Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors

OBJECTIVE: To describe rates and concordance of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in adolescent childhood cancer survivors and their mothers and fathers. METHOD: Participants were 150 adolescent survivors of childhood cancer, 146 mothers, and 103 fathers who completed the Impact of Events Scale-Revised, the Posttraumatic Stress Disorder Reaction Index, and the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: PTSS are common in families of childhood cancer survivors. Parents reported more symptomatology than former patients. Mothers and fathers had relatively equal rates of current PTSD and levels of PTSS. Nearly 30% of mothers met diagnostic criteria since their child's diagnosis, with 13.7% currently experiencing PTSD. Nearly 20% of families had at least one parent with current PTSD. Ninety-nine percent of the sample had at least one family member reexperiencing symptoms. CONCLUSIONS: Both PTSD and PTSS help in understanding the experience of adolescent cancer survivors and their families. Within families of childhood cancer survivors, it is likely that some member may be experiencing treatable bothersome memories, arousal, or avoidance specific to the cancer experience.     

Cognitive behaviour therapy for posttraumatic stress disorder

Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed. Finally, future directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be conducted with enhanced methodological rigour and public health relevance.     

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population.     

Evaluation of physical activity habits in patients with posttraumatic stress disorder

OBJECTIVE: In this study, we present data from a survey that aimed to assess the physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder. METHOD: Fifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37+/-12 years, and the mean time between diagnosis and follow-up was 3.6+/-4.2 years. RESULTS: Substantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation. DISCUSSION: Several studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits. CONCLUSION: Our findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.     

Substance use behaviors as a mediator between posttraumatic stress disorder and physical health in trauma-exposed college students

Introduction  Research within the field of traumatic stress has documented a strong link between posttraumatic stress disorder (PTSD) and adverse physical health outcomes, although the mechanisms contributing to this relationship are unclear. Method  The current study examined substance use behaviors as one such mediator in a mixed civilian trauma population. Participants were 136 undergraduates exposed to a variety of civilian traumas. They completed measures assessing trauma exposure, substance use behaviors, and physical health outcomes. Results  Moderate correlations were found between PTSD symptom severity, substance use, and adverse health outcomes. Mediational analyses indicated that substance use behaviors, especially alcohol and drug use, mediated the relationship between PTSD and health outcomes.     

Sexual trauma, posttraumatic stress disorder, and health behavior

The authors tested whether sexual traumatization is associated with poorer health behavior and also evaluated the role of posttraumatic stress disorder (PTSD) in this relationship. They mailed questionnaires to 419 women who had visited a San Diego Veterans Administration primary care clinic in 1998 and received 221 responses, a 56% return rate. They found that a history of sexual assault was associated with increased substance use, risky sexual behaviors, less vigorous exercise, and increased preventive healthcare. They then used regression-based techniques to test whether PTSD mediates the relationship between a history of sexual assault and health behaviors and discovered support for this hypothesis in relation to substance use. PTSD symptoms were also associated with less likelihood of conducting regular breast self-examinations. Findings from the study highlight the value of programs designed to (1) identify trauma victims, (2) screen for problematic behaviors, and (3) intervene to improve long-term health outcomes.     

Risk factors of child physical abuse by parents with mixed anxiety-depressive disorder or posttraumatic stress disorder

Aim

To determine the risk that parents with mixed anxiety and depressive disorder (MADD) or posttraumatic stress disorder (PTSD) will physically abuse their child and evaluate the specific contribution of mental health, perceived social support, experience of childhood abuse, and attributes of family relations to the risk of child physical abuse.

Method

The study conducted in 2007 included men (n = 25) and women (n = 25) with a diagnosis of MADD, men with a diagnosis of PTSD (n = 30), and a control sample of parents from the general population (n = 100, 45 men and 55 women) with children of elementary school age. General Information Questionnaire, Child Abuse Experience Inventory, Perceived Social Support Scale, and the Child Abuse Potential Inventory (CAPI) Clinical Abuse Scale were used.

