Sentence completion test in combat veterans with and without PTSD: preliminary findings

The preservation of procedural memory in individuals with schizophrenia has been confirmed by methods such as the Tower of Hanoi, pursuit rotor and mirror reading tests. However, the cognitive procedural memory of Japanese subjects with schizophrenia has never been assessed using mirror reading. To better determine the characteristics of cognitive procedural memory in schizophrenia, a Japanese version of the mirror reading task, consisting of cards with words written in Japanese katakana characters in mirror image, was administered to 18 Japanese patients with schizophrenia and 21 normal controls. The results indicated that the patients indeed learned the skill despite exhibiting lower overall performances in reading time than the controls, their scores displaying correlation with the severity of schizophrenic negative symptoms. This suggests that procedural memory for this task is retained in individuals with schizophrenia. It is important for them to use their preserved procedural memory for efficient rehabilitative efforts.     

Replication and expansion of findings related to racial differences in veterans with combat-related PTSD

Racial differences in those seeking treatment at a Veterans Affairs Medical Center (VAMC) outpatient posttraumatic stress disorder (PTSD) treatment program were examined. One hundred eleven (71 Caucasian and 40 African American) veterans were compared on both self-report measures and interview measures of PTSD, depression, dissociation, and general psychopathology. Participants completed the following self-report measures: the Beck Depression Inventory, the Dissociative Experiences Scale, the Mississippi Combat PTSD Scale, and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants also completed the Clinician Administered PTSD Scale (CAPS-1), which is a structured interview for PTSD, and completed a non-structured clinical interview. The two groups did not differ on measured demographic variables, nor were there significant differences on self-report or interview measures of anxiety, depression, or PTSD symptomatology. Contrary to expectation, groups did not differ on self-report measures of dissociation, paranoia, or schizophrenia. African Americans were significantly more likely to endorse items of bizarre mentation from the MMPI-2. These results suggest that African American and Caucasian veterans with combat-related PTSD do not differ with regard to manifestation or severity of psychopathology.     

Anger, dissociation, and PTSD among male veterans entering into PTSD treatment

Prior research suggests that dissociation and anger are risk factors for the development of posttraumatic stress disorder (PTSD). Research found that trauma survivors with higher levels of anger also report more severe PTSD overall. Studies also support a relationship between PTSD severity and dissociation. Only one prior study of sexual assault survivors by Feeny, Zoellner, and Foa (2000) examined the relationships among dissociation, anger, and PTSD. While Veterans have been found to report high levels of anger and dissociation, the relationship between these factors and PTSD has not been examined among Veterans. This paper examines the relationship among anger, dissociation, and PTSD in treatment-seeking Veterans who presented for evaluation at the PTSD Clinic in the VA Ann Arbor Healthcare System during a four year period. Anger and dissociation predicted PTSD, hyperarousal, and avoidance/numbing severity while dissociation predicted intrusive severity. The implications of these results for clinical practice are discussed.     

Adjunctive risperidone treatment and sleep symptoms in combat veterans with chronic PTSD

Sleep disturbances are core symptoms of posttraumatic stress disorder (PTSD) and are often resistant to treatment. One reason for the recent use of atypical antipsychotics in PTSD appears to be their effects on sleep. Study objectives were (1) to evaluate preliminarily the sleep effects of adjunctive risperidone, and (2) to evaluate the use of sleep diaries versus the more standard retrospective sleep assessments. This was a pilot, open-label, 12-week, flexible-dose trial of adjunctive risperidone in male veterans with a primary diagnosis of chronic, combat-related PTSD, partially responsive to current medications. Diagnostic interviews were administered at baseline, and PTSD ratings were obtained at baseline and at 6 and 12 weeks. Self-report sleep measures, including morning logs, were obtained at baseline and 6 weeks. Seventeen patients completed at least 6 weeks of the trial. Global ratings of sleep disturbance improved. Changes in frequency of awakenings and reductions in trauma-related dreams were only evident via morning log assessments. Nighttime awakening frequency derived from the sleep logs but not from the Pittsburgh Sleep Quality Index (PSQI) decreased significantly. There were no changes in the PSQI nightmare item; however, sleep log data indicated a reduced proportion of traumatic dreams at 6 weeks. Preliminary results suggest that adjunctive risperidone may benefit sleep disturbances associated with chronic PTSD. Prospective logs may be more sensitive to change than are retrospective scales.     

