Temporal relationships between Gulf War deployment and subsequent psychological disorders in Royal Australian Navy Gulf War veterans

Background  

Although much has been published on the effects of the 1990/1991 Gulf War on the psychological health of veterans, few studies have addressed the pattern and timing of post-war development of psychological disorders. Our study aims to identify the most common psychological disorders that first appeared post-Gulf War, the period of peak prevalence and the sequence of multiple psychological disorders.     

Social predictors of psychotic experiences: specificity and psychological mechanisms

It has become widely accepted that the psychotic disorders are endpoints of atypical developmental trajectories indexed by abnormal emotional and cognitive development early in life. However, the role of environmental factors in determining these trajectories has received relatively little attention. In this article, we argue that (1) the influence of environment on psychosis can best be understood if we focus on specific types of psychotic experiences such as hallucinations and delusions, (2) these symptoms are the products of specific cognitive biases and deficits, and (3) the development of these particular patterns of cognitive functioning is influenced by specific kinds of environmental adversity. This approach is at variance with more conventional approaches because it suggests that each type of experience, rather than being the manifestation of a common underlying illness process, is a product of a specific set of causal variables. Importantly, these variables include environmental determinants, although not to the exclusion of endogenous factors such as neurodevelopmental impairment or genetic vulnerability. We discuss the implications of this approach for neurobiological and genetic research into psychosis, as well as clinical practice.     

Medically evaluated psychological and physical health of Australian Gulf War veterans with chronic fatigue

OBJECTIVE: The aim of this study was to evaluate fatigue in Australian Gulf War veterans and a military comparison group according to the 1994 chronic fatigue syndrome (CFS) definition and investigate the relation with exposures. METHODS: Comprehensive medical, psychological and reported exposure assessments of 1,456 veterans and 1,588 comparison group in a cross-sectional study. RESULTS: More Gulf War veterans had fatigue at all levels than did the military comparison group. The findings may be at least partly explained as an "active-deployment effect." The odds ratios increased with increasing clinical evaluation of the nature of the fatigue, even after adjustment for current psychiatric disorders in addition to other possible confounding factors. CONCLUSION: Medically unexplained chronic fatigue was more common, but not more disabling, in veterans than in the comparison group, but veterans with unexplained chronic fatigue had poorer health than veterans without. Within both populations, CFS is uncommon and at a similar level to the general community.     

Neurophysiologic analysis of neuromuscular symptoms in UK Gulf War veterans: a controlled study

BACKGROUND: UK veterans who were deployed to the Gulf in 1990 to 1991 reported higher prevalence of neuromuscular symptoms. OBJECTIVE: To investigate whether these Gulf War-related symptoms were associated with objective evidence of neuromuscular dysfunction. METHODS: Forty-nine Gulf War veterans with more than four neuromuscular symptoms (Gulf-ill), 26 Gulf-well veterans, 13 symptomatic Bosnian veterans (Bosnia-ill), and 22 symptomatic veterans who were not deployed to the Gulf (Era-ill) underwent detailed neurophysiologic assessment: nerve conduction studies, quantitative sensory and autonomic testing, and concentric needle and single-fiber electromyography (EMG). RESULTS: Nerve conduction studies detected carpal tunnel syndrome in two Gulf-ill, two Gulf-well, one Bosnia-ill, and three Era-ill veterans. Ulnar neuropathy was detected in one Gulf-ill and two Era-ill veterans. However, results of detailed nerve conduction studies of the Gulf-ill veterans were comparable with results observed in the other three groups. Quantitative sensory and autonomic assessments also failed to show any specific abnormalities in the Gulf-ill group. Similarly, quantitative assessment of concentric needle and single-fiber EMG detected no chronic denervation or myopathic changes or any abnormalities of neuromuscular transmission in the Gulf-ill veterans. CONCLUSION: Gulf War-related neuromuscular symptoms are not associated with specific impairments of peripheral nerves, neuromuscular junctions, or skeletal muscles.     

Elderly Israeli Holocaust survivors during the Persian Gulf War: a study of psychological distress.

