Vulnerability to post-traumatic stress disorder and psychological morbidity in aged holocaust survivors

OBJECTIVE: Although high rates of post-traumatic stress disorder (PTSD) and psychological morbidity have been consistently reported in Holocaust survivors (HS), reports are inconsistent about which factors are associated with psychological morbidity. In a study of the oldest HS cohort yet reported, we aim to clarify why this variability exists by examining factors associated with PTSD and psychological morbidity, including for the first time measures of personality and defense mechanisms. METHODS: One hundred HS randomly selected from a convenience sample of 309 respondents to a survey of Jewish persons aged 60 years and older living in the community in Sydney were assessed using the following instruments: demographics, severity of trauma experienced, General Health Questionnaire (GHQ-28), PTSD diagnosis (DSM-IV), Brief Psychiatric Rating Scale, Impact of Events Scale, Defense Style Questionnaire, modified Eysenck Personality Inventory. RESULTS: Older age, experience of more severe trauma, use of immature defense mechanisms and higher neuroticism were associated with significant PTSD and psychological morbidity; severity of trauma was associated with PTSD and with more severe psychological morbidity. CONCLUSIONS: A profile of survivors at-risk can be identified that may have application to survivors of more recent holocausts. Late life may be a period of vulnerability in the aftermath of severe trauma.     

Leukocyte glucocorticoid receptor expression and immunoregulation in veterans with and without post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is associated with a dysregulation of the hypothalamus-pituitary-adrenal axis (HPA axis). In addition, there is evidence for altered glucocorticoid receptor (GR) expression and function in peripheral blood mononuclear cells. The aim of the present study was to differentiate between the effect of trauma exposure and PTSD on leukocyte GR expression and glucocorticoid immune regulation. Leukocyte GR binding characteristics and glucocorticoid sensitivity of immune activity, determined as the effect of dexamethasone (DEX) on in vitro cytokine release and T-cell proliferation, were compared between veterans with PTSD, traumatized veterans without PTSD and healthy controls. Leukocyte GR density was significantly lower in veterans with and without PTSD compared to healthy controls. DEX-induced inhibition of T-cell proliferation was significantly lower in PTSD compared to trauma and healthy controls. DEX-induced increase in lipopolysaccharide-stimulated interleukin-10 was less pronounced in traumatized veterans with and without PTSD compared to healthy controls. No group differences were observed in the effect of DEX on other cytokines or in baseline immune activity, except for lower tumor necrosis factor-alpha production in PTSD patients compared to healthy controls. The results suggest that trauma exposure is sufficient to induce changes in GR binding characteristics, whereas resistance of T-cell proliferation to DEX only occurs in PTSD. DEX resistance of in vitro immune activity was not a general phenomenon, but was restricted to specific immune functions.     

张北地震后应激障碍患者神经内分泌和细胞因子的研究

目的研究应激障碍患者血浆皮质醇、生长激素、泌乳素和白细胞介素(IL)2,6,8与正常个体的差异.方法于河北省张北尚义发生里氏6.2级地震后3个月,在当地选取因地震导致的创伤后应激障碍(PTSD)患者34例(PTSD组),未达到PTSD诊断标准且不符合其他精神障碍的受应激个体30例(非PTSD受应激组),未受应激者34名(对照组),进行血浆皮质醇、生长激素、泌乳素和白细胞介素(IL)2,6,8的检测.血浆皮质醇、生长激素、泌乳素、IL-2检测采用放射免疫法; IL-6和IL-8检测采用酶联免疫法.结果 PTSD组患者和非PTSD受应激组的血浆皮质醇浓度均明显高于对照组,差异有统计学意义(P=0.013,P=0.006);血浆IL-2浓度均明显低于对照组,差异均有统计学意义(P=0.000,P=0.000).三组间泌乳素及IL-6的差异无统计学意义(P=0.389,P=0.363).PTSD组的生长激素浓度与非PTSD受应激组(P=0.099)及对照组(P=0.511)的差异无统计学意义.非PTSD受应激组的生长激素浓度明显高于对照组(P=0.014).PTSD组患者IL-8浓度明显高于非PTSD受应激组 (P=0.021), 而与对照组的差异无统计学意义 (P=0.078).非PTSD受应激组IL-8浓度明显低于对照组(P=0.000).结论 PTSD患者的神经内分泌和免疫系统有异常改变.     