Results

Total results on the Clinical Abuse Scale of the CAPI indicated higher risk of child physical abuse in parents with MADD (273.3 ± 13.6) and in fathers with PTSD (333.21 ± 17.98) than in parents from the general population (79.6 ± 9.9) (F = 110.40, P < 0.001; t_PTSD,MADD = 13.73, P < 0.001). A hierarchical regression analysis showed that the greatest predictors in the multivariate model were mental health difficulties, poorer economic status, poor social support, and physical and verbal aggression in partner conflicts.

Conclusion

Parents with MADD and PTSD exhibit high risk of child abuse. Since parents with PTSD have significantly higher risk of child abuse than parents with MADD, further large-sample research is needed to clarify the relationship between PTSD intensity and the risk of child abuse.The World Health Organization lists family violence as one of the most important contemporary public health issues. It defines physical abuse of children as “any intentional use of physical action against a child that causes or is likely to cause harm to the child’s health, survival, development or dignity, including beating, kicking, shaking, biting, strangulation, scalding, burning, deliberate poisoning and suffocation, or failure to prevent physical injury (or suffering)” (1).Contemporary theoretical models explain child abuse in the family as a complex phenomenon caused by an interaction of multiple factors (2,3) at different ecological levels – individual, relational, community, and societal. In this study, the focus is on parent-related individual and relationship factors. The individual risk factors include circumstances in the parent’s personal history that can increase the risks for child abuse. Previous research has focused on the history of maltreatment in parents’ childhood, mental health problems, lack of self-control when upset or angry, misuse of alcohol or drugs, social isolation, poor parenting skills, positive attitude toward the use of physical punishment as a means for discipline, and financial difficulties. The most important relationship risk factors include mental health problems of family members, marriage or intimate relationship difficulties, partner violence in the family, lack of support network in stressful or difficult life situations, and lack of support in child rearing from family members (3).Although international research demonstrated that psychiatric disorders were an important risk factor for child maltreatment (4-8), no research focusing on this topic has been carried out in Croatia so far. International research indicated that the most frequently analyzed groups of disorders in child-abusing parents were anxiety disorders, depression, antisocial behaviors, personality disorders, and dissociative disorders. However, most of the previous studies have neglected several important methodological concerns. First, the parents who are usually included in these studies are the mothers, whereas the study of the fathers’ mental health problems associated with child abuse has received much less attention. Second, posttraumatic stress disorder (PTSD) is rarely included in research as a predictor or risk factor for abuse – it is more often studied as a consequence of exposure to family violence (9-11). Also, while there are studies on mental health difficulties of parents who have been registered for violence against children, clinical populations of parents have been much less studied.The focus of this research is the risk assessment of child abuse by parents of both sexes who have not been registered as perpetrators of violence against children, and who have a diagnosis of a psychiatric disorder – PTSD or mixed anxiety and depression disorder (MADD). Starting from ecosystem and interactive models of violence against children in the family, mental disorders of the parents were considered in interaction with their socio-demographic characteristics and personal histories (such as childhood abuse), as well as current family dynamics (such as social support and quality of partner relations). The aims of this study were:1. To compare the risk of physical child abuse, perceived social support, experience of childhood abuse, and some characteristics of family relations between parents with MADD, parents with PTSD, and parents from the general population.2. To test the contribution of mental health, perceived social support, the experience of childhood abuse, and some features of family relations to the risk of physical child abuse by parents with MADD or PTSD and by parents from the general population.     

