Neopterin production in posttraumatic stress disorder before and after pharmacotherapy

Post-traumatic stress disorder (PTSD) has been associated with decreased neopterin levels. In the present study, we evaluated whether this low neopterin levels would normalize following pharmacotherapy with sertraline in PTSD. Fourteen patients with PTSD and 14 controls were enrolled in the study. A clinical evaluation and measurements of neopterin levels before and after sertraline treatment were performed. In addition, all patients were assessed with the Clinician Administered PTSD Scale (CAPS). The mean neopterin levels were significantly lower in the patient group than control group at baseline and were negatively correlated with the duration of illness, or severity of illness. Sertraline treatment decreased the symptoms of PTSD; however this was not accompanied by a significant increase in neopterin production. In conclusion, our results reveal that the failure for neopterin to normalize through symptom alleviation suggests that either neopterin may be a trait marker of the illness, or that more sustained treatment is necessary to elevate the neopterin production. Received: 30 September 2002 / Accepted: 12 December 2002 Correspondence to Dr. Murad Atmaca     

Vulnerable populations in an American Red Cross shelter after Hurricane Katrina

TOPIC: During Katrina, people suddenly encountered multiple losses, including homes, finances, medications, and death of loved ones. The Model of Vulnerable Populations illustrates how reduced resources placed individuals at greater risk for harm. PURPOSE: Using vignettes and the Model of Vulnerable Populations, a psychiatric nurse discusses her experiences as an American Red Cross psychiatric/mental health nurse volunteer after the Katrina disaster at a Mississippi shelter. CONCLUSIONS: The role of the mental health nurse volunteer was demonstrated by assessment and interventions of advocacy, referral, crisis intervention, and general support and education. PRACTICE IMPLICATIONS: Using the Model of Vulnerable Populations, psychiatric nurses can improve mental health assessment and services by counseling, advocacy, triage, and teaching disease prevention strategies such as hand washing.     

DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population

Type and prevalence of Axis I and Axis II disorders (DSM-III) were assessed in a sample of 298 consecutive psychiatric outpatients. The instruments used were SCID and SIDP. About half of the Axis I diagnoses consisted of different subgroups of depression. Most patients had more than one diagnosis, anxiety being the second most common disorder. Eighty one percent of the subjects met the criteria for a personality disorder diagnosis; half of them obtained more than one Axis II diagnosis. Personality disorder was more common among men than among women. Avoidant and dependent personality disorders constituted the most frequent diagnoses.     

Variability and severity of depression and anxiety in post traumatic stress disorder and major depressive disorder

In order to better characterize the similarities in and differences between the nature of the affective disturbance associated with Posttraumatic Stress Disorder (PTSD) and with Major Depressive Disorder (MDD), self-reported mood and anxiety ratings were examined in PTSD subjects, MDD subjects, and subjects without a psychiatric disorder while they were undergoing a chronobiologic study. Based on serial ratings on visual analogue scales over a 24 hr period, PTSD subjects showed comparable levels of depression as the MDD group, as measured by the mean and maximum levels of mood; however, they had greater mood variability, as measured by the range and coefficients of variation of the mood ratings. The MDD but not the PTSD group had significantly lower mood variability than the non-psychiatric group, as measured by the coefficients of variation. The PTSD group reported higher levels of anxiety than the non-psychiatric or MDD group but showed no differences in any measure of variability of anxiety. These findings suggest there are phenomenologic differences in the affective symptoms experienced by patients with PTSD and with MDD and that mood variability may distinguish between them.     

Rumination in posttraumatic stress disorder

Recent studies have shown that rumination is a powerful predictor of persistent posttraumatic stress disorder (PTSD). However, to date, the mechanisms by which rumination maintains PTSD symptoms are little understood. Two studies of assault survivors, a cross-sectional (N = 81) and a 6-month prospective longitudinal study (N = 73), examined several facets of ruminative thinking to establish which aspects of rumination provide the link to PTSD. The current investigation showed that rumination is not only used as a strategy to cope with intrusive memories but it also triggers such memories. Certain characteristics of rumination, such as compulsion to continue ruminating, occurrence of unproductive thoughts, and "why" and "what if" type questions, as well as negative emotions before and after rumination, were significantly associated with PTSD, concurrently and prospectively. These characteristics explained significantly more variance in PTSD severity than the mere presence of rumination, thereby indicating that not all ways of ruminative thinking are equally maladaptive.     

