The effect of nicotine and trauma context on acoustic startle in smokers with and without posttraumatic stress disorder

Rationale  

Exaggerated startle response is a prominent feature of posttraumatic stress disorder (PTSD) although results examining differences in the acoustic startle response (ASR) between those with and without PTSD are mixed. One variable that may affect ASR among persons with PTSD is smoking. Individuals with PTSD are more likely to smoke and have greater difficulty quitting smoking. While smokers with PTSD report that smoking provides significant relief of negative affect and PTSD symptoms, the effects of smoking or nicotine deprivation on startle reactivity among smokers with PTSD are unknown.     

Mortality rates between treated post-traumatic stress disorder Israeli male veterans compared to non-diagnosed veterans

The literature suggests that post-traumatic stress disorder (PTSD) is associated with increased mortality. However, to date, mortality rates amongst veterans diagnosed with post-traumatic stress disorder have not been reported for Israeli veterans, who bear a different profile than veterans from other countries. This study aims to evaluate age-adjusted mortality rates amongst Israeli Defense Forces veterans with and without PTSD diagnosis. The study was carried out in a paired sample design with 2457 male veterans with treated PTSD and 2457 matched male veterans without a PTSD diagnosis. Data on PTSD and non-PTSD veterans was collected from the Rehabilitation Division of the Israeli Ministry of Defense (MOD) and the Israeli Defense Forces' (IDF) special unit for treatment of combat stress reaction. Mortality data were collected from the Ministry of the Interior (MOI) computerized database. Comparison of mortality rates between PTSD and non-PTSD veterans was done using paired observations survival analysis by applying a proportional hazards regression model. Overall no statistically significant difference in mortality rates was found between veterans with treated PTSD and veterans without PTSD. These findings hold even when excluding veterans who died in battle and including non-PTSD veterans who died before their matched PTSD veteran was diagnosed. However, among pairs with similar military jobs PTSD group had significantly less mortality. The results of this large national cohort suggest that treated PTSD is not associated with increased mortality. We submit that the lack of this association represents the “net” pathophysiology of PTSD due to the unique characteristics of the sample.     

Prevalence of posttraumatic stress disorder in alcohol dependent patients in Poland

The present study investigates the prevalence of comorbid posttraumatic stress disorder (PTSD) in a sample of Polish alcohol dependent patients and examines the relationship between comorbid PTSD and alcohol use-related problems. Patients (n=458) were recruited from randomly chosen clinical settings and were administered self-report measures of trauma exposure, PTSD symptomatology, and alcohol use-related problems. From this sample, 67% of the patients reported having experienced at least one criterion A traumatic event, and 60% of them reported multiple traumas. Approximately 25% of them met the criteria for current PTSD. The only significant difference between the PTSD and non-PTSD groups was abuse/dependence of other psychoactive substances. However, patients reporting physical assaults committed by a non-stranger reported more frequent PTSD diagnosis, more extensive symptomatology, more conflicts with the law and more physical injuries due to drinking. The findings of the study confirm the importance of assessing trauma and PTSD in alcohol dependent patients.     

Drinking motives among heavy-drinking veterans with and without posttraumatic stress disorder

Objective: This study examined patterns of drinking motives endorsed by heavy drinking veterans who either did or did not meet criteria for posttraumatic stress disorder (PTSD). Method: Data were collected from 69 veterans of Operations Enduring Freedom or Iraqi Freedom (OEF/OIF) who had screened positive for hazardous drinking. The sample was 91.3% male and 65.2% Caucasian. Based on a structured interview, 58% of the sample met criteria for PTSD. Results: The PTSD group scored higher than the non-PTSD group on scales measuring drinking to cope with anxiety and depression and similarly to the non-PTSD group on scales measuring social, enhancement and conformity motives. Coping and social motives were significantly correlated with adverse alcohol consequences. Overall, the PTSD group showed stronger relations between coping scales and aspects of alcohol misuse, relative to the non-PTSD group. Conclusion: These findings suggest first, that among heavy drinking OEF/OIF veterans there is a high base rate of PTSD. Second, coping motives are frequently reported in this population, and they seem to be related to a more severe pattern of alcohol-related consequences. These findings underscore the importance of assessing the interplay between PTSD and substance abuse in trauma-exposed samples.     

