:24505510

  15. Ocular toxicity from systemically administered xenobiotics

    PubMed Central

    Gokulgandhi, Mitan R; Vadlapudi, Aswani Dutt; Mitra, Ashim K

    2015-01-01

    Introduction The eye is considered as the most privileged organ because of the blood–ocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. Areas covered The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. Expert opinion Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation. PMID:22803583

  16. Prevalence of PTSD and Depression among Junior Middle School Students in a Rural Town Far from the Epicenter of the Wenchuan Earthquake in China

    PubMed Central

    Sun, Xue-li; Huang, Yi; Hashimoto, Kenji; Gao, Cheng-ge

    2012-01-01

    Context On May12th 2008, a devastating earthquake measuring 8.0 on the Richter scale, struck Wenchuan county and surrounding areas in China. The prevalence of mental illness among children and adolescents in a rural town far from the earthquake epicenter is unknown. Objective To assess the prevalence of posttraumatic stress disorder (PTSD) and depression among junior middle school students in a rural town Ningqiang county, 327 km from the earthquake epicenter. Design, Setting, and Participants A population-based mental health survey was conducted in March, 2009. Main Outcome Measure Survey Self-designed General Condition Survey Scale, Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-rating Scale for Children (DSRSC) were used to sample 1,841 junior middle school students in Ningqiang county, ten months after the Wenchuan earthquake. Results The prevalence rate of a high-risk for PTSD was 28.4%, with 32.7% among females, 23.8% among males (female vs. male, p<0.001), 38.6% in the severe exposure group and 24.3% in the mild exposure group (severe vs. mild exposure, p<0.001). For depressive symptoms, the overall prevalence was 19.5%, with 24.0% among females, 14.7% among males, 24.5% in the severe exposure group and 17.5% in the mild exposure group (female vs. male, p<0.001; severe vs. mild exposure, p<0.001, respectively). In multivariate analysis, factors such as “having felt despair”, or “danger” and “having own house destroyed or damaged” were significantly associated with PTSD symptoms. Female gender and delayed evacuation in females, and earthquake related experiences in males were significantly associated with depression. Conclusion Traumatic events experienced during the earthquake were significantly associated with symptoms of PTSD and depression in children and adolescents, ten months after the Wenchuan earthquake. These data highlight a need for mental health services for children and adolescents in rural areas, far

  17. PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students with a Trauma History

    PubMed Central

    Tripp, Jessica C.; McDevitt-Murphy, Meghan E.; Avery, Megan L.; Bracken, Katherine L.

    2015-01-01

    Objective Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related consequences have been linked to emotion dysregulation. Sex differences exist in both emotion regulation dimensions and alcohol use patterns. This investigation examined facets of emotion dysregulation as potential mediators of the relationship between PTSD symptoms and alcohol-related consequences and whether differences may exist across sexes. Methods Participants included 240 college students with a trauma history who reported using alcohol within the past three months and completed measures of PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related consequences, and negative affect. The six facets of emotion dysregulation were examined as mediators of the relationship between PTSD symptoms and alcohol-related consequences in the full sample and by sex. Results There were differences in sexes on several variables, with women reporting higher PTSD scores and Lack of Emotional Awareness. Men reported significantly higher drinks per week in a typical week and a heavy week. There were significant associations between the variables for the full sample, with PTSD showing associations with five facets of emotion dysregulation subscales: Impulse Control Difficulties when Upset, Difficulties Engaging in Goal-Directed Behavior, Nonacceptance of Emotional Responses, Lack of Emotional Clarity, and Limited Access to Emotion Regulation Strategies. Alcohol-related consequences were associated with four aspects of emotion dysregulation: Impulse Control Difficulties when Upset, Difficulties Engaging in Goal-Direct Behavior, Nonacceptance of Emotional Reponses, and Limited Access to Emotion Regulation Strategies. Two aspects of emotion regulation, Impulse Control Difficulties and Difficulties Engaging in Goal Directed Behavior, mediated the relationship between PTSD symptoms and alcohol-related consequences in the full sample, even after adjusting for the effects of negative affect

  18. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population.