Clinical characteristics and health service use of veterans with comorbid bipolar disorder and PTSD

OBJECTIVE: This study aimed to increase the understanding of the clinical characteristics and utilization of health services among veterans with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). METHODS: A retrospective chart review was conducted that examined the clinical and health service use data of 139 male veterans with bipolar disorder (N=49), PTSD (N=49), or comorbid bipolar disorder and PTSD (N=41) who obtained services over two years from the Department of Veterans Affairs Salt Lake City Health Care System. RESULTS: Compared with patients with bipolar disorder or those with PTSD alone, those with both conditions had significantly higher mean Clinical Global Impression-Severity scores and required more frequent inpatient psychiatric treatment. Patients with both conditions and those with bipolar disorder were significantly less likely to have received psychotherapy and antidepressant pharmacotherapy than patients with PTSD. CONCLUSIONS: Patients with both conditions have a more severe illness course than those with bipolar disorder alone. Psychotherapy and antidepressant pharmacotherapy may be underutilized among patients with comorbid bipolar disorder and PTSD.     

PTSD factor structure differences between veterans with and without a PTSD diagnosis

This study examined differences in posttraumatic stress disorder's (PTSD) factor structure between veterans with and without a PTSD diagnosis. An archival dataset of 378 trauma-exposed Canadian veterans (mostly men) was used. The sample was divided into participants who met DSM-IV criteria for PTSD (n=230) and those who did not (n=148), based on a structured diagnostic interview. Confirmatory factor analysis was conducted to determine which empirically supported four-factor PTSD model best fit the data: (1) King, Leskin, King, and Weathers' (1998) Emotional Numbing model of Reexperiencing, Avoidance, Emotional Numbing and Hyperarousal factors, or (2) Simms, Watson, and Doebbeling's (2002) Dysphoria model of Reexperiencing, Avoidance, Dysphoria, and Hyperarousal factors. Results indicated that both models fit slightly better in the No-PTSD group. A series of measurement invariance tests demonstrated that the two groups varied on all parameters with the exception of factor loadings. The PTSD-group had larger intercepts, factor means, and residual error variance, suggesting that these participants had greater PTSD severity but more measurement error associated with their PTSD ratings. This study contributes to our understanding of how a PTSD diagnosis impacts the structure of PTSD symptoms at the latent level.     

Comparison of comorbid physical illnesses among veterans with PTSD and veterans with alcohol dependence

Posttraumatic stress disorder (PTSD) is associated with high rates of medical service use and with self-reported poor health. Male veterans admitted to a rehabilitation unit for PTSD (N=55) or alcohol dependence (N=38) were evaluated for comorbid psychiatric and medical conditions and health risk factors. Patients with PTSD were more likely to have osteoarthritis, diabetes, heart disease, comorbid depression, obesity, and elevated lipid levels. These findings suggest that there may be a relationship between specific medical conditions, possibly mediated by behavioral risk factors, among the aging population of veterans with PTSD.     

Unresolved grief in combat veterans with PTSD

Clinicians have documented the importance of loss of comrades during combat as a significant source of distress. However, empirical studies have not focused on unresolved grief as a possible outcome of combat experiences. Consequently, unresolved grief has often been treated "after the fact" in the context of treating PTSD and depressive symptoms. In this study, we therefore, sought to demonstrate the prominence of combat-related grief-specific symptoms in a sample of Vietnam veterans being treated for PTSD. Our results indicated that indeed this sample of veterans reported high levels of grief-specific symptoms comparable to that found in bereaved individuals whose spouse had recently died, verifying its prominence as an important component of combat-related stress. Furthermore, grief severity was uniquely associated with losses of comrades during combat whereas no such relationship was shown for trauma or depressive symptoms. The latter finding suggested that in fact higher levels of grief stemmed from interpersonal losses during the war and was not simply an artifact of current general distress level.     