Treating comorbid panic disorder in veterans with posttraumatic stress disorder

This study compares the effectiveness of panic control treatment (PCT) with that of a psychoeducational supportive treatment (PE-SUP) in treating panic disorder among a veteran sample with a primary diagnosis of chronic posttraumatic stress disorder (PTSD). Thirty-five patients randomized to receive 10 individual sessions of either PCT or PE-SUP underwent assessments at pretreatment, at 1-week posttreatment, and at a 3-month follow-up. Intent-to-treat analyses of covariance showed that PCT participants significantly improved on panic severity at posttreatment and panic fear at the 3-month follow-up. The PCT group also showed significant reductions in anxiety sensitivity at posttreatment and follow-up compared with that of the PE-SUP group. A significantly higher proportion of persons (63%) in the PCT group was panic free by the follow-up period compared with that of the PE-SUP group (19%). Patient self-report and clinician ratings showed no changes in general anxiety, depression, and PTSD symptoms in either group. These findings indicated that PCT was superior to an active control therapy in reducing the frequency, severity, and distress associated with panic disorder and suggested that brief cognitive-behavioral therapy for panic is effective for persons with chronic PTSD.     

翻车事故幸存者中精神创伤后应激障碍

对一次翻车事故22位幸存者中 PTSD 的发生及表现作了研究。调查分别于事故3月和4年后进行,采用 DSM-Ⅲ-R PTSD 诊断标准及 SCL—90、HAMA、HAMD,SDSS 量表。共发现9例(41%)幸存者患有 PTSD、其中1例于事故1年半后病情缓解,余8例直至4年后仍无改善。患者一直出现的症状是触景生情样的强烈精神痛苦、努力回避能唤起创伤回忆的活动或处境。4年后患者感到与他人疏隔、前途渺茫感加重。患者精神躯体的痛苦较重,社会功能受损,但无一人主动求治。本文提出应对此病予以重视、提供干预。     

Depression in comorbid obsessive-compulsive disorder and posttraumatic stress disorder

Previous findings suggested a unique role that depression symptoms might play in the comorbid relationship between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). However, the nature of this role remains unclear. Thus, the current study examined ways in which OCD and PTSD symptoms vary as a function of depression, as well as the mediating role of depression in the OCD-PTSD relationship, in 104 individuals seeking treatment for refractory OCD. Findings revealed that depressed individuals in the treatment-refractory OCD sample report higher levels of overall obsessing and greater severity of PTSD. In addition, depression appeared to mediate the relation between OCD and PTSD. Implications of findings are discussed.     

Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for gulf war-related health concerns

OBJECTIVES: Studies of the relationship of posttraumatic stress disorder (PTSD) to physical symptoms in war veterans consistently show a positive relationship. However, traumatic experiences causing PTSD may correlate with other war exposures and medical illnesses potentially accounting for those symptoms. METHODS: We analyzed data obtained from 21,244 Gulf War veterans seeking care for war-related health concerns to assess the relationship of PTSD to physical symptoms independent of environmental exposure reports and medical illness. At assessment, veterans provided demographic information and checklists of 15 common physical symptoms and 20 wartime environmental exposures. Up to seven ICD-9 provider diagnoses were ranked in order of estimated clinical significance. The relationship of provider-diagnosed PTSD to various physical symptoms and to the total symptom count was then determined in bivariate and multivariate analyses. RESULTS: Veterans diagnosed with PTSD endorsed an average of 6.7 (SD = 3.9) physical symptoms, those with a non-PTSD psychological condition endorsed 5.3 (3.5), those with medical illness endorsed 4.3 (3.4), and a group diagnosed as "healthy" endorsed 1.2 (2.2). For every symptom, the proportion of veterans reporting the symptom was highest in those with PTSD, second highest in those with any psychological condition, third highest in those with any medical illness, and lowest in those labeled as healthy. The PTSD-symptom count relationship was independent of demographic characteristics, veteran-reported environmental exposures, and comorbid medical conditions, even when symptoms overlapping with those of PTSD were excluded. CONCLUSIONS: PTSD diminishes the general health perceptions of care-seeking Gulf War veterans. Clinicians should carefully consider PTSD when evaluating Gulf War veterans with vague, multiple, or medically unexplained physical symptoms.     

