Clinical and Neuropsychological Predictors of Posttraumatic Stress Disorder

Although acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity.One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD.Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive.These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.     

Achieving Successful Chemical Dependency Recovery in Veteran Survivors of Traumatic Stress

Many veterans of the Vietnam War are still suffering the emotional and physical scars of combat often fought in an oblivion of alcohol and drugs. Through the years, the progression of the disease of Chemical Dependency may have led them to seek help through a variety of resources that either ignored the chemical use and attempted to resolve the behavioral issues or dealt only with the use of chemicals and never identified the Post Traumatic stress Disorder resulting from their Vietnam service. The results were constant relapse, and an ensuing declaration that the client was unwilling to accept treatment. This article intends to increase the awareness of the counselors working with veterans, as well as provide treatment information necessary for successful recovery and a return to holism, health and a serene chemical free quality of life.     

Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life.

Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners.

Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes).

Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited.

Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.     

Posttraumatic Stress Disorder as a Risk Factor for Cardiovascular Disease: A Literature Review and Proposed Mechanisms

Emotional stress has long been associated with cardiovascular disease (CVD), however it is relatively recent that the evidence for a causal link has been more firmly established. While the term posttraumatic stress disorder (PTSD) has only been described since the 1970s, there is now substantial evidence, among various populations, that PTSD is associated with increased CVD risk, and that this risk is independent of other CVD risk factors. Although it is not possible to identify any one single mechanism responsible for the associations observed, it is likely that increased haemodynamic forces, inflammatory and thrombotic changes as well as elevated cholesterol levels are contributors. Despite the logistic difficulties in researching the physiological responses to PTSD, this should be a priority area for future research to guide therapies targeted at reducing CVD risk associated with this major stress disorder.     

Posttraumatic Stress Disorder and Cocaine Dependence: Order of Onset

To investigate differences between patients whose posttraumatic stress disorder (PTSD) preceded their cocaine dependence and vice versa, 33 patients with comorbid PTSD and cocaine dependence were divided into two groups: one in which the trauma and PTSD occurred before onset of cocaine dependence (primary PTSD) and one in which the PTSD occurred after cocaine dependence was established (primary cocaine). In the primary-PTSD group, the trauma was generally childhood abuse. In the primary-cocaine group, the trauma was generally associated with the procurement and use of cocaine. In the primary-PTSD group, there were significantly more women, more other Axis I diagnoses, more Cluster B and C Axis II diagnoses, and more benzodiazepine and opiate use. In the primary-Cocaine group, there was a trend toward more cocaine use in the previous month. Significant clinical differences between these two groups may warrant different types of treatment or differing treatment emphasis. (Am J Addict 1998; 7:128–135)     

The Link Between Substance Abuse and Posttraumatic Stress Disorder in Women

Research has documented a high incidence of comorbid posttraumatic stress disorder (PTSD) and substance abuse. Women substance abusers, in particular, show high rates of this dual diagnosis (30% to 59%), most commonly deriving from a history of repetitive childhood physical and/or sexual assault. Rates for men are two to three times lower and typically stem from combat or crime trauma. Patients with both disorders are characterized by high severity on a multitude of psychological and treatment variables and use of the most severe drugs (cocaine and opioids). Treatment research on women is limited but suggests the possibility of retaining patients and achieving positive outcomes.     

Posttraumatic Stress Disorder and Alcohol Use Disorder: A Critical Review of Pharmacologic Treatments

Treatment of alcohol use disorder (AUD) is complicated by the presence of psychiatric comorbidity including posttraumatic stress disorder (PTSD). This is a critical review of the literature to date on pharmacotherapy treatments of AUD and PTSD. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment was undertaken to identify relevant randomized controlled trials (RCTs). The studies were independently evaluated (ILP and TLS) and those that evaluated the efficacy of a pharmacotherapy for individuals diagnosed with AUD and PTSD and were RCTs were selected. Studies were grouped in 3 categories: (i) those that evaluated first‐line treatments for PTSD, (ii) those that evaluated medications to target AUD, and (iii) those that evaluated medications hypothesized to be effective in targeting alcohol consumption as well as PTSD symptoms. Nine RCTs were identified; 3 focused on medications to treat PTSD, 4 focused on AUD, and 3 to target both. One study included both a medication to treat PTSD and 1 to treat AUD so was discussed twice. All but 1 of the studies found that PTSD symptoms and drinking outcomes improved significantly over time. There is not 1 agent with clear evidence of efficacy in this comorbid group. The results for medications to treat PTSD are inconclusive because of contradictory results. There was weak evidence to support the use of medications to treat AUD among those with comorbidity with PTSD. Findings for medications that were hypothesized to treat both disorders were also contradictory. Most studies provided a combination of interventions to treat both disorders. Despite the contradictory results, this review suggests that individuals with AUD and comorbid PTSD can safely be prescribed medications used in noncomorbid populations and patients improve with treatment.     

Sexual and Physical Assault History and Posttraumatic Stress Disorder in Substance-Dependent Individuals

The authors explored the relationship between sexual and physical assault and posttraumatic stress disorder (PTSD) in individuals seeking treatment for substance use disorders by giving 100 substance-dependent inpatients (50 men, 50 women) a structured interview on traumatic life events and lifetime histories of sexual and physical assault. Sixty-six percent of individuals had a history of sexual or physical assault. Half of the assault victims met DSM-III-R criteria for PTSD, whereas no one in the non-assault group met criteria for PTSD. Type of assault and specific characteristics of victims were significantly associated with psychiatric disorders. Women bad higher rates of sexual assault history, serial assault, and familial assault than men. Individuals who bad experienced childhood assault bad earlier age at onset of substance dependence than those who had not experienced childhood assault. Sexual and physical assault histories and psychopathology should be assessed in all substance-dependent individuals. More accurate and specific treatment planning may improve treatment outcomes.     

创伤后应激障碍的老年患者心率变异性分析

目的 探讨老年患者发生创伤后应激障碍（PTSD）时自主神经功能改变的特点.方法 采用心率变异性（HRV）分析指标,检测PTSD老年患者（A组,n=32）的HRV参数并与同年龄创伤后未发生PTSD者（B组,n=30）以及同年龄组健康人群（对照组,n=80）进行对比分析.结果 ①A组、B组与对照组相比,SDNN、SDANN、SDNN Index差异均有显著统计学意义（均P＜0.01）;②夜间HRV各项参数与白天比较,SDNN Index [（33.32±22.38）ms、（28.05±19.02）ms]差异有统计学意义（P＜0.05）,SDNN[（48.00±26.55）ms、（43.18±19.91）ms]、rMSSD[（29.18±14.79）ms、（28.00±14.56）ms]、PNN50[（7.81±2.37）ms、（7.57±2.78）ms]及SDANN[（30.18±18.10 ）ms、（29.77±12.98）ms]差异均无统计学意义（均P ＞0.05）.结论 PTSD可引起老年患者自主神经张力异常及调节功能失衡,这种损害以夜间明显.在治疗原发病的同时,应重视PTSD的发生及其对老年人自主神经功能的影响.     

Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder

To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH?, n=3,660), those with PH and no PTSD (PTSD?/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD?/PH?, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH? group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH? group as in the PTSD?/PH+ or PTSD?/PH? group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care.