Long-term coping with combat stress

The present report examined ongoing patterns of coping in Vietnam combat veterans from community, outreach, and treatment samples. After reviewing various schemas for conceptualizing coping which exist in the literature, seven coping strategies empirically derived from the Horowitz Coping Inventory were described. Results indicated that the modes of coping most associated with combat intensity were the same as those associated with more symptomatology and a clinical diagnosis of PTSD in the present: event processing, time out for reflection, religion, and denial. Veterans who improved in short-term therapy for PTSD, on the other hand, used emotional expression and sublimation strategies. The findings were discussed in terms of the disorder of PTSD, the recovery process, and conceptual models of adaptation to stress.     

Multivariate assessment of explicit memory function in combat veterans with posttraumatic stress disorder

Declarative memory impairment is a frequent complaint of patients suffering from posttraumatic stress disorder (PTSD). We assessed memory, attention, visual spatial skills, and executive function in Vietnam combat veterans with (n = 19) and without (n = 13) PTSD. Although PTSD subjects demonstrated a generalized impairment relative to non-PTSD subjects on a majority of tasks, only attention and memory provided unique and independent prediction of PTSD versus non-PTSD status. Our findings suggest that memory functioning represents a neurocognitive domain of specific relevance to the development of PTSD in trauma-exposed individuals, which can be distinguished from generalized attentional impairment as well as the effects of trauma exposure severity, IQ, comorbid depression, history of alcohol use, and history of developmental learning problems.     

Predictors of chronic stress among Vietnam veterans: Stressor exposure and intrusive recall

The present study examined the relationship between military service during the Vietnam era and chronic stress among Vietnam combat veterans, noncombat military controls, and nonmilitary age-mates. Psychological, behavioral, and biochemical indices of stress were assessed. Results demonstrated that exposure to combat was not associated with symptoms of chronic stress. However, reported intrusiveness of recalled imagery associated with stressful combat events was an important predictor of long-term symptoms of stress irrespective of combat exposure. In addition, the interaction of combat exposure and intrusive thinking was significantly related to symptoms of chronic stress. These data suggest that intrusive thinking may reflect an important individual difference variable that could help predict long-term responding to stressors.This article was accepted for publication under the Editorship of Charles R. Figley.     

Open trial of nefazodone for combat veterans with posttraumatic stress disorder

Fourteen combat veterans completed a 9-week open trial of nefazodone for treatment of posttraumatic stress disorder (PTSD). Overall PTSD symptoms as measured by the Clinician-Administered PTSD Scale (CAPS) showed a modest but statistically significant decrease with nefazodone treatment. Decreases in CAPS reexperiencing and avoidance, but not hyperarousal symptoms, approached statistical significance. Anxiety decreased significantly, and there were trends toward decreased depression and anger on structured assessments. This study adds to the clinical evidence that nefazodone may be helpful for the management of PTSD symptoms.     

Pierre Janet's treatment of post-traumatic stress

Pierre Janet's therapeutic approach to traumatized patients was the first attempt to create a systematic, phase-oriented treatment of post-traumatic stress. Janet viewed the trauma response basically as a disorder of memory which interfered with effective action. Relying heavily on the use of hypnosis, he taught that the treatment of post-traumatic psychopathology consisted of forming a stable therapeutic relationship; retrieving and transforming traumatic memories into meaningful experiences; and taking effective action to overcome learned helplessness. Most of his observations and recommendations are as challenging today as when he first made them, starting a century ago.Written while the first author was affiliated with the Department of Pscyhiatry, Free University Hospital, Amsterdam, Netherlands     

Diagnosis and treatment of combat stress reaction: Current attitudes of military physicians

This study examined the attitudes of 203 Israel Defense Forces (IDF) military physicians regarding the causes and treatment of combat stress reaction. The findings indicate that subjects tended primarily to endorse situational rather than predispositional explanations for the causation of the CSR. They attributed the highest levels of responsibility for treatment to the frontline physician and to commanders, and the least amount of responsibility to the casualty himself. These findings suggest that military physicians do not hold CSR casualties responsible for the causation or the treatment of the stress reaction. CSR is now viewed within the medical model. It is considered by doctors to be within the purview of medicine and CSR casualties are considered legitimate objects of medical concern. The stigma attached to the phenomenon in the past thus appears to have diminished considerably.     