Outcome of influenza vaccination in combat-related post-traumatic stress disorder (PTSD) patients

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after exposure to extreme traumatic experience such as war trauma, and is accompanied by fear, helplessness or horror. Exposure to trauma can result in immune dysregulation and influence susceptibility to infectious disease as well as vaccine efficacy. The aim of the study was to determine the relation of psychological stress and the immune response to influenza vaccination in combat-related PTSD patients (n = 28). Detection of anti-viral antibody titre was performed by inhibition of haemagglutination assay. Ex vivo tetramer staining of CD8(+) T lymphocytes was used to monitor T cells specific for human leucocyte antigen (HLA)-A*0201-restricted influenza A haemagglutinin antigens before and after vaccination. Twenty patients showed a fourfold antibody titre increase to one or both influenza A viral strains, and 18 of them showed the same response for both influenza B viral strains. Ten of 15 healthy controls showed a fourfold rise in antibody titre to both influenza A viral strains and eight of them showed the same response for both influenza B viral strains. HLA-A*0201(+) PTSD patients (n = 10) showed a significant increase of influenza-specific CD8 T cells after vaccination. Although those PTSD patients had a lower number of influenza-specific CD8(+) T cells before vaccination compared to HLA-A*0201(+) healthy controls (n = 6), there was no difference in influenza A antibody titre between PTSD patients and control subjects before vaccination. The generated humoral and cellular immune response in PTSD patients argues against the hypothesis that combat-related PTSD in war veterans might affect protection following influenza vaccination.     

Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics of both the PC-PTSD and the PCL. A validation study conducted with a sample of 352 service members showed that both the PC-PTSD and PCL had good diagnostic efficiency. The overall diagnostic efficiency assessed by the area under the curve (AUC) was virtually the same for both the PC-PTSD and PCL. The most efficient cutoff values for the PC-PTSD were either 2 or 3 "yes" responses with the latter favoring specificity. For the PCL, the most efficient cutoff values were between 30 and 34, mirroring recommended PCL cutoff values from some studies in primary care settings. The examination of item characteristics suggested a 4-item PCL with an AUC virtually identical to that of the full PCL. Item analyses also identified that the most discriminate item in both scales pertained to symptoms of avoidance. Implications and limitations are discussed.     

Effects of posttraumatic stress disorder status and covert hostility on cardiovascular responses to relived anger in women with and without PTSD

Previous literature has found greater heart rate (HR) and blood pressure (BP) responses during relived anger, and a positive association between covert hostility and relived anger, in male veterans with posttraumatic stress disorder (PTSD). This study investigated hostility and cardiovascular responses to a relived anger task in 120 women (70 with PTSD and 50 without PTSD). Women with PTSD reported greater hostile beliefs and covert hostility than non-PTSD controls, reported greater anger and anxiety during the anger recall task, and had higher resting HR. In general, the relationship between PTSD and cardiovascular response was moderated by covert hostility, which was associated with greater baseline diastolic BP and greater HR during relived anger and anger recovery among women with PTSD, but not among non-PTSD controls. Results suggest that the relationship between PTSD and cardiovascular response is moderated by hostility.     

Effects of posttraumatic stress disorder status and covert hostility on cardiovascular responses to relived anger in women with and without PTSD

Previous literature has found greater heart rate (HR) and blood pressure (BP) responses during relived anger, and a positive association between covert hostility and relived anger, in male veterans with posttraumatic stress disorder (PTSD). This study investigated hostility and cardiovascular responses to a relived anger task in 120 women (70 with PTSD and 50 without PTSD). Women with PTSD reported greater hostile beliefs and covert hostility than non-PTSD controls, reported greater anger and anxiety during the anger recall task, and had higher resting HR. In general, the relationship between PTSD and cardiovascular response was moderated by covert hostility, which was associated with greater baseline diastolic BP and greater HR during relived anger and anger recovery among women with PTSD, but not among non-PTSD controls. Results suggest that the relationship between PTSD and cardiovascular response is moderated by hostility.