A biopsychosocial treatment approach to Post-Traumatic stress disorder

Post-Traumatic stress disorder (PTSD) is defined and treatment discussed from a combined biologic, psychologic, and social perspective. Literature relevant to each parameter is discussed. Pharmacologic interventions are described along with guidelines to carrying out the psychotherapeutic process which should accompany the former. Finally, insight is offered into the problems of the PTSD patient in using social support, with suggestions for their treatment.     

Post-traumatic stress disorder following a suicide attempt

How commonly does a suicide attempt lead to post-traumatic stress disorder? The terrifying nature of events before and after many suicide attempts and the increasing rates of suicide attempts in the general population suggest that PTSD as a result of a suicide attempt should not be a rare occurrence. However, a thorough review of the literature revealed no reports. We provide one case report and discuss the theoretical, clinical, and research questions linking traumatic suicide attempts to subsequent PTSD.     

Post-traumatic stress disorder and the MMPI-2

This study compared the MMPI-2 profiles of 27 veterans diagnosed with post-traumatic stress disorder with a non-PTSD comparison group of 27 veteran patients receiving inpatient treatment for other mental disorders. Three multivariate analyses of variance were conducted comparing the two groups on the 10 traditional clinical scales, the 12 supplemental scales and the 15 new content scales on the MMPI-2. The PTSD group obtained a mean profile with peak elevations on the F validity scale and on clinical Scales 2 (D) and 8 (Sc). The multivariate analysis of variance comparing the PTSD and non-PTSD groups across the 10 traditional clinical scales was not significant. The multivariate analyses of variance comparing the two groups on the 12 supplemental scales and the 15 content scales were significant. Significant univariate supplemental scale differences were found on the Keane PTSD scale (PK) and the Post-Traumatic Stress Disorder (PS) scale with the PTSD group scoring higher on PK and PS. Significant univariate content scale differences were found for the Anger (ANG) scale with the PTSD group scoring higher. A cut-off score of 28 on the PK scale correctly classified 76% of the overall sample, 67% of the PTSD group and 85% of the non-PTSD-comparison group.     

Cognitive functioning in Post-Traumatic Stress Disorder

Twelve Post-Traumatic Stress Disorder (PTSD) patients, 12 psychiatric patients matched for severity of psychopathology, and 12 normal controls were assessed for cognitive functioning by means of a comprehensive test battery. Both patient groups felt subjectively more impaired than normals. Performance on measures of intelligence, organicity, verbal fluency, memory, and attention was significantly poorer in patients than in normals. The performance of the PTSD patients and that of the psychiatric controls was, however, very similar. The premorbid intelligence of both the PTSD patients and the psychiatric controls was average and had deteriorated significantly by the time of current testing. These cognitive problems were not secondary to alcohol, drug abuse, or head injury. The results suggest a cognitive impairment in post-traumatic patients.     

Myocardial infarction and post-traumatic stress disorder

Studies concerning the development of a post-traumatic stress disorder related to severe illness are scarce. The confrontation with myocardial infarction may be a very stressful event. Twenty-three patients consecutively admitted for first myocardial infarction were studied. After two years 1 of 18 survivors had been suffering from a partial post-traumatic stress disorder. Similarities and differences in the psychological reactions following potential traumatic events are discussed.     

Post-traumatic stress disorder as a sequela of guillain-barre syndrome

Post-traumatic stress disorder (PTSD) was observed in a 24 year-old female following severe Guillain-Barre syndrome (GBS). A review of the literature uncovered no previously mentioned examples of PTSD resulting from GBS or other medical illnesses. GBS-induced PTSD shared the features of PTSD seen following other traumatic events.     

Diverse motives for fictious post-traumatic stress disorder

Fictitious cases of Vietnam-related post-traumatic stress disorder (PTSD) present a difficult diagnostic problem. In settings where the motives of avoiding criminal responsibility or gaining financially are apparent, the clinician is alerted to possible fictious cases. But there are a variety of other reasons for fictious presentation of PTSD that the clinician needs to consider. These other reasons include psychotic disorders, concealing other behavior, gaining special attention in a Vietnam veteran PTSD role, explaining and covering up a dysfunctional life, and factitious disorder. Case examples are presented of these various fictious presentations of post-Vietnam PTSD.This brief report was accepted for publication under the Editorship of Charles R. Figley.     