Pierre Janet on post-traumatic stress

One hundred years ago, in 1889, Pierre Janet published L'Automatisme Psychologique, his first work to deal with how the mind processes traumatic experiences. Janet claimed that vehement emotions interfere with proper appraisal and appropriate action. Failure to confront the experience fully leads to dissociation of the traumatic memories and their return as fragmentary reliving experiences: feeling states, somatic sensations, visual images, and behavioral reenactments. A century later, Janet still provides an unsurpassed framework for integrating current knowledge about the psychodynamic, cognitive, and biological effects of human traumatization.     

The contribution of wartime,pre-war,and post-war factors to self-efficacy: A longitudinal study of combat stress reaction

The current study is designed to investigate factors that shape combat-related self-efficacy expectations following breakdown in combat, and changes in the relative importance of each of these factors as time elapses. In the current study, a sample of Israeli frontline soldiers in the Israel Lebanon War (1982) who were diagnosed as having combat stress reaction was followed-up 1, 2, and 3 years after combat. At these three points of time, we assessed their psychiatric status and combat-related perceived self-efficacy. In addition, we gathered information about the soldiers' behavior and affect during battle, their adjustment prior to military training, the number of wars in which they had participated, and whether they broke down in these prior wars. Results show that self-efficacy following war was influenced by the specific characteristics of events that occurred during the war, the soldiers' current psychiatric status, and their adjustment prior to military training. In addition, it was found that with the passage of time, the importance of the characteristics of the trauma diminishes, and other factors take precedence. The results were discussed in terms of Bandura's conceptualization of self-efficacy.     

Post-traumatic stress disorder among the injured of theintifada

The current study aimed to assess the prevalence of PTSD among Palestinians who sustained serious bodily injuries during theintifada, as well as to delineate factors having an effect on the development and attenuation of PTSD symptomatology. Results indicated evidence of high prevalence of PTSD among the injured. No significant differences in PTSD prevalence for demographic, situational, and trauma-related variables were found except for the age factor. Prevalence of PTSD among adolescents was significantly higher than among adults. It seemed that the injury itself was so intensely overwhelming that the other variables were overshadowed. Implications for further research and stress management techniques were discussed.     

Functional neuroanatomical correlates of the effects of stress on memory

Recently there has been an increase in interest in the relationship between stress and memory. Brain regions which are involved in memory function also effect the stress response. Traumatic stress results in changes in these brain regions; alterations in these brain regions in turn may mediate symptoms of posttraumatic stress disorder (PTSD). Neural mechanisms which are relevant to the effects of stress on memory, such as fear conditioning, stress sensitization, and extinction, are reviewed in relation to their implications for PTSD. Special topics including neural mechanisms in dissociation, neurobiological approaches to the validity of childhood memories as they apply to controversies over the False Memory Syndrome, and implications of the effects of stress on memory for psychotherapy, are also reviewed. The findings discussed in this paper are consistent with the formulation that stress-induced alterations in brain regions and systems involved in memory may underlie many of the symptoms of PTSD, as well as dissociative amnesia, seen in survivors of traumatic stress.     

Complex PTSD in Victims Exposed to Sexual and Physical Abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.     

