Acute Posttraumatic Stress Disorder Research Articles

The Prevalence of Posttraumatic Stress Disorder Among Children and Adolescents Affected by Tsunami Disaster in Tamil Nadu

The Asian earthquake and subsequent tsunami of December 2004, one of the largest natural disasters in recent history, resulted in the deaths of over 250,000 people and massive destruction in 8 countries. As with any disaster, children are at risk for developing short- and long-term psychological consequences, including posttraumatic stress disorder (PTSD). One area particularly affected by this disaster was southern India. Five hundred twenty-three juvenile survivors of the tsunami were studied to determine the prevalence of PTSD. The survey was conducted in 2 waves. Interviews were conducted by postgraduate psychiatric social work students, proficient in the local language of Tamil and trained in PTSD-related data collection. The Impact of Event Scale-8 items Tamil Version and Child Behaviour Checklist Post-traumatic Stress Disorder-Tamil Revised Version, with age-specific measures and validated for the local culture and language, were used for the study. Our study revealed a prevalence of 70.7% for acute PTSD and 10.9% for delayed onset PTSD. PTSD was more prevalent among girls and more severe among adolescents exposed to loss of life or property. These results indicate that PTSD is widely prevalent among the survivors of the tsunami, reinforcing the need to develop an effective, culturally sensitive outreach therapy strategy for them.

Longitudinal Study of Acute Stress Disorder, Posttraumatic Stress Disorder and Dissociation Following Myocardial Infarction

Since dissociation has been recognized as a marker of posttraumatic processes, this study examines the chronological relations between dissociation and stress reactions (acute stress disorder, ASD, and posttraumatic stress disorder, PTSD) following myocardial infarction (MI). One hundred sixteen MI patients were examined twice: within 1 week of the trauma (time 1) and 7 months later (time 2). Sixty-seven matched controls were studied in a parallel interval. ASD was assessed at time 1, PTSD at time 2, and dissociative tendencies at both times. ASD and PTSD were moderately associated with levels of dissociation. In addition, while the MI patients did not differ from the controls in level of dissociation, both in time 1 and time 2, among the MI group, PTSD was associated with an increase in dissociation. These findings may reflect either the development of two comorbid entities, or a presentation of a dissociative subtype of PTSD.

Psychological stress reactions of women in Sweden who have been assaulted: Acute response and four-month follow-up

Violence is a global health problem. Women in particular are likely to be targets of violent behavior. This study investigated the reactions of female victims to an individual act of interpersonal violence. A sample of 68 assaulted women registered as injured parties in 2 police districts were assessed for symptoms of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) at 3 weeks and after 4 months. Risk factors for developing psychological distress in the long-term were explored. High rates of ASD symptoms and distress measured with Post Traumatic Symptom Scale (PTSS-10), Impact of Event Scale (IES), and General Health Questionnaire (GHQ-20) were reported by the women in the acute phase. Four months post-assault, the high rates of stress reactions measured with PTSS-10, IES, and GHQ-20 were significantly reduced, but not for all the women. Dissatisfaction with one's previous life, previous mental health problems, post-assault life events and earlier abuse were risk factors for 4 months post-assault stress reactions.

Heart rate of motor vehicle accident survivors in the emergency department, peritraumatic psychological reactions, ASD, and PTSD severity: A 6‐month prospective study

This small-scale study investigates the relationships between the heart rate of motor vehicle accident survivors presenting in the emergency department (ED) and acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) symptom severity. It also examines the relationships between the survivor's heart rate in the ED and peritraumatic dissociation and peritraumatic distress reported 2 weeks posttrauma. Fifty motor vehicle accident (MVA) survivors were assessed 2 weeks, 1 (N = 42), 3 (N = 37), and 6 months (N = 37) post-MVA. The heart rate in the ED predicted self-reported ASD symptom severity and clinician-rated PTSD symptom severity at 6 months but not at 1 or 3 months. Survivors' heart rate in the ED was significantly correlated with peritraumatic dissociation but not peritraumatic distress. These findings support the role of elevated ED heart rate as a predictor of both ASD and chronic PTSD symptom severity and may help to clarify the discrepant findings of previous research.

Relationship Between Posttrauma GABA Plasma Levels and PTSD at 1-Year Follow-Up

Gamma-aminobutyric acid (GABA) exerts a prominent effect on central adrenergic stress responses in times of high stress and has been associated with acute posttraumatic stress disorder (PTSD). The authors examined the association between low posttrauma plasma GABA levels and long-term PTSD.Plasma GABA levels were measured in 78 victims of road traffic accidents who met criteria for trauma exposure on arrival at a trauma department and were admitted for at least 3 days. Patients were assessed for PTSD and major depressive disorder at 6-week and 1-year follow-ups.At 6 weeks and at 1 year, mean posttrauma GABA levels were significantly lower among subjects who met all or nearly all criteria for PTSD than among those who did not. Among patients who met all or nearly all criteria for PTSD at 6 weeks, 75% of those with posttrauma GABA levels above 0.20 mmol/ml no longer met criteria at 1 year. By contrast, among patients whose GABA levels were below 0.20 mmol/ml, 80% met all or nearly all criteria for PTSD at 1 year. Two-thirds of patients who met all or nearly all criteria for PTSD at 1 year also met criteria for major depressive disorder.A plasma GABA level above 0.20 mmol/ml may protect against chronic PTSD and may represent a marker of recovery from trauma.