The prevalence of lifetime and partial post-traumatic stress disorder in Vietnam theater veterans

A complete understanding of the consequences of service in a war zone includes examining the lifetime and current prevalence of post-traumatic stress disorder (PTSD), and of partial PTSD. Cases of partial PTSD are persons who have clinically significant symptoms of PTSD, but who do not meet the full diagnostic criteria. The National Vietnam Veterans Readjustment Study (NVVRS) estimated the lifetime prevalence of PTSD to be 30.9% among male theater veterans, 26.% among females; lifetime prevalence of partial PTSD was an additional 22.5% and 21.2%, respectively; current prevalence of partial PTSD was 11.1% in males and 7.8% in females. NVVRS findings indicate that of the 1.7 million veterans who ever experienced significant symptoms of PTSD after the Vietnam war, approximately 830,000 (49%) still experience clinically significant distress and disability from symptoms of PTSD. The contribution of partial PTSD represents an estimated additional 350,000 veterans.     

Alexithymia as a predictor of treatment response in post-traumatic stress disorder

Fifty-seven veterans with post-traumatic stress disorder (PTSD) completed the Alexithymia Provoked Response Questionnaire (APRQ) upon entering an 8-week randomized trial comparing phenelzine, imipramine, and placebo. Low alexithymia on the APRQ significantly predicted improvement on the avoidance items of the Impact of Events Scale (IES) particularly among patients treated with placebo, but was not associated with changes in the intrusion items of the scale.     

ICU护士创伤后应激障碍的调查分析

目的了解ICU护士创伤后应激障碍症状的发生情况,为保持和促进ICU护士的身心健康提供依据。方法整群抽取济南市3所三级甲等综合医院4个ICU 170名护士,采用创伤后应激障碍症状清单平民版及自制ICU创伤事件量表对其进行问卷调查。结果 ICU创伤事件总发生情况平均得分为1.10±0.49,对ICU护士精神影响程度平均得分为2.05±0.53。ICU护士创伤后应激障碍症状阳性率为21.76%。不同工作年限ICU护士创伤后应激障碍症状水平存在统计学差异(P<0.05)。创伤后应激障碍症状总分及各维度分别与12项ICU创伤事件的影响程度得分及总分呈正相关(r=0.201~0.489,均P<0.05)。结论 ICU护士创伤后应激障碍发生率较高,护理管理者应高度重视ICU护士的身心健康,有针对性地进行心理辅导与咨询。     

Familial abuse and post-traumatic stress disorder

Previous study of a sample of 149 adolescent runaways showed that youths who left home because of familial physical abuse were more likely than youths who left home for other reasons to report symptomatology consistent with the diagnostic criteria of Post-Traumatic Stress Disorder (PTSD). The literature suggests that stress reactions, such as PTSD, are not direct responses to stressors, such as familial abuse. Rather, these relationships are mediated by factors which influence a person's ability to cope with stressors. This paper reports the results of exploring two factors which influence coping ability: (1) perceptions of control over the stressor, and (2) the availability of intrafamilial social support. Using information from the same sample of 149 adolescent runaways, we compared youth who left home because of familial physical abuse to youth who did not on the basis of these two coping resources. Results show that victims of familial physical abuse are significantly more likely than are other runaways to believe that they could not have changed or controlled the events that led to their running. Further, the intrafamilial social support systems of these young victims are highly dysfunctional. Study findings support the contention that factors which decreased the coping ability of runaway victims of familial abuse heightened the probability of their developing Post-Traumatic Stress Disorder.     

Violence,trauma, and post-traumatic stress disorder among women drug users

In order to examine the association between the experience of violent events, trauma, and post-traumatic stress disorder among women drug users, 105 women in treatment for addictive disorders were interviewed. One hundred four of the study participants reported trauma in 1 or more of 14 categories of traumatic events, 59% of whom reported symptoms consistent with a diagnosis of posttraumatic stress disorder. Among those with PTSD, 97% reported one or more violent traumas as compared with 73% of those without PTSD. The likelihood of PTSD was strongly associated with the number of violent traumas reported by a woman. Women in recovery from drug addiction are likely to have a history of violent trauma and are at high risk for post-traumatic stress disorder. Screening for PTSD among women with an addictive disorder should become part of the diagnostic and treatment routine.     

Post-traumatic stress disorder (PTSD) in battered women: A shelter sample

A sample of 77 battered women in shelters was examined for the presence or absence of a post-traumatic stress disorder (PTSD) diagnosis. Self-report data were obtained on battery characteristics, extent of intrusion and avoidance, depression, anxiety, and general psychopathology. Eight-four percent of the sample met the DSM-III-R criteria for PTSD according to self-report. The reported subjective distress regarding the battery experience was positively correlated with presence and degree of PTSD, intrusion, depression, anxiety, and general psychopathology. Extent of abuse was positively related to presence and degree of PTSD, depression, anxiety, and overall symptom distress. Length of the abusive relationship was least related to the outcome variables. The results of this study indicated that the shelter population of battered women is at high risk for post-traumatic stress disorder and this is linked with characteristics of the battery experience. The usefulness of these findings with regards to diagnosis and treatment is discussed.     

The prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod,multisource assessment of psychiatric disorder

Findings from the Congressionally mandated National Vietnam Veterans Readjustment Study indicate that nearly one-half million Vietnam veterans—15.2% of the men and 8.5% of the women who served in Vietnam—suffer from post-traumatic stress disorder (PTSD) fifteen or more years after their military service. Current PTSD prevalence rates for Vietnam veterans are significantly and substantially higher than the rates for their comparable Vietnam generation peers, which range from 0.3% to 2.5%. Additionally, the current prevalence rate among male Vietnam veterans was found to differ significantly among race/ethnicity subgroups: 27.9% among Hispanic men, 20.6% among black men, 13.7% among white/other men. Multivariate analyses indicated that although background factors are significantly related to the current prevalence of PTSD, the current prevalence is much higher among Vietnam veterans than among era veteran and civilian counterpart comparison groups even after background differences are taken into account. These analyses also demonstrated the important role of exposure to combat and other types of war zone stress in the current prevalence of the disorder.     

Post-traumatic stress disorder among Croat soldiers in the defence war in Croatia 1991–1993

During the Defence War in Croatia from 1991 to 1993 prospective case-control study was designed with a randomly selected sample of 60 wounded (30 with disabling and 30 with non-disabling injuries) and 30 active soldiers. They were not professionally trained soldiers, but had joined the war by spontaneously defending their homes. None of them had requested help or had any previous psychiatric diagnosis. The aim of this study is to establish the influence of the general characteristics and traumas of soldiers on the development of post-traumatic stress disorder. General characteristics and traumas between the group of soldiers who developed PTSD and those who did not were compared. A significant difference was found in the type of injuries of the soldiers between the two groups. In the group of soldiers who developed PTSD, 53 per cent had non-disabling injuries, 29 per cent permanent disabling injuries and 18 per cent were active soldiers. There was no significant difference found in the general characteristics of the study groups. We found that soldiers with non-disabling injuries (less seriously wounded) developed PTSD more often than the more seriously wounded soldiers. Less seriously wounded soldiers suffered tremendous stress caused by consciously experiencing and living through being wounded. © 1998 John Wiley & Sons, Ltd.     

Post-traumatic stress disorder in Dutch psychiatric in-patients

The present study addresses the use of standardized PTSD scales in determining traumatization in psychiatric inpatients. Twenty-eight (53%) out of 53 psychiatric inpatients reported an experience of a psychological trauma. Fifteen subjects did fulfill the stressor criterion of DSM-III-R, while the trauma of another 12 subjects appeared to be a major negative life event. On two PTSD scales, on average, the 15 traumatized subjects showed the highest scores. On these PTSD scales the 12 subjects with major life events appeared to resemble the nontraumatized subjects. In general psychiatric symptomatology, as measured by the SCL-90, the traumatized subjects showed a significant higher Phobic Anxiety score. It is concluded that specific PTSD scales can differentiate between objectively traumatized patients and other patients, while a general psychiatric screening instrument (SCL-90) cannot.This article was accepted for publication under the Editorship of Charles R. Figley.     

When disaster strikes,acute stress disorder may follow

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.     

Contextual issues in the assessment of post-traumatic stress disorder

In recent years, there has been an explosion of information on the etiology, assessment, and treatment of post-traumatic stress disorder (PTSD) in individuals exposed to a wide variety of traumatic stressors. Comprehensive assessment techniques are being developed for diagnosis and treatment evaluation in PTSD; however, there remain numerous pragmatic issues related to the context of assessment for PTSD. Issues addressed in this paper include (1) implications of the purpose of the assessment (e.g., crisis intervention, treatment planning, evaluation for compensation); (2) sequelae of the assessment, including positive and negative outcomes of exposure to traumatic memories during assessment, (3) characteristics and training of the assessor and the impact of exposure to reports of traumatic events on the assessor; and (4) features of PTSD which affect the ease of case-finding and suggest the necessity for training a variety of health care providers to recognize symptoms of PTSD.     

Depressive features in holocaust survivors with post-traumatic stress disorder

The present study was designed to explore several aspects of depressive phenomenology, including current symptoms, dependency (anaclitic) and self-criticism (introjective) themes, and issues of self-efficacy, in Holocaust survivors with and without posttraumatic stress disorder (PTSD). The Depressive Subscale of the Symptom Checklist-90 (SCL-90) and the Depressive Experiences Questionnaire (DEQ) were administered to 23 Holocaust survivors and 18 demographically-matched controls. Holocaust survivors with PTSD scored significantly higher on the SCL-90 depression scale, and portrayed more self-criticism on the DEQ, than Holocaust survivors without PTSD and demographically-matched non-exposed subjects. The data suggest that depressive symptoms in individuals who have been severely traumatized are more severe when associated with a concurrent PTSD. Furthermore, groups suffering different types of trauma may show similarities in psychological dimensions of depression.