Free radicals in patients with post-traumatic stress disorder

There is mounting evidence indicating that reactive free radical species (FRs) are involved in initiation and development of many different forms of human pathologies including psychiatric disorders. In the present study, we aimed to determine whether antioxidant enzyme (glutathione peroxidase, GSH-Px; superoxide dismutase, SOD and catalase, CAT) activities and malondialdehyde (MDA) levels, a product of lipid peroxidation, were associated with post-traumatic stress disorder (PTSD). The study comprised 14 patients who had been diagnosed with PTSD according to DSM-IV criteria and met the admission criteria and 14 healthy controls. The activities of GSH-Px SOD, CAT and MDA were measured in both the patients and controls. In addition, all patients were assessed using the Clinician Administered PTSD Scale (CAPS). The mean GSH-Px, SOD, CAT activities and MDA levels of the patient group did not differ from those of the controls. However, in patients, the GSH-Px and SOD activities were significantly and positively correlated with CAPS scores, while there was a trend toward positive correlations between CAPS scores and MDA or CAT. In conclusion, our results suggest that the production of FRs does not seem to be related to PTSD.     

Implications of biological findings for psychological treatments of post-traumatic stress disorder.

The goal of this article is to initiate dialogue among those conducting research on the biological aspects of post-traumatic stress disorder (PTSD) and clinicians and researchers concerned with developing effective psychological treatments for PTSD. Important biological findings in PTSD are reviewed, paying special attention to the clinical implications of these findings. A discussion of the psychological treatments effective for PTSD follows, focusing on how these empirically supported treatments may address some of the issues raised by the biological findings. Finally, suggestions are made for future directions for psychological treatment development for this disabling condition, examining how these innovative treatment approaches may be relevant to the reviewed biological findings.     

颅脑损伤患者术后创伤后成长与创伤后应激障碍的相关性

目的 观察颅脑损伤患者术后创伤后成长水平及创伤后应激障碍(PTSD)情况,分析创伤后成长水平与PTSD的关系.方法 选取2017-02—2019-02郑州市第九人民医院手术治疗的63例颅脑损伤患者,所有患者术后1个月接受创伤后成长评定量表(PTGI)评估,依据评估结果分为高水平组与低水平组,调查2组一般资料并评估患者术...     

Trauma exposure and post-traumatic stress disorder in bipolar disorder

Introduction  

There is a lack of data about post-traumatic stress disorder (PTSD) in European bipolar patients compared to the US-population. This study was conducted to ascertain the rates and types of traumatic events and PTSD in bipolar-I disorder.     

Neuroimaging studies in post-traumatic stress disorder

The past decade has seen a rapid advance in understanding of the neural circuits of post-traumatic stress disorder (PTSD), which has largely been due to the application of neuroimaging to the study of this disorder. Based on studies in animals of the effects of stress on the brain, dysfunction of the medial prefrontal cortex, hippocampus, and amygdala have been hypothesized to underlie symptoms of PTSD. Neuroimaging studies in PTSD have been consistent with these hypotheses, with the most replicated findings showing decreased medial prefrontal cortical function in PTSD. Other replicated findings include decreased inferior frontal gyrus function, decreased hippocampal function, increased posterior cingulate function, and, in some behavioral paradigms, increased amygdala function. Several studies have now shown changes in structure (smaller volume) of the hippocampus in PTSD. These studies are beginning to map out a neural circuitry of PTSD that may have future implications for diagnosis and treatment.     

Memory processes in post-traumatic stress disorder

The relation between emotion and memory is highly complex and, on the surface, the studies conducted are full of contradictions. A consensus is gradually emerging that emotion is likely to benefit memory for central details while disadvantaging memory for peripheral details, and that extremely high levels of emotion lead to strong conditioned responses while impairing conscious memory processes. These phenomena are illustrated well in post-traumatic stress disorder (PTSD), where intense flashbacks can co-exist with disorganized and incomplete narrative memory. These findings are related to the dual representation theory of memory in PTSD, and the implications for therapy are briefly discussed.     

Functional neuroimaging in post-traumatic stress disorder

Traumatic stress has a broad range of effects on brain function. Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Brain studies in patients with post-traumatic stress disorder replicated findings in animal studies by finding alterations in these brain areas. Brain areas implicated in post-traumatic stress disorder play an important role in the stress response as well as memory, highlighting the important interplay between memory and the traumatic stress response. Future studies are required to assess the relationship between recovery from traumatic stress and changes in brain function.     