Relationship Between Posttrauma GABA Plasma Levels and PTSD at 1-Year Follow-Up

Gamma-aminobutyric acid (GABA) exerts a prominent effect on central adrenergic stress responses in times of high stress and has been associated with acute posttraumatic stress disorder (PTSD). The authors examined the association between low posttrauma plasma GABA levels and long-term PTSD. Plasma GABA levels were measured in 78 victims of road traffic accidents who met criteria for trauma exposure on arrival at a trauma department and were admitted for at least 3 days. Patients were assessed for PTSD and major depressive disorder at 6-week and 1-year follow-ups. At 6 weeks and at 1 year, mean posttrauma GABA levels were significantly lower among subjects who met all or nearly all criteria for PTSD than among those who did not. Among patients who met all or nearly all criteria for PTSD at 6 weeks, 75% of those with posttrauma GABA levels above 0.20 mmol/ml no longer met criteria at 1 year. By contrast, among patients whose GABA levels were below 0.20 mmol/ml, 80% met all or nearly all criteria for PTSD at 1 year. Two-thirds of patients who met all or nearly all criteria for PTSD at 1 year also met criteria for major depressive disorder. A plasma GABA level above 0.20 mmol/ml may protect against chronic PTSD and may represent a marker of recovery from trauma.

Life events and adjustment following myocardial infarction

This study examines the implications of both pre-Myocardial Infarction (MI) and post-MI life events on the severity of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) symptomatology. 116 MI patients were examined twice. At Time 1, within a week of the MI, severity of ASD and pre-MI life events were assessed, and medical measures were obtained from patients' hospital records. At Time 2, seven months later, severity of PTSD and post-MI life events were assessed. Although pre-MI life events were associated with both ASD and PTSD symptom severity, the relation between these events and PTSD was mediated by ASD. Post MI stressful life events made an independent contribution to PTSD severity. These findings emphasize the fact that traumatic events do not occur in isolation and that their emotional impact is related to other events that occur both before and after.

Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero*

The present study compared rates of posttraumatic stress disorder (PTSD) in relief workers at the World Trade Center collapse from two sources: direct exposure to the disaster site and indirect exposure through survivor narratives. Standardized clinical interviews for PTSD were conducted with 109 relief workers 6-8 months after the September 11th terrorist attacks. Rates of acute PTSD from direct and indirect exposure to traumatic stressors were 6.4% and 4.6%, respectively. The findings suggest that indirect exposures can lead to PTSD even when Criterion A1 of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR; American Psychiatric Association, 2000, p. 463), i.e., "experienced by a family member or other close associate" is not met. Further research is necessary to define precisely the parameters of indirect traumatic exposure that may be linked to the development of PTSD.

Early post-traumatic stress disorder in relation to acute stress reaction: An ICD-10 study among help seekers following an earthquake

Disaster research related to earthquakes has almost exclusively dealt with their long-term psychosocial impact; besides, diagnoses were previously based only on DSM criteria. Therefore, it is pertinent to assess stress-related reactions of earthquake victims during the early post-disaster period through the application of ICD-10 criteria. For the first 3 weeks following an earthquake, 102 help-seekers were assessed based on a checklist of sociodemographic variables and a semi-structured interview for the detection of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) according to ICD-10. Forty-four subjects (43%) fulfilled the ICD-10 criteria for PTSD; all but one of them had suffered ASR. Moreover, among a series of potential predictors for PTSD, ASR was found to be the only significant one; this indicates a definite association between ASR and early development of PTSD. Logistic regression to predict group membership (PTSD/no PTSD) based on specific ASR symptoms showed that accelerated heart rate and feelings of derealization were the only significant predictors for early PTSD. Individuals who fulfill the ICD-10 diagnostic criteria for ASR following an earthquake are at high risk for subsequent occurrence of early PTSD. Increased heart rate and feelings of derealization within the first 48 h after the traumatic event appear to be the principal factors associated with the development of early PTSD. In addition to their potential value for timely prevention and treatment, these findings raise important nosological issues pertaining to the current diagnostic classification of stress-related disorders (ICD-10 versus DSM-IV).