Hippocampal function in posttraumatic stress disorder

Recent studies have reported memory deficits and reduced hippocampal volumes in posttraumatic stress disorder (PTSD). The goal of the current research was to use functional neuroimaging and a validated explicit memory paradigm to examine hippocampal function in PTSD. We used positron emission tomography (PET) and a word-stem completion task to study regional cerebral blood flow (rCBF) in the hippocampus in 16 firefighters: 8 with PTSD (PTSD group) and 8 without PTSD (Control group). During PET scanning, participants viewed three-letter word stems on a computer screen and completed each stem with a word they had previously encoded either deeply (High Recall condition) or shallowly (Low Recall condition). Relative to the Control group, the PTSD group exhibited significantly smaller rCBF increases in the left hippocampus in the High vs Low Recall comparison. However, this finding reflected relatively elevated rCBF in the Low Recall condition in the PTSD group. Collapsing across High and Low Recall conditions, (1) the PTSD group had higher rCBF in bilateral hippocampus and left amygdala than the Control group, and (2) within the PTSD group, symptom severity was positively associated with rCBF in hippocampus and parahippocampal gyrus. The groups did not significantly differ with regard to accuracy scores on the word-stem completion task. The PTSD group had significantly smaller right (and a trend for smaller left) hippocampal volumes than the Control group. The results suggest an abnormal rCBF response in the hippocampus during explicit recollection of nonemotional material in firefighters with PTSD, and that this abnormal response appears to be driven by relatively elevated hippocampal rCBF in the comparison condition.     

Reactivation of posttraumatic stress disorder after minor head injury

This report describes the reactivation of a posttraumatic stress disorder (PTSD) after a minor head injury in two young women who had recovered from extreme stress caused by sexual abuse during adolescence. Intrusive thoughts, images, dreams, and phobic avoidance bear a direct relationship to the specific circumstances of both head injury and sexual abuse, and were associated with obsessive-compulsive symptoms, generalized anxiety with panic, and depression. These findings suggest that in some individuals minor head injuries may induce not only extreme stress reactions, but also cause the reactivation of symptoms related to previous traumatic experiences. Depression and Anxiety 8:43–47, 1998. © 1998 Wiley-Liss, Inc     

Latent profile analyses of posttraumatic stress disorder,depression and generalized anxiety disorder symptoms in trauma-exposed soldiers

Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Questionnaire-9 (assessing depression) were administered to 1266 trauma-exposed Ohio National Guard soldiers. Results indicated three discrete subgroups based on symptom patterns with mild (class 1), moderate (class 2) and severe (class 3) levels of symptomatology. Classes differed in symptom severity rather than symptom type. Income and education significantly predicted class 1 versus class 3 membership, and class 2 versus class 3. In conclusion, there is heterogeneity regarding severity of PTSD-depression-GAD symptomatology among trauma-exposed soldiers, with income and education predictive of class membership.     

Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event

Background: Hurricane Ike struck the Galveston Bay area of Texas on September 13, 2008, leaving substantial destruction and a number of deaths in its wake. We assessed differences in the determinants of posttraumatic stress disorder (PTSD) and depression after this event, including the particular hurricane experiences, including postevent nontraumatic stressors, that were associated with these pathologies. Methods: 658 adults who had been living in Galveston and Chambers counties, TX in the month before Hurricane Ike were interviewed 2–5 months after the hurricane. We collected information on experiences during and after Hurricane Ike, PTSD and depressive symptoms in the month before the interview, and socio‐demographic characteristics. Results: The prevalence of past month hurricane‐related PTSD and depression was 6.1 and 4.9%, respectively. Hurricane experiences, but not socio‐demographic characteristics, were associated with Ike‐related PTSD. By contrast, lower education and household income, and more lifetime stressors were associated with depression, as were hurricane exposures and hurricane‐related stressors. When looking at specific hurricane‐related stressors, loss or damage of sentimental possessions was associated with both PTSD and depression; however, health problems related to Ike were associated only with PTSD, whereas financial loss as a result of the hurricane was associated only with depression. Conclusions: PTSD is indeed a disorder of event exposure, whereas risk of depression is more clearly driven by personal vulnerability and exposure to stressors. The role of nontraumatic stressors in shaping risk of both pathologies suggests that alleviating stressors after disasters has clear potential to mitigate the psychological sequelae of these events. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Salivary cortisol and posttraumatic stress disorder in a low-income community sample of women.