Insanity defense in post-traumatic stress disorder

We report the forensic psychiatric evaluation of a 40 year old Iraqi who suffers from a posttraumatic stress disorder (PTSD). She committed multiple non violent shopliftings. We mention criteria for a possible causal relationship between the PTSD and the crimes and discuss, why we affirm a insanity defense in this case.     

创伤性脑损伤患者创伤后成长与创伤后应激障碍的调查研究

目的分析创伤性脑损伤（TBI）患者创伤后成长（PTG）与创伤后应激障碍（PTSD）的现况及其影响因素。 方法通过便利抽样的方法,选取首都医科大学附属北京天坛医院神经外科自2019年7月至2020年1月就诊的85例TBI患者为研究对象,使用创伤后成长评定量表（PTGI）、创伤后应激障碍量表平民版（PCL-C）调查TBI患者的PTG水平、PTSD情况,并进一步分析TBI患者PTG的影响因素。 结果TBI患者PTGI总分为（58.41±23.05）分,处于低水平。PCL-C得分为（36.18±16.52）分,PCL-C阳性症状检出率为41.2%。多元线性回归分析结果显示,文化程度、性格类型、社会支持、警觉性增高、创伤再体验是TBI患者PTG的影响因素。TBI患者文化水平低、外向型性格、社会支持水平越高其PTG水平越高。TBI事件后警觉性反应低者,PTG水平较高,创伤再体验症状促进PTG的发生。 结论TBI患者创伤后早期同时出现PTG及PTSD,通过调动患者个体内部因素及外在社会联系等方面积极因素,可能提高患者PTG水平。     

Fluvoxamine treatment in veterans with combat-related post-traumatic stress disorder

This study was designed to investigate the efficacy of the antidepressant fluvoxamine in the treatment of combat-related post-traumatic stress disorder (PTSD). Fifteen veterans with combat-related PTSD and no other psychiatric diagnosis except depression were recruited to participate in a 14-week open-label study of fluvoxamine. Patients underwent a 30-day washout period and were rated with the Clinician Administered PTSD Scale (CAPS), Mississippi Scale, Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) at baseline, and every 2 weeks until week 14. Three patients stopped fluvoxamine prematurely due to side effects and 7 withdrew consent before completing the 14-week trial. Eight patients completed at least 8 weeks of treatment. The total daily dose of fluvoxamine ranged from 100 to 300 mg with a mean daily dose of 150 mg at week 14. Intent-to-treat analysis revealed a significant improvement in total CAPS scores, and in the intrusion and the avoidance/numbing subscales. The CAPS hyper-arousal scores did not change significantly. HAM-A score also improved significantly. No significant changes were seen on the Mississippi scale, HAM-D, or Beck Depression Inventory in the intent-to-treat analysis. In summary, our study shows that fluvoxamine appears to improve combat-related PTSD symptoms but not depressive symptoms. The high attrition rate and lack of a placebo group limits the conclusions of our study. Controlled studies of fluvoxamine in the treatment of PTSD are warranted.     

Traumatic experiences,post-traumatic stress disorder and obsessive-compulsive disorder

This paper explores the links between traumatic experiences, post-traumatic stress disorder and obsessive-compulsive disorder. The development of obsessions and compulsions following trauma is noted, with case examples. The similarities in some aspects of the two disorders are also highlighted. Comments are made on the possible causal pathways, and on treatment implications.     

Social and health functioning in female primary care patients with post-traumatic stress disorder with and without comorbid substance abuse

The present study examined whether post-traumatic stress disorder (PTSD) and comorbid substance use disorder (SUD) is associated with greater social and health morbidity than PTSD without SUD in a sample of female primary care patients. Participants were administered diagnostic interviews and assessed for work productivity, quality of interpersonal relationships, and degree of health functioning. No significant differences were found between the women with current PTSD and a comorbid lifetime substance use disorder (N = 56) and those with current PTSD and no lifetime substance use disorders (N = 60) in degree of work productivity, interpersonal functioning, and overall well-being and health, as well as number of lifetime medical illnesses. These findings suggest that the presence of comorbid SUD may not explain the level of social and health difficulties associated with the dual diagnosis of PTSD and SUD.     

Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder

Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.