OBJECTIVE: The aim of the current study was to systematically assess the psychological effects of the Persian Gulf War on a nonclinical group of elderly Israeli civilians with and without a Holocaust background. METHOD: Sixty-one elderly Holocaust survivors and 131 elderly civilians without a Holocaust background completed questionnaires in their homes. Measures included sense of safety, symptoms of psychological distress, and levels of state and trait anxiety. RESULTS: Findings indicate that Holocaust survivors perceived higher levels of danger and reported more symptoms of acute distress than comparison subjects. In addition, they displayed higher levels of both state and trait anxiety. CONCLUSIONS: Findings do not support the notion that prior experience with extreme stress has an inoculating effect that leads to greater resilience in dealing with other forms of stress. On the contrary, Holocaust experience was found to render the elderly more vulnerable rather than less. These findings of greater vulnerability among Holocaust survivors are of particular significance since they stem from a nonclinical group.     

Social class and psychological disturbance: The influence of positive and negative experiences

Summary Recent studies by the Midtown investigators found that, except for people experiencing no stress factors, lower class individuals were consistently in poorer mental health than those of higher status — regardless of the number of stress factors experienced. The present paper is concerned with testing the hypothesis that the Midtown findings may be due to a differential distribution of positive experiences in the various classes, experiences which might act to diminish or minimize the influence of stress. Data collected from a sample of 600 residents of a small New England State allowed for the testing of this hypothesis. Analysis of the data suggests that with regard to the relationship between class and psychological disturbance, social class position may be best regarded as a condition affectingboth positive experiences and stress, two variables that are more directly and immediately related to disturbance. While it has long been recognized that there are probably more stresses in lower class life, the possibility that there may also be social class differences in positive experiences which might tend to mitigate against these stresses has been largely ignored by previous investigators.

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Zusammenfassung Jüngste Untersuchungen aus dem Kreis der Midtown-F'orscher ergaben, daß, abgesehen von Leuten, die keinen Stress-Faktoren ausgesetzt sind, sich Angehörige der unteren Sozialklasse durchgängig bei schlechterer seelischer Gesundheit befanden als jene mit höherem Status — unabhängig von der Anzahl belastender Erfahrungen. Die vorliegende Abhandlung befaßt sich mit der Untersuchung der Hypothese, daß die Midtown-Ergebnisse einer unterschiedlichen Verteilung positiver Erfahrungen in den verschiedenen Klassen zuzuschreiben sind, Erfahrungen, die dazu führen können, den Einfluß von Stress zu verhindern oder auf ein Minimum zu reduzieren. Die von einem Sample von 600 Einwohnern eines kleinen Staates von New England gewonnenen Daten gestatteten die Untersuchung dieser Hypothese. Die Analyse der Daten legte nahe, daß im Hinblick auf die Beziehung zwischen Sozialklasse und psychischer Störung, die soziale Stellung am besten als eine Bedingung angesehen werden kann, die sowohl positive Erfahrungen wie Stress beeinflußt, zwei Variablen, die direkter und unmittelbarer mit Störungsreaktionen verknüpft sind. Während schon lange erkannt worden ist, daß es wahrscheinlich mehr Belastungen im Leben der niederen Sozialklasse gibt, ist die Möglichkeit weitgehend durch frühere Untersucher ignoriert worden, daß es auch Klassenunterschiede bei positiven Erfahrungen geben kann, die dazu beitragen, diese Belastungen zu mildern.

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Résumé De récentes études faites par les chercheurs de «Midtown» ont démontré que, excepté pour les personnes n'étant pas soumises à un stress, les individus des couches sociales inférieures étaient de façon permanente en moins bonne santé mentale que ceux bénéficiant d'un status plus élevé, sans tenir compte du nombre d'expériences sources de stress. Le présent rapport est consacré à l'étude de l'hypothèse de l'auteur, selon laquelle le résultat de la recherche «Midtown» serait dû à une distribution différentielle des expériences positives d'après les classes, expériences tendant à diminuer ou à minimiser l'influence du stress. Les données recueillies dans un échantillonnage de 600 habitants d'un petit Etat de la Nouvelle Angleterre ont permis de contrôler cette hypothèse. Il ressort de l'analyse de ces données que si l'on considère les relations existant entre classes sociales et troubles psychiques, la classe sociale peut influencer aussi bien les expériences positives que le stress, ces deux variables étant étroitement liées aux troubles. Bien qu'on sache depuis longtemps qu'il y a probablement plus de situations stressantes dans les classes inférieures, l'éventualité d'une différence de niveau de classes en ce qui concerne les expériences positives tendant à tempérer les difficultés a été tout à fait ignorée jusqu'a présent.