    PubMed

    Raji, Cyrus A; Willeumier, Kristen; Taylor, Derek; Tarzwell, Robert; Newberg, Andrew; Henderson, Theodore A; Amen, Daniel G

    2015-09-01

    PTSD and TBI are two common conditions in veteran populations that can be difficult to distinguish clinically. The default mode network (DMN) is abnormal in a multitude of neurological and psychiatric disorders. We hypothesize that brain perfusion SPECT can be applied to diagnostically separate PTSD from TBI reliably in a veteran cohort using DMN regions. A group of 196 veterans (36 with PTSD, 115 with TBI, 45 with PTSD/TBI) were selected from a large multi-site population cohort of individuals with psychiatric disease. Inclusion criteria were peacetime or wartime veterans regardless of branch of service and included those for whom the traumatic brain injury was not service related. SPECT imaging was performed on this group both at rest and during a concentration task. These measures, as well as the baseline-concentration difference, were then inputted from DMN regions into separate binary logistic regression models controlling for age, gender, race, clinic site, co-morbid psychiatric diseases, TBI severity, whether or not the TBI was service related, and branch of armed service. Predicted probabilities were then inputted into a receiver operating characteristic analysis to compute sensitivity, specificity, and accuracy. Compared to PSTD, persons with TBI were older, male, and had higher rates of bipolar and major depressive disorder (p < 0.05). Baseline quantitative regions with SPECT separated PTSD from TBI in the veterans with 92 % sensitivity, 85 % specificity, and 94 % accuracy. With concentration scans, there was 85 % sensitivity, 83 % specificity and 89 % accuracy. Baseline-concentration (the difference metric between the two scans) scans were 85 % sensitivity, 80 % specificity, and 87 % accuracy. In separating TBI from PTSD/TBI visual readings of baseline scans had 85 % sensitivity, 81 % specificity, and 83 % accuracy. Concentration scans had 80 % sensitivity, 65 % specificity, and 79 % accuracy. Baseline-concentration scans had 82

  19. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population.

    PubMed

    Raji, Cyrus A; Willeumier, Kristen; Taylor, Derek; Tarzwell, Robert; Newberg, Andrew; Henderson, Theodore A; Amen, Daniel G

    2015-09-01

    PTSD and TBI are two common conditions in veteran populations that can be difficult to distinguish clinically. The default mode network (DMN) is abnormal in a multitude of neurological and psychiatric disorders. We hypothesize that brain perfusion SPECT can be applied to diagnostically separate PTSD from TBI reliably in a veteran cohort using DMN regions. A group of 196 veterans (36 with PTSD, 115 with TBI, 45 with PTSD/TBI) were selected from a large multi-site population cohort of individuals with psychiatric disease. Inclusion criteria were peacetime or wartime veterans regardless of branch of service and included those for whom the traumatic brain injury was not service related. SPECT imaging was performed on this group both at rest and during a concentration task. These measures, as well as the baseline-concentration difference, were then inputted from DMN regions into separate binary logistic regression models controlling for age, gender, race, clinic site, co-morbid psychiatric diseases, TBI severity, whether or not the TBI was service related, and branch of armed service. Predicted probabilities were then inputted into a receiver operating characteristic analysis to compute sensitivity, specificity, and accuracy. Compared to PSTD, persons with TBI were older, male, and had higher rates of bipolar and major depressive disorder (p < 0.05). Baseline quantitative regions with SPECT separated PTSD from TBI in the veterans with 92 % sensitivity, 85 % specificity, and 94 % accuracy. With concentration scans, there was 85 % sensitivity, 83 % specificity and 89 % accuracy. Baseline-concentration (the difference metric between the two scans) scans were 85 % sensitivity, 80 % specificity, and 87 % accuracy. In separating TBI from PTSD/TBI visual readings of baseline scans had 85 % sensitivity, 81 % specificity, and 83 % accuracy. Concentration scans had 80 % sensitivity, 65 % specificity, and 79 % accuracy. Baseline-concentration scans had 82

  20. The Moderating Effect of State Anger on Treatment Outcome in Female Adolescents With PTSD.

    PubMed

    Kaczkurkin, Antonia N; Asnaani, Anu; Zhong, Jody; Foa, Edna B

    2016-08-01

    Trauma experienced in childhood and adolescence negatively affects the development of adaptive regulation of emotions and is associated with greater symptoms of anger. Prior research has suggested that high levels of anger may impede the outcome of treatment in adults with posttraumatic stress disorder (PTSD). The current study investigated whether high levels of anger resulted in poorer treatment outcomes in adolescent girls with PTSD. Participants included 61 female adolescent survivors of sexual abuse or assault who were randomized to either prolonged exposure for adolescents (PE-A) or client-centered therapy (CCT) for traumatized children for 8-14 weekly sessions. Participants were followed for 12 months posttreatment. High levels of state anger at baseline were associated with less improvement in PTSD symptoms in the CCT group than the PE-A group (d = 0.62). The moderating effects of state anger on improvement in PTSD symptoms was significant with emotion regulation difficulties, which may underlie anger symptoms (d = 0.58) in the model. The results of this study suggessted that high state anger was less of an impediment to treatment of PTSD for those receiving PE-A than those receiving less differentiated approaches such as CCT. PMID:27459380