BACKGROUND: Studies of male combat veterans with posttraumatic stress disorder have demonstrated a profile of low cortisol. Studies with women with posttraumatic stress disorder (PTSD) have focused on childhood sexual abuse and holocaust survivors, both of whom experienced trauma during development, which could be different than adult trauma exposure. METHODS: Using an epidemiologic sample of low-income women from an urban area in Michigan, we conducted structured psychiatric interviews and saliva cortisol collection on a subsample of women with exposure to trauma but never PTSD (n = 72), recent PTSD (n = 29), and past PTSD (n = 70). Saliva cortisol was collected at awakening, 30 minutes later, at bedtime, and during a clinic visit. RESULTS: Recent trauma exposure but not past trauma exposure led to an increase in saliva cortisol. Neither recent PTSD nor past PTSD resulted in any saliva cortisol changes compared with the trauma exposed, never PTSD group. Recent major depression (past 12 months) demonstrated a weak effect (p =.08) on bedtime saliva cortisol. CONCLUSIONS: While recent trauma exposure can increase saliva cortisol, neither recent nor past PTSD affected saliva cortisol in our community sample of women. Our data do not support saliva cortisol changes associated with PTSD.     

Posttraumatic stress disorder six months after an earthquake

Background and aims  Various studies assessed rates of post-traumatic stress disorder (PTSD) following natural disasters including earthquakes. Yet, samples were often non-representative or small or both. This study aims to assess the prevalence of PTSD and predictors of PTSD 6 months after an earthquake in a rural region of Italy. Methods  A questionnaire was handed out to a representative sample of approximate 3,000 people in the region of Molise in Italy 6 months after an earthquake in October/November 2002. The questionnaire assessed socio-demographic characteristics, aspects of the event, the experience of symptoms immediately after the earthquake, and symptoms of PTSD. Results  Questionnaires of 2,148 people were returned, representing a response rate of 73.7%. The final analysis was based on 1,680 people. The screening tool provided a PTSD prevalence rate of 14.5%. Male gender, age under 55 years, and better school education predicted lower rates of PTSD. More variance was explained when psychological symptoms of immediately after the event were also included as predictors. Conclusion  The findings on predictors are consistent with the literature. Whilst personal characteristics explain only a small variance of PTSD six months after the event, early psychological distress allows a better prediction of who is likely to have PTSD 6 months later.     

Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancy

Background: Few studies have considered whether elective and/or spontaneous abortion (EAB/SAB) may be risk factors for mental health sequelae in subsequent pregnancy. This paper examines the impact of EAB/SAB on mental health during subsequent pregnancy in a sample of women involved in a larger prospective study of posttraumatic stress disorder (PTSD) across the childbearing year (n=1,581). Methods: Women expecting their first baby completed standardized telephone assessments including demographics, trauma history, PTSD, depression, and pregnancy wantedness, and religiosity. Results: Fourteen percent (n=221) experienced a prior elective abortion (EAB), 13.1% (n=206) experienced a prior spontaneous abortion (SAB), and 1.4% (n=22) experienced both. Of those women who experienced either an EAB or SAB, 13.9% (n=220) appraised the EAB or SAB experience as having been “a hard time” (i.e., potentially traumatic) and 32.6% (n=132) rated it as their index trauma (i.e., their worst or second worst lifetime exposure). Among the subset of 405 women with prior EAB or SAB, the rate of PTSD during the subsequent pregnancy was 12.6% (n−51), the rate of depression was 16.8% (n=68), and 5.4% (n−22) met criteria for both disorders. Conclusions: History of sexual trauma predicted appraising the experience of EAB or SAB as “a hard time.” Wanting to be pregnant sooner was predictive of appraising the experience of EAB or SAB as the worst or second worst (index) trauma. EAB or SAB was appraised as less traumatic than sexual or medical trauma exposures and conveyed relatively lower risk for PTSD. The patterns of predictors for depression were similar. Depression and Anxiety, 2010.© 2010 Wiley‐Liss, Inc.     

Latent structure of posttraumatic stress disorder symptoms in an adolescent sample one month after an earthquake

Increasing empirical studies suggest that the tripartite posttraumatic stress disorder (PTSD) model described in the DSM-IV does not accurately account for the underlying PTSD factor structure, and several alternative models have been proposed. The present study investigated a newly refined, five-factor model of PTSD symptoms in a sample of Chinese adolescent survivors of an earthquake. A total of 1198 middle school students (653 females, 526 males) with a mean age of 14.4 years (SD = 1.1, range: 11–18) participated in this study one month after an earthquake. The novel five-factor model comprised of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal demonstrated significantly better fit than two alternative four-factor models. Further analyses revealed differentiable relations between the PTSD factors and external measures of anxiety and depression. These findings provide empirical support for the robustness of five-factor model, and carry implications for further reorganization of PTSD criteria.     