     

Behavioural and psychological symptoms of dementia in an Alzheimer's disease case successfully treated with natural medicine: association with gonadotropins

Pharmacotherapies for the behavioural and psychological symptoms of dementia are limited; novel agents for the symptoms are still needed. Herein, we report the case of an 80‐year‐old male patient with Alzheimer's disease whose severe agitation, insomnia and sexual delusions were successfully treated with a traditional natural Japanese (Kampo) medicine, keishi‐ka‐ryukotsu‐borei‐to. We found that administrating keishi‐ka‐ryukotsu‐borei‐to increased his serum luteinizing hormone level, which could be inversely associated with his behavioural and psychological symptoms. This report suggests that keishi‐ka‐ryukotsu‐borei‐to is a possible alternative treatment for the behavioural and psychological symptoms of dementia, especially sexual delusions.     

Contributions of risk and protective factors to prediction of psychological symptoms after traumatic experiences

ObjectiveTraumatic experiences cause considerable suffering and place a burden on society due to lost productivity, increases in suicidality, violence, criminal behavior, and psychological disorder. The impact of traumatic experiences is complicated because many factors affect individuals' responses. By employing several methodological improvements, we sought to identify risk factors that would account for a greater proportion of variance in later disorder than prior studies.MethodIn a sample of 129 traumatically injured hospital patients and family members of injured patients, we studied pre-trauma, time of trauma, and post-trauma psychosocial risk and protective factors hypothesized to influence responses to traumatic experiences and posttraumatic (PT) symptoms (including symptoms of PTSD, depression, negative thinking, and dissociation) two months after trauma.ResultsThe risk factors were all significantly correlated with later PT symptoms, with post-trauma life stress, post-trauma social support, and acute stress symptoms showing the strongest relationships. A hierarchical regression, in which the risk factors were entered in 6 steps based on their occurrence in time, showed the risks accounted for 72% of the variance in later symptoms. Most of the variance in PT symptoms was shared among many risk factors, and pre-trauma and post-trauma risk factors accounted for the most variance.ConclusionsCollectively, the risk factors accounted for more variance in later PT symptoms than in previous studies. These risk factors may identify individuals at risk for PT psychological disorders and targets for treatment.     

Adolescents' bereavement experiences. Prevalence, association with depressive symptoms, and use of services.

The present study set out to estimate the prevalence of bereavement experiences in adolescents, the association between these experiences and depressive symptoms and the attitudes of bereaved young people to professional interventions. The study was based on 1746 adolescents aged between 11 and 16 years from two secondary schools in Northern England. Questionnaire measures of bereavement experiences and depressive symptoms were completed by the adolescents in the classroom. One thousand three hundred and fifty-five (77.6%) reported that at least one of their first-or second-degree relatives or close friends had died. These losses were associated with increased levels of depressive symptoms in comparison with the loss of other relatives or pets. The impact of the loss of someone close depended to an important extent on the young person's perception of how the loss had changed their lives. Most adolescents did not feel the need for professional services. Those who did use these services had higher levels of depressive symptoms, suggesting that service use was likely to have been appropriate.     

Factitious disorders with psychological symptoms.

BACKGROUND: Factitious disorders with psychological symptoms have been underdiagnosed and hence undertreated. Historically, the literature has focused on factitious disorder with physical symptoms, particularly Munchausen's syndrome. METHOD: The authors report three cases of factitious disorder with psychological symptoms that had diverse clinical presentations. RESULTS: Two of the patients had features of a psychiatric Munchausen's syndrome--being middle-aged, aggressive men who falsified their symptoms, treatments, and backgrounds. The third patient was a younger woman with comorbid substance abuse, dysthymia, and borderline personality disorder. CONCLUSION: The authors feel that there is a need for refinement of diagnostic criteria, greater awareness, and evaluation of treatment approaches for this condition.     

Electroacupuncture treatment of obesity with psychological symptoms

The aim was to study the effect of placebo EA, electroacupuncture (EA), and diet on obesity and accompanying psychological symptoms. One hundred and sixty-five volunteer women participated in the study. There were three groups: (i) Placebo EA, (ii) EA, and (iii) diet restriction group. EA was performed by using three ear and six body points. There was a 4.8% reduction in weight of patients with EA application, whereas patients with a diet restriction and placebo EA had a 2.5% and 2.7% weight reduction, respectively. There were significant decreases in phobia, anger, anxiety, obsession, paranoid symptoms, and depression in the EA groups compared to those of the placebo EA and diet groups. It was suggested that electroacupuncture may be an effective therapy for obesity including the psychological signs and symptoms in women.     