Separation Anxiety as a Mediator Between Acute Morphine Administration and PTSD Symptoms in Injured Children

Emerging evidence suggests that individuals who receive morphine while hospitalized demonstrate a decrease in symptoms of posttraumatic stress disorder (PTSD). However, the mechanisms of effects are not yet well understood. The goal of the current study was to examine three possible mediators for this effect. Sixty-one injured (burns, motor vehicle accidents, falls, and assaults) children were assessed during hospitalization and again 3 months post discharge. Assessment included acute and follow-up child report measures of pain, PTSD, and anxiety symptoms, as well as a medical record review for medication administration and pulse during hospitalization. Pathway analyses were conducted to test the potential mediating roles of pain reduction, noradrenergic attenuation, and separation anxiety on the association between morphine and PTSD. Results suggest that a reduction in separation anxiety may mediate the association between morphine administration and PTSD symptom reduction at 3 months. These findings have implications for our understanding of morphine's effects on psychological functioning following an acute injury and for direct clinical care.

Persistierende Dissoziation als Prädiktor posttraumatischer Belastungsstörungen bei psychosozialen Fachkräften

The author prospectively examined the power of persistent dissociation in predicting acute and chronic posttraumatic stress disorder symptoms (PTSD) in psychologists, psychotherapists, crisis intervention teams and clergymen after a disaster. 135 psychosocial disaster workers were assessed (6 weeks and 6 months after the catastrophe) with the Acute Stress Disorder Scale (ASDS), the Posttraumatic Stress Diagnostic Scale (PDS) and the German short version of the Dissociative Experience Scale (FDS-20). Correlational analysis and a hierarchical multiple regression analysis were conducted. Persistent dissociation and acute stress symptoms were correlated with later acute and chronic PTSD diagnosis. Together, persistent dissociation und acute stress symptoms accounted for 74 % (m)/36 % (w) of the acute and 58 % (m)/44 % (w) of the variance in PTSD symptoms. The results support that persistent dissociation is a main predictor of acute and chronic posttraumatic stress symptoms in disaster workers.

The Effect of Early Poststressor Intervention with Sertraline on Behavioral Responses in an Animal Model of Post-Traumatic Stress Disorder

Whereas several well-controlled studies have established the selective serotonin reuptake inhibitors (SSRIs) as the recommended first-line pharmacotherapeutic agents for acute and chronic post-traumatic stress disorder (PTSD), drug interventions in the acute postexposure phase have not been studied to the same extent and tend to be largely speculative. This study employed an animal model which assesses prevalence of individual stress-response behavior patterns in order to assess the short-term effects of a brief treatment regimen with an SSRI (sertraline) administered immediately after stress-exposure, with those of an identical delayed regimen and of saline. Prevalence rates of rats displaying extreme anxiety-like behavioral responses to predator stress, compared to partial and minimal responses, were assessed in the elevated plus maze and startle response paradigms, with and without intraperitoneal administration of sertraline for 7 days immediately postexposure, or 7 days after exposure. Immediate postexposure administration of sertraline reduced anxiety-like and avoidant behavior, decreased hyperarousal responses and diminished the overall incidence of extreme (PTSD-like) behavioral responses, compared to the delayed treatment regimen and to saline controls. Brief immediate poststress exposure treatment with sertraline reduced prevalence rates of extreme behavioral disruption in the short-term. SSRI drugs are thus worthy of further investigation as agents of secondary prevention in the acute aftermath of stress-exposure.

Trauma-Related Risk Factors in Mineworkers with PTSD: A Prospective Follow-Up Study

The aim of this prospective follow-up study was to investigate the role of trauma-related factors in the development of acute and chronic Posttraumatic Stress Disorder (PTSD) among South African gold mineworkers involved in disabling and reportable earth-fall mine accidents. A consecutive sample of 200 mineworkers who were involved in earth-fall mine accidents was evaluated over a period of seven months. A history of previous trauma exposure was associated with both acute and chronic PTSD. Injury severity predicted acute PTSD but could not differentiate between subjects with acute PTSD that developed chronic PTSD and those whose symptoms went into remission. The intensity and severity of the precipitating earth-fall event were associated with acute and chronic PTSD. Being pinned down by rocks was the earth-fall-related event that predicted chronic PTSD most accurately. The intensity of the traumatic earth-fall event was found to be a more significant predictor for acute PTSD than previous exposure to trauma. Based on these results, recommendations were made to manage trauma in the mining sector.