Work locus of control and its relationship to stress perception, related affections, attitudes and behaviours from a domain-specific perspective

This research aims to examine the value of applying the Work Locus of Control Scale in predicting work-related outcomes. Study 1 surveyed 323 employees from different companies in China and found that the domain-specific scale was more predictive than the general scale in predicting perceived stressors, rather than in predicting organizational affective commitment and altruistic behaviour. Study 2 applied a multi-wave and multi-source design and used commensurate Likert scales to measure work and general locus of control. Participants were 344 employees from one corporation. Work locus of control was found to be more useful in predicting supervisor-rated job performance, conscientious and altruistic behaviours. These findings help understand the theory-based and measurement-based reasons for the advantages of using domain-specific measures. They claim the importance for employing the domain-specific measure to predict work-related perceptions and behaviours. Implications for the theory and practice are discussed.     

Mental defenses and posttraumatic stress disorder: Assessment of criminal intent

Since its formal introduction into psychiatric nomenclature more than a decade ago, the diagnosis of posttraumatic stress disorder (PTSD) has become firmly entrenched in the legal landscape. In part, this is because PTSD seems easy to understand. It is one of only a few mental disorders for which the psychiatric Diagnostic and Statistical Manual (DSM) describes a known cause. Since the diagnosis is usually based on patients' self-report, however, it creates the possibility of distortion aimed at avoidance of criminal punishment, and, as a result, has achieved mixed success as a criminal defense. When providing expert testimony, mental health witnesses must take care to distinguish between mere PTSD and a causal connection between PTSD and the criminal act in question. PTSD has not only been used to abrogate or diminish responsibility, but also to arrange pre-trial plea bargaining agreements or play a role in sentencing determinations. The author explores various uses and potential abuses of PTSD in criminal jurisprudence and offers suggestions regarding retrospective PTSD assessment.     

笑声瑜伽对非小细胞肺癌化疗患者压力知觉的影响

目的 探讨笑声瑜伽在非小细胞肺癌化疗患者中的应用效果。 方法 按照整群随机法，选取在呼吸科2个病区住院治疗的84例非小细胞肺癌化疗患者分为两组各42例。对照组实施常规护理教育，干预组在此基础上实施笑声瑜伽干预，干预前后采用知觉压力量表，焦虑、抑郁自评量表，积极心理资本量表评价干预效果。 结果 干预组患者干预后压力知觉、焦虑、抑郁评分显著低于对照组，积极心理资本评分显著高于对照组（均P＜0.05）。 结论 笑声瑜伽能有效缓解患者的压力知觉水平和焦虑、抑郁情绪，提高患者的积极心理资本水平。     

A brief report about the concepts of hand disorders in the Canon of Medicine of Avicenna

Avicenna contributed to development in many fields of medicine. The Canon of Medicine is the masterpiece of Avicenna's medical books in which he wrote on the anatomy of the upper extremity, fractures, dislocations, and nerve and tendon injuries. Reviewing these subjects pertinent to hand disorders reveals Avicenna's concepts about hand disorders a millennium ago.     

The association between peritraumatic dissociation and acute stress reactions among rescue personnel 36–48h after a gas pipe explosion in Tel‐Aviv: a preliminary report

The association between peritraumatic dissociation and acute stress reactions were examined among rescue personnel 36–48h after exposure to a gas pipe explosion resulting in a collapsed building in Tel Aviv. The entire rescue personnel were examined for peritraumatic dissociation and acute stress reactions. The results showed that among men there was a negative association between peritraumatic dissociation and acute stress reactions. Among women, there was a positive association between peritraumatic dissociation and acute stress reactions. These results correspond with previous studies that found an association between peritraumatic dissociation and acute stress reactions. Explanations to these results are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Factors modifying stress from adverse effects of immunosuppressive medication in kidney transplant recipients