Co-morbid post-traumatic stress disorder in a substance misusing clinical population

BACKGROUND: USA studies have reported high rates of co-morbid post-traumatic stress disorder (PTSD) and substance (drugs and alcohol) dependence/misuse. Avoidance of trauma reminders and associated distress may be achieved by the use of drugs and alcohol, alternatively a substance abusing lifestyle might predispose such individuals to experience traumatic events. This may have implications for treatment and management of patients with co-morbid substance misuse and PTSD. There have been no British studies looking at the extent of traumatic life events and post-traumatic stress disorder amongst substance misusers, although high rates of reported sexual and physical abuse have been reported in two recent UK studies with drug- and alcohol-dependent patients in clinical settings. AIMS: (i) To investigate the prevalence of co-morbid PTSD in a UK substance use disorder (SUD) inpatient clinical population; (ii) to identify the characteristics, severity and types of trauma experienced; (iii) to compare SUD patients with and without co-morbid PTSD on substance use and history, psychological/psychiatric and social variables METHOD: This is a cross-sectional study involving interviews with patients and case note review. SUD inpatients were interviewed about traumatic experiences, PTSD, and addiction. RESULTS: Ninety-four percentage reported experiencing one or more PTSD criterion A traumatic experiences. 38.5% met criteria for current PTSD and 51.9% for lifetime PTSD. Significant differences between the PTSD and non-PTSD groups were found in PTSD and trauma-related variables, notably social variables and distress associated with traumatic experiences, but few differences were found in addiction severity (medical and psychiatric composite scores of the ASI) and psychiatric symptomatology. CONCLUSIONS: This study highlights not only the importance of assessment of trauma and PTSD amongst substance misusers but, conversely the need for the assessment of substance abuse among victims of PTSD. Co-morbid psychopathology is common, so trauma histories and PTSD symptoms may become embedded in other co-morbid psychopathology.     

Development of puffing behavior along burning time of a cigarette — No relation to alveolar inhalation or nicotine delivery of the cigarettes?

The curves of the cumulative smoke volumes (CSV), as determined by the number of puffs, the puff intervals, the single puff durations, and puff volumes, of 108 nondeprived smokers who smoked two personal brand cigarcttes revealed statistically distinct clusters. Pronounced nonlinear increases in the puff intervals and modest decreases in the puff volumes were seen generally, but they varied in extent between clusters as did the number of puffs and estimated mouth intake of nicotine. Most clusters (representing 80% of the smokers) did not deviate significantly from a linear development of the CSV curves, and those that did were characterized by particularly short puff intervals. Most of the subjects moved from the first to the second cigarette into clusters of similar shapes. However, none of these conclusions showed any relation either to the nicotine yield of the cigarettes or to the pre- to postsmoking tidal CO. It was therefore concluded that the sensory consequences of the physicochemical changes in smoke composition between the first and last puff or other as yet unknown psychological factors are more likely candidates than nicotine satiation for explaining the typical changes in puffing behavior along burning time of a cigarette.     

Posttraumatic stress disorder,smoking, and cortisol in a community sample of pregnant women

Background

The prevalence of posttraumatic stress disorder (PTSD) in the United States is higher among pregnant women than women generally. PTSD is related to adverse birth outcomes via physiological and behavioral alterations, such as smoking.