Coping flexibility predicts post-traumatic stress disorder and depression in human rights advocates

An emerging body of research on individuals exposed to trauma shows that the ability to flexibly employ different coping styles is associated with better adjustment. Specifically, individuals who use both “trauma-focused” (focusing on the experience and significance of a potentially traumatic event) and “forward-focused” (optimism, helping others, goal-oriented thinking) coping styles exhibit less psychological disturbance after trauma exposure than those with less coping flexibility. We investigated whether greater coping flexibility is associated with less Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in an international sample of human rights advocates. In an online, cross-sectional study, 346 international human rights advocates completed self-reported measures of PTSD, MDD, trauma exposure, and the Perceived Ability to Cope with Trauma (PACT) scale. Results showed that coping flexibility was associated with lower rates and symptom severity of PTSD and MDD. Whereas both trauma-focused and forward-focused coping were associated with lower rates of PTSD, the inverse relationship between coping flexibility and MDD was driven primarily by less forward-focused coping. These findings are the first to show that lower levels of coping flexibility may be an important factor underlying vulnerability to PTSD and MDD among human rights advocates. Longitudinal studies are needed to clarify whether coping flexibility can mitigate the potential negative mental health impact of traumatic stress over the course of one’s career in international human rights advocacy.     

Psychological trauma,posttraumatic stress disorder and trauma-related depression: A mini-review

There are various types of traumatic stimuli, such as catastrophic events like wars, natural calamities like earthquakes, and personal trauma from physical and psychological neglect or abuse and sexual abuse. Traumatic events can be divided into type I and type II trauma, and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’ self-evaluation of the traumatic events. Individual stress reactions to trauma include posttraumatic stress disorder (PTSD), complex PTSD and trauma-related depression. Trauma-related depression is a reactive depression with unclear pathology, and depression occurring due to trauma in the childhood has gained increasing attention, because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy, which is similar to the pattern observed for PTSD. Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse, it is necessary to explore its pathogenesis and therapeutic strategy.     

Differential etiology of posttraumatic stress disorder with conduct disorder and major depression in male veterans.

BACKGROUND: Epidemiologic studies reveal that posttraumatic stress disorder (PTSD) is highly comorbid with both conduct disorder and major depression in men. The genetic and environmental etiology of this comorbidity has not been examined. METHODS: Data were analyzed from 6744 middle-aged male-male monozygotic and dizygotic twins from the Vietnam Era Twin Registry. Conduct disorder, major depression, and PTSD were assessed via telephone interview using the Diagnostic Interview Schedule for the DSM-III-R in 1992. Structural equation modeling was used to estimate additive genetic, shared environmental, and individual-specific environmental effects common and specific to conduct disorder, major depression, and PTSD. RESULTS: The association between conduct disorder and PTSD was explained primarily by common shared environmental influences; these explained 10% (95% confidence interval: 6%-17%) of the variance in PTSD. The association between major depression and PTSD was largely explained by common genetic influences; these explained 19% (95% confidence interval: 11%-26%) of the variance in PTSD. CONCLUSIONS: Our findings suggest that different etiologic mechanisms explain the association of conduct disorder and major depression with PTSD in male veterans. If replicated in other populations, results suggest research aimed at identifying specific genetic and environmental factors that influence PTSD may benefit from starting with those that have been more consistently and strongly associated with major depression and conduct disorder.     

The association between self-reported change in vote for the presidential election of 2012 and posttraumatic stress disorder symptoms following Hurricane Sandy

The relationship between vote change for the presidential election in 2012 and posttraumatic stress disorder (PTSD) symptoms has not been previously explored. An online sample of 1000 people mainly from New York Metropolitan Area was surveyed during the fourth week of November 2012 after Hurricane Sandy, shortly after the US Presidential election. Participants completed a questionnaire battery which included disaster related questions and PTSD symptoms. Logistic regression revealed a significant association between vote change and elevated risk for PTSD symptoms. This result may indicate that PTSD symptoms are associated with behavioral actions such as vote change.