The prevalence and correlates of trauma-related symptoms in schizophrenia spectrum disorder

Research has suggested that many with schizophrenia have been exposed to significant trauma, both after and before the onset of their illness. Less clear is how commonly significant levels of trauma symptoms are found in schizophrenia, how often they co-occur, and what their relationship is with positive and negative symptoms. To examine these issues, we concurrently assessed trauma history, trauma symptoms using the Trauma Symptom Inventory, and symptoms using the Positive and Negative Syndrome Scale. Participants were 68 individuals with schizophrenia spectrum disorders who provided reliable reports of at least one traumatic event from an original sample of 81 individuals. Results revealed that two thirds of participants reported clinically significant trauma symptoms that included at least intrusive experiences, defensive avoidance, or dissociation. Greater levels of depression and disturbance of volition were significantly correlated with greater levels of anxious arousal, intrusive experiences, defensive avoidance, dissociation, and total number of significantly elevated trauma scales. Delusions were correlated with intrusive experiences, dissociation, and number of significantly elevated trauma scales, whereas hallucinations were correlated with irritability and total number of significantly elevated trauma scales. Results suggest that trauma symptoms may be commonly experienced in schizophrenia and linked with the phenomenology of the disorder.     

Psychiatric diagnoses in Gulf War veterans with fatiguing illness

The purpose of this study was to determine whether Gulf War Illness (GWI) can be explained by the presence of psychiatric disorders as assessed by DSM-III-R. To reduce the heterogeneity amongst Persian Gulf War veterans with GWI (PGV-F), only those were studied who presented with severe fatigue as a major complaint and also fulfilled clinical case definitions for Chronic Fatigue Syndrome, Idiopathic Chronic Fatigue, and/or Multiple Chemical Sensitivity. A total of 95 Registry PGVs were examined; 53 presented with GWI and 42 did not report any post-war health problems (PGV-H). All subjects were assessed for the presence of DSM-III-R Axis I psychiatric disorders. Compared to PGV-Hs, 49% of PGV-Fs had similar post-war psychiatric profiles: either no, or only one, psychiatric disorder was diagnosed. Psychiatric profiles of the remaining 51% of PGV-Fs were significantly different from PGV-Hs in that most of these veterans suffered from multiple post-war psychiatric diagnoses. The presence of psychiatric disorders as assessed by DSM-III-R criteria cannot explain symptoms of Gulf War Illness among all Persian Gulf veterans with severe fatiguing illness.     

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation

Objectives: To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health.

Methods: Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling.

Results: Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = ?.5052; CI_.95 = ?1.0364, ?.0429 and point estimate = ?.7792; CI_.95 = ?1.6369, ?.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping.

Conclusion: Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.     

Small intestinal bacterial overgrowth in irritable bowel syndrome: association with colon motility, bowel symptoms, and psychological distress

Abstract  Small intestinal bacterial overgrowth (SIBO) has been implicated in the pathogenesis of irritable bowel syndrome (IBS), although the issue is still under debate. The aim of this study was to determine the prevalence of SIBO in those with IBS and its association with colonic motility, bowel symptoms and psychological distress. Sucrose hydrogen and methane breath tests were performed in 158 IBS patients and 34 healthy controls (HC). Thresholds for pain and urgency were tested by barostat in the descending colon. The motility index (MI) was calculated as the average area under the curve for all phasic contractions. Questionnaires assessed psychological distress, IBS symptom severity (IBS-SS), IBS quality of life (IBS-QOL) and self-reported bowel symptoms. Fifty-two of 158 (32.9%) IBS patients had abnormal breath tests compared with six of 34 (17.9%) HC (χ² = 0.079). SIBO (SIBO+) and non-SIBO (SIBO−) patients did not differ in the prevalence of IBS subtypes, IBS-SS, IBS-QOL and psychological distress variables. IBS patients had a greater post-distension increase in MI than HC, but there was no difference between SIBO+ and SIBO− patients. Predominant methane producers had higher urge thresholds (28.4 vs 18.3, P  < 0.05) and higher baseline MI (461 vs 301.45, P  < 0.05) than SIBO− IBS patients, and they reported more 'hard or lumpy stools' when compared with predominant hydrogen producers ( P  < 0.05) and SIBO− IBS patients ( P  < 0.05). SIBO is unlikely to contribute significantly to the pathogenesis of IBS. Methane production is associated with constipation.