Methods

We utilize salivary cortisol measures to examine how traumatic stress, smoking and the hypothalamic–pituitary–adrenal axis interact. Pregnant women (n = 395) gave cortisol specimens as part of a cohort study of PTSD and pregnancy at three health systems in the Midwestern United States. Women were divided into three groups: nonsmokers, quitters (who stopped smoking during pregnancy), and pregnancy smokers. Mean cortisol values at three points, sociodemographics, trauma history, and PTSD were compared across groups. We assessed the association of smoking group and PTSD with late afternoon cortisol levels.

Results

Smokers, quitters, and nonsmokers differed on demographic risk factors and PTSD symptom load. Late afternoon and bedtime cortisol measures were significantly positively correlated with smoking in pregnancy, with smokers with PTSD presenting the highest cortisol levels. Regression analysis showed that smoking in pregnancy was associated with higher late afternoon cortisol in an additive manner with PTSD symptoms.

Conclusions

Smoking appears to have a different relationship with cortisol level for those with and without PTSD. This is the first study to show additive effects of smoking and PTSD on cortisol levels in pregnant women. Since high cortisol, smoking, and PTSD have been shown to adversely affect perinatal outcomes, and since those continuing to smoke in pregnancy had the highest PTSD symptom load, PTSD-specific smoking cessation programs in maternity settings are warranted.     

Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: an initial evaluation

Outcomes after behavioral couples therapy (BCT) were compared for 19 dually diagnosed veterans with combat-related PTSD and a substance use disorder (SUD, primarily alcohol dependence) and 19 veterans with SUD only. Clients with and without comorbid PTSD had very similar pre-treatment clinical profiles on dimensions of substance misuse, relationship functioning, and psychological symptoms. Further, both PTSD and non-PTSD clients showed good compliance with BCT, attending a high number of BCT sessions, taking Antabuse, and going to AA. Finally, both PTSD and non-PTSD groups improved from before BCT to immediately after and 12 months after BCT. Specific improvements noted were increased relationship satisfaction and reductions in drinking, negative consequences of drinking, male-to-female violence, and psychological distress symptoms. Extent and pattern of improvement over time were similar whether the client had PTSD or not. The present results suggest that BCT may have promise in treating clients with comorbid SUD and combat-related PTSD.     

Immediate antecedents of cigarette smoking in smokers with and without posttraumatic stress disorder: a preliminary study

Using ambulatory methods for 1 day of monitoring, the authors of this study investigated the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. Smoking was strongly related to craving, positive and negative affect, PTSD symptoms, restlessness, and several situational variables among PTSD smokers. For non-PTSD smokers, the only significant antecedent variables for smoking were craving, drinking coffee, being alone, not being with family, not working, and being around others who were smoking. These results are consistent with previous ambulatory findings regarding mood in smokers but also underscore that, in certain populations, mood and symptom variables may be significantly associated with ad lib smoking.     

Investigation of mainstream smoke aerosol of the argileh water pipe.

A first-generation smoking machine and protocol have been developed in order to study the mainstream smoke aerosol and elucidate thermal-fluid processes of the argileh water pipe. Results using a common mo'assel tobacco mixture show that, contrary to popular perceptions, the mainstream smoke contains significant amounts of nicotine, "tar" and heavy metals. With a standard smoking protocol of 100 puffs of 3 s duration spaced at 30-s intervals, the following results were obtained in a single smoking session: 2.25 mg nicotine, 242 mg nicotine-free dry particulate matter (NFDPM), and relative to the smoke of a single cigarette, high levels of arsenic, chromium and lead. It was found that increasing puff frequency increased the NFDPM but had little effect on nicotine delivery, while removing the water from the bowl increased by several-fold the nicotine, but had little effect on NFDPM. It was also found that the charcoal disk heat source contributed less than 2% of total particulate matter (TPM), and that characteristic temperatures of the tobacco varied from 450 degrees C nearest the heat source to 50 degrees C furthest away, indicating that the NFDPM is likely a result of devolatilization rather than chemical reaction, and will thus differ significantly in composition from that of cigarette smoke.     