Diagnosis of posttraumatic stress disorder in Viet Nam veterans: preliminary findings

Sixty-six Viet Nam veterans were evaluated for posttraumatic stress disorder. Several of the DSM-III criteria for the disorder, but no other clinical features, distinguished patients diagnosed as having the disorder from others. The findings tend to validate the DSM-III construct for this disorder.     

PTSD and utilization of medical treatment services among male Vietnam veterans

This study investigated the effect of posttraumatic stress disorder (PTSD) on help-seeking for physical problems. Merging two large data sets resulted in a sample of 1773 male Vietnam veterans from white, black, Hispanic, Native Hawaiian, and Japanese American ethnic groups. Predictors of utilization included PTSD, other axis I disorders, and substance abuse. In analyses that adjusted only for age, PTSD was related to greater utilization of recent and lifetime VA medical services, and with recent inpatient care from all sources. Further analysis showed that the increased utilization associated with PTSD was not merely due to the high comorbidity between PTSD and other axis I disorders. The uniqueness of the association between PTSD and medical utilization is discussed in terms of somatization and physical illness.     

Learning and memory in aging combat veterans with PTSD

The California Verbal Learning Test (CVLT) was administered to examine learning and memory performance in aging combat veterans with (n = 30) and without PTSD (n = 20), and veterans unexposed to combat (n = 15). Combat veterans with PTSD (PTSD+) showed many impairments compared to non-exposed veterans, but only long-delay free recall consistently discriminated the PTSD+ group from combat-exposed subjects without PTSD (PTSD-), when data were corrected for subscale scores on the WAIS (Vocabulary, Block Design). Alterations in total learning were associated with PTSD when controlling for substance abuse and depression. Two contrast measures, proactive interference and recognition hits, distinguished combat from noncombat veterans, and may be related to trauma exposure. Impairments in total learning are similar to what has been observed in Holocaust survivors. However, increased severity of rapid forgetting may be a specific alteration in older combat veterans, likely reflecting aspects of both combat exposure and aging.     

Clinical presentation of PTSD in World War II combat veterans.

Clinicians have increasingly recognized posttraumatic stress disorder (PTSD) among Vietnam veterans, but the disorder may be easily overlooked among World War II combat veterans. The authors review recent studies of PTSD in older veterans and describe five cases that illustrate the diverse clinical presentations of PTSD in this population. Symptoms included anxiety, cognitive and somatic complaints, depression, alcohol dependence, and amnestic periods. Despite the varied presentations, a fairly consistent patient profile emerged. Patients avoided reminders of war, showed an exaggerated startle response, and experienced restless sleep and chronic anxiety. Factors associated with exacerbations of symptoms were retirement and reminders of war experiences. Although past studies have emphasized resuppression of the trauma, the authors encourage a flexible approach to treatment, including exploratory techniques.     

Evaluation of objective and subjective clinical outcomes in combat veterans with and without mild TBI and PTSD: A four-group design

Introduction: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are highly prevalent comorbid conditions in military Veterans. However, lack of appropriate comparison groups has clouded interpretation of the chronic effects of these conditions. The present study evaluated the neuropsychological, psychiatric/neurobehavioral, and functional outcomes associated with mTBI and PTSD in a well-characterized sample of combat-exposed Veterans.