INTRODUCTION: The adverse effects of immunosuppression appear in the majority of patients with a negative impact on morbidity, mortality and quality of life. The group of adverse symptoms manifested as changes in appearance, mood and energy are often more stressful than serious metabolic changes because of their direct negative influence on patients' well-being. The aim of this study is to explore the adverse symptoms of immunosuppressive medication which are the most stressful for transplanted patients, and which are the modifying factors. PATIENTS AND METHODS: A total of 157 adult kidney transplant recipients from two transplant centres in Slovakia with a functioning graft transplanted <7 yr ago were examined. Patients participated in an interview focusing on stress from adverse effects, and their education and social support. Medical records were searched for information about immunosuppression protocols, dialysis treatment before transplantation, type of received organ and period after transplantation. The effect of the selected variables on the total score for stress from adverse effects was tested using ANOVA. The effect of the selected factors on stress from each single adverse effect was explored using t-test and ANOVA. RESULTS: The most stressful symptoms were pain, weakness, weight gain, facial changes, depression and anxiety. The mean value of the total score for stress from adverse effects was 8.03 +/- 6.53 (minimum 0, maximum 30, range: 0-64), indicating low stress. Women and patients with lower education significantly more often felt the adverse effects of immunosuppression as stressful (p < 0.001 and p < 0.05, respectively). Age, social support, dialysis modality before transplantation, time from transplantation and type of immunosuppressive treatment did not affect the total score for stress from adverse effects. However, variables that were not significant in the overall score reached significance in some symptoms. CONCLUSIONS: Women and patients with lower education significantly more often felt the adverse effects of immunosuppression as stressful; in a more detailed analysis the use of new drugs was connected with less stress in some symptoms. The use of these drugs can improve life quality for transplant recipients, decrease non-compliance, and thus prevent graft loss.     

机械牵张应力对骨化颈椎后纵韧带成纤维细胞的影响

目的探讨机械牵张应力对体外培养的颈椎后纵韧带骨化症（OPLL）患者颈椎韧带成纤维细胞的影响。方法对2012年1月至2013年12月 OPLL 与颈椎外伤但无后纵韧带骨化（非OPLL）患者（各15例）行前路颈椎手术治疗,术中取韧带标本。采用组织块培养法进行细胞体外培养,免疫细胞化学及免疫荧光技术检测胞质波形蛋白。采用 Flexercell 4000细胞加载培养系统分别对两组患者第3代细胞进行机械牵张应力加载,逆转录-聚合酶链式反应（RT-PCR）方法检测两组成纤维细胞应力刺激前及刺激后12、24 h 成骨特异性指标骨钙素、碱性磷酸酶与Ⅰ型胶原 mRNA 表达。结果免疫细胞化学及免疫荧光检测显示胞质波形蛋白呈阳性表达。OPLL组后纵韧带成纤维细胞经机械牵张应力刺激12 h后,骨钙素、碱性磷酸酶及Ⅰ型胶原 mRNA 表达明显升高,应力刺激前后差异具有统计学意义;而非OPLL组应力刺激前后骨钙素、碱性磷酸酶及Ⅰ型胶原 mRNA 表达无明显变化。结论机械牵张应力可促使OPLL患者后纵韧带成纤维细胞骨钙素、碱性磷酸酶及Ⅰ型胶原mRNA表达增加,促进其骨化,其在OPLL进展中发挥重要作用。     

CCU转出患者家属迁移应激及影响因素分析

目的探讨CCU转出至普通病房患者家属迁移应激现况及影响因素,为针对性干预提供参考。方法对114名CCU转出患者家属采用一般资料问卷、家属迁移应激量表、疾病不确定感家属量表及照顾者负担问卷进行调查分析。结果患者家属迁移应激得分38.07±7.28,照顾者负担得分74.15±8.47,疾病不确定感得分77.93±6.95;性别、学历、亲属关系、家庭收入、医疗付费方式、CCU入住时间、疾病不确定感及照顾者负担是患者家属迁移应激的主要影响因素(调整R~2=0.552;P0.05,P0.01)。结论 CCU转出患者家属照顾者负担及疾病不确定感水平较高,迁移应激明显,其影响因素众多;医护人员应高度重视,加强沟通,避免患者家属盲目担心,以使患者安心转至普通病房继续治疗。