急诊重症患者机械通气脱机后发生创伤后应激障碍的危险因素分析

目的:分析急诊重症患者于机械通气脱机后发生创伤后应激障碍(PTSD)的危险因素.方法:回顾性选择某院急诊室收治的160例重症患者为研究对象,统计患者机械通气脱机后PTSD的发生率,并以患者发生PTSD为因变量,以可能造成PTSD的相关因素(患者基线资料)为自变量,分析PTSD发生的危险因素.结果:160例患者机械通气脱...     

Post-traumatic stress disorder in UK police officers

Prevalence rates for post-traumatic stress disorder (PTSD) in police officers may be six or more times the prevalence rates for the community. Once established, is PTSD in police officers more severe than PTSD in civilians? This small study looks at the symptom frequencies in established cases of PTSD in 31 police officers and 72 civilians and compares the two. No significant differences were found, although there was a tendency for higher use of alcohol and to try not to think about the trauma. Police officers had more experiences of reliving the trauma or acting as if the trauma were recurring but, again, not to a significant degree.     

Trauma and post-traumatic stress disorder in women: a review

In the aftermath of traumas such as combat or sexual assault, both men and women may experience similar symptoms, including post-traumatic stress disorder (PTSD). However, epidemiological studies have yielded higher rates of PTSD in women than in men in general populations, and there are also a number of gender differences in clinical presentation after trauma. Thus, in a study by the authors of patients presenting with physical trauma after interpersonal violence, women were more likely than men to have been previously assaulted, or to have sustained injury by a relative or someone known to them, but less likely to have used substances at the time of the assault or to require emergency surgery. A better understanding of the particular factors that contribute to higher rates of PTSD in women may ultimately shed light on the pathogenesis of this complex disorder. This article reviews gender differences in exposure to trauma and subsequent PTSD, emphasizing those features that characterize trauma and PTSD in women.     

Rates and symptoms of PTSD among cocaine-dependent patients

OBJECTIVE: This study evaluated lifetime traumatic events and current posttraumatic stress disorder (PTSD) symptoms in a substance abuse sample. METHOD: Participants in the study consisted of 558 (75.1% male) cocaine-dependent individuals who completed self-report measures of trauma and PTSD symptoms prior to entry into treatment. RESULTS: Results showed a high number of lifetime traumatic events, even among those without PTSD. General disaster was the most prevalent. Current PTSD was found in 10.9% of the participants, with a significantly higher rate among women (21.6%) than among men (7.2%). For those with PTSD, the most prominent PTSD symptom cluster was arousal, and the most common symptoms were restricted affect, detachment and irritability. Participants with PTSD endorsed a large number of symptoms, almost double that needed to meet diagnostic criteria; however, neither number of traumas nor type of trauma was associated with their level of PTSD symptoms. Even among those not meeting PTSD criteria, subthreshold symptoms were found, with avoidance the most prominent cluster. Sociodemographic and recent cocaine use variables did not differentiate the PTSD from non-PTSD groups. CONCLUSIONS: PTSD is present in a sizeable percentage of cocaine-dependent treatment-seeking patients, particularly women. Clinicians might address arousal symptoms in particular, which were the most prominent symptom cluster, and which may be exacerbated by cocaine use. Even among those without PTSD, lifetime trauma is substantial and subthreshold PTSD symptoms are common. Vulnerability to PTSD needs further study, as sociodemographic and cocaine use variables did not distinguish between PTSD and non-PTSD groups.     