Method: Participants included 73 Iraq/Afghanistan Veterans (91.8% male; age: M = 34.00, SD = 6.39) divided into four groups: mTBI-only (n = 23), PTSD-only (n = 14), comorbid mTBI + PTSD (n = 19), and combat-control (CC; n = 17). Participants were administered a neuropsychological assessment and completed questionnaires assessing psychiatric/neurobehavioral symptoms and functional outcomes.

Results: Kruskal-Wallis H-tests showed no group differences across measures of neuropsychological functioning; however, there were significant differences across groups on all psychiatric/neurobehavioral variables examined. In general, the comorbid and PTSD-only groups endorsed the most severe symptoms, followed by the mTBI-only and CC groups, respectively. As for functional outcomes, the comorbid and PTSD-only groups had higher rates of service-connection disability and greater perceived decline in work and education-related abilities, relative to the mTBI-only and CC groups, despite similar proportions of Veterans employed or in school in each group.

Conclusions: Findings suggest that Veterans with comorbid mTBI + PTSD and PTSD alone are at greatest risk for experiencing long-lasting subjective distress, including negative perceptions of their ability to work or pursue an education, despite being comparable to mTBI-only and CC Veterans on objective measures of functioning. Our results highlight the importance of emphasizing mental health treatment in this population.     

Symptom patterns associated with chronic PTSD in male veterans: new findings from the National Vietnam Veterans Readjustment Study

A subsample of 255 male Vietnam veterans from the National Vietnam Veterans Readjustment Study received in-depth psychiatric diagnostic interviews. This paper focuses on the 88 veterans with a war-related onset of PTSD. Among these veterans, the avoidance cluster, especially its symptoms of numbing, was most strongly associated with chronic PTSD; less strongly but also significantly associated was the hyperarousal cluster. Further analyses show that these associations are not artifacts of the relationship of symptom patterns to prewar demographic factors (race/ethnicity, socioeconomic status, age at entry into Vietnam), comorbidity, treatment and compensation seeking, or probable severity of war-related trauma. We conclude that certain symptom profiles may predict enduring pathological responses to trauma and therefore provide targets for intervention efforts.     

MMPI-2 based subgroups of veterans with combat-related PTSD: differential patterns of symptom change after treatment

Considerable research has focused on the use of the MMPI to assess posttraumatic stress disorder (PTSD) through identification of mean profile configurations and the development of PTSD subscales. Little work, however, has addressed the heterogeneity of profiles evident in PTSD populations. This study investigated the MMPI-2 profiles of 158 Australian treatment-seeking Vietnam veterans with combat-related PTSD to identify distinct subgroups. Three robust subgroups were identified on the basis of their MMPI-2 profile and compared on PTSD and associated symptomatology. These subgroups consisted of a mild PTSD group with subclinical personality pathology, and two severe PTSD groups that differed in levels of personality disturbance and general psychopathology. Most notably, differences between these latter two groups occurred in the areas of externalization, alienation, and propensity for acting out. These groups were labeled as subclinical, trauma profile, and global. The groups demonstrated significant differences in the patterns of recovery after treatment. The subclinical group demonstrated little change after treatment. In contrast, the trauma profile and global groups both improved, although the trauma profile group demonstrated greater PTSD symptom reduction than the global group.     

Trauma-related dreams of Australian veterans with PTSD: content, affect and phenomenology

Objective: Consensus on the parameters of trauma-related dreams required to meet criteria for post-traumatic stress disorder (PTSD) is critical when: (i) the diagnosis requires a single re-experiencing symptom; and (ii) trauma dreams are prevalent in survivors without PTSD. Method: This study investigated the phenomenology of PTSD dreams in 40 veterans, using structured interview and self-report measures. Results: Dream content varied between replay, non-replay, and mixed, but affect was largely the same as that experienced at the time of trauma across all dream types. ANOVA indicated no difference between dream types on PTSD severity or nightmare distress. Conclusions: The findings provide preliminary support for non-replay dreams to satisfy the DSM B2 diagnostic criterion when the affect associated with those dreams is the same as that experienced at the time of the traumatic event.