Cigarette smoking, ambulatory cardiovascular monitoring, and mood in Vietnam veterans with and without chronic posttraumatic stress disorder

This study investigated the association among cigarette smoking, posttraumatic stress disorder (PTSD), and ambulatory cardiovascular and mood monitoring in 117 male Vietnam combat veterans (61 with PTSD and 56 without PTSD). Positive smoking status was associated with higher systolic blood pressure (SBP) and heart rate (HR), as well as greater diastolic blood pressure (DBP) variability. Compared to individuals without PTSD, PTSD patients had higher HR, anger/hostility ratings, and depression/anxiety ratings. Significant diagnosis by smoking status interactions were found indicating that compared to nonsmokers with PTSD, smokers with PTSD had higher DBP, mean arterial pressure (MAP), and positive affect. Ad lib cigarette smoking during the previous 30 min did not have a significant effect on mood or cardiovascular parameters, except in non-PTSD smokers who reported lower depression/anxiety ratings after smoking. Findings suggest that the effect of smoking on cardiovascular parameters may be amplified in smokers in PTSD. Findings suggest that the interrelationships among cardiovascular parameters, cigarette smoking, and PTSD deserve more research attention.     

Pain and post traumatic stress disorder - review of clinical and experimental evidence

Pain and Post Traumatic Stress Disorder (PTSD) are highly comorbid conditions. Patients with chronic pain have higher rates of PTSD. Likewise, patients with PTSD are often diagnosed with numerous chronic pain conditions. Despite the high pain-PTSD comorbidity, the neurobehavioral mechanisms underlying this phenomenon are incompletely understood and only recently researchers have started investigating it using experimental models. In this article, we systematically review the substantial clinical evidence on the co-occurrence of pain and PTSD, and the limited experimental evidence of pain processing in this disorder. We provide a detailed overview of the psychophysical and brain imaging experiments that compared somatosensory and pain processing in PTSD and non-PTSD populations. Based on the presented evidence, an extensive body of literature substantiates the clinical coexistence of pain and PTSD in patients but the limited experimental data show inconsistent results highlighting the need for well-controlled future studies. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.     

Determinants of puff duration in cigarette smokers: I

This research was undertaken to provide information about variables that might account for the decreases in puff duration that consistently occur as a whole cigarette is smoked. Cigarette smoking was investigated under conditions in which subjects smoked cigarettes which they could not see. In a series of three experiments, the length of the tobacco rod, the length of the cigarette holder, and the cigarette nicotine delivery were systematically manipulated. The results showed that puff duration correlates with the length of the tobacco rod, and that visual stimulus control, satiation, distance from the burning ember to the smoker's mouth, nicotine delivery, particulate build-up during smoking, and subjective acceptability of cigarette smoke do not contribute significantly to the control of puff duration.     

Pharmacotherapy of post-traumatic stress disorder

In the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R and DSM-IV, the diagnosis of post-traumatic stress disorder (PTSD) requires the presence of three symptom clusters: re-experiencing, avoidance and hyperarousal. The selective serotonin reuptake inhibitors (SSRIs), in particular sertraline and paroxetine, have emerged as the treatment of choice for trauma victims experiencing these three symptom clusters. While not approved by the U.S. Food and Drug Administration, other pharmacological agents are often used, some for symptoms found in victims of early, chronic or extreme stress. Referred to as having type II trauma, complex PTSD, disorders of extreme stress and enduring personality change after catastrophic experience, these patients, with symptoms such as dissociation, somatization and self-injurious behavior, need to be recognized as suffering from a trauma-related disorder qualitatively different from that presently captured in the DSM-IV. In this paper we will refer to DSM-IV's construct as simple PTSD (sPTSD); to complex PTSD/disorders of extreme stress as cPTSD/DES; and to both as PTSD. We will review existing evidence for the efficacy of SSRIs in treating sPTSD as well as different pharmacological interventions that are necessary for the treatment of cPTSD/DES. In addition, since both sPTSD and cPTSD/DES frequently coexist with other mental disorders, treatment of comorbid PTSD will be addressed. Finally, given that existing rating scales are not designed to measure symptoms of cPTSD/DES, we will describe the Symptoms of Trauma Scale (SOTS), designed to measure symptoms of both sPTSD and cPTSD.