Acute stress disorder and posttraumatic stress disorder symptoms among patients severely injured in motor vehicle accidents in Japan

Objective The prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in seriously injured survivors of motor vehicle accidents (MVAs) in Japan was investigated. Furthermore, predictive factors in the early stage for development of PTSD were evaluated. Method Subjects were consecutive samples ( N=100) of patients hospitalized with severe MVA injuries surveyed at two time points: within 1 month after the MVA and then 6 months later. In the first survey, we conducted the Acute Stress Disorder Interview and compiled results of a self-rating questionnaire; in the second survey, we conducted a structured clinical interview via telephone. Results The prevalence of ASD and PTSD were 9.0% and 8.5%, respectively. The shift from ASD to PTSD was more pronounced when we included partial diagnoses of ASD and PTSD. Three predictive factors for PTSD were identified through multiple logistic analysis: ASD-positive, presence of persistent physical disability and physical injury severity. Conclusions Even among severely injured MVA survivors, most acute stress symptoms subside over time. However, having ASD or partial ASD in the early stage, and the presence of physical disability as an aftereffect are strong predictive factors for PTSD. These findings validate the importance of evidence-based intervention for ASD to forestall PTSD.

Changes in the Psychiatric Landscape

Changes in the Psychiatric Landscape

Trauma among emergency responders and terrorism investigators: Suggestions for conducting needed research

This article discusses the paucity of information that exists concerning the traumas and stresses that affect emergency responders (ERs) and terrorism investigators (TIs). There has not yet been an indepth, phenomenological, qualitative study examining the perceptions of ERs or TIs during and after emergency incidents to determine whether their experiences led to serious stress or trauma.More research is needed concerning the work experiences of these individuals, which is often dangerous, sometimes taking place in horrific settings, and often occurring in high pressure and high profile situations. We do not know why some ERs and TIs are traumatized by their experiences and others are not. We do not know why some are able to cope with their various stressors in a healthy manner when others develop symptoms clearly indicative of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). We are not certain to what degree the severity of the trauma experienced directly affects the severity of these symptoms, and we have not studied the resultant ability or inability of ERs and TIs to continue to work and interact with family and friends.By conducting additional studies on this topic, ERs and TIs can be taught better coping mechanisms, we can establish more proactive professional mental health responses, gain a more empathetic understanding of ERs and TIs, and help emergency and law enforcement organizations prepare more effective educational and training materials.

Elevated Cerebrospinal Fluid Substance P Concentrations in Posttraumatic Stress Disorder and Major Depression

The authors tested the hypothesis that concentrations of the pain-transmitting neuropeptide substance P are elevated in the CSF of patients with major depression or posttraumatic stress disorder (PTSD), which have overlapping symptoms. The authors also sought to determine if CNS substance P concentrations change on provocation of symptoms in PTSD patients. The authors measured CSF substance P concentrations in medication-free patients with either major depression or PTSD and in healthy comparison subjects. Next, using a within-subject, crossover design, the authors sampled CSF for 6 hours through an indwelling subarachnoid catheter in PTSD patients before, during, and after exposure to a 60-minute traumatic or neutral videotape stimulus. Both depressed and PTSD patients had significantly elevated basal CSF substance P concentrations. In the challenge study, marked increases in CSF substance P concentrations were found only after precipitation of PTSD symptoms. CSF substance P concentrations increased by 169% and 90.6% of baseline levels at 10 and 70 minutes, respectively, after the start of the traumatic videotape but changed by only 1.1% and -8.1% of baseline levels 10 and 70 minutes after the start of the neutral videotape. These results suggest that elevated CNS substance P concentrations are involved in both major depression and PTSD. The marked increase in CSF substance P concentrations during and after the symptom-provoking stimulus, but not after the neutral stimulus, implicates CNS release of substance P in the mechanism of acute PTSD symptoms. These data also reveal that CNS substance P responds acutely to psychological stress in humans.

Elevated Cerebrospinal Fluid Substance P Concentrations in Posttraumatic Stress Disorder and Major Depression

The authors tested the hypothesis that concentrations of the pain-transmitting neuropeptide substance P are elevated in the CSF of patients with major depression or posttraumatic stress disorder (PTSD), which have overlapping symptoms. The authors also sought to determine if CNS substance P concentrations change on provocation of symptoms in PTSD patients. The authors measured CSF substance P concentrations in medication-free patients with either major depression or PTSD and in healthy comparison subjects. Next, using a within-subject, crossover design, the authors sampled CSF for 6 hours through an indwelling subarachnoid catheter in PTSD patients before, during, and after exposure to a 60-minute traumatic or neutral videotape stimulus. Both depressed and PTSD patients had significantly elevated basal CSF substance P concentrations. In the challenge study, marked increases in CSF substance P concentrations were found only after precipitation of PTSD symptoms. CSF substance P concentrations increased by 169% and 90.6% of baseline levels at 10 and 70 minutes, respectively, after the start of the traumatic videotape but changed by only 1.1% and -8.1% of baseline levels 10 and 70 minutes after the start of the neutral videotape. These results suggest that elevated CNS substance P concentrations are involved in both major depression and PTSD. The marked increase in CSF substance P concentrations during and after the symptom-provoking stimulus, but not after the neutral stimulus, implicates CNS release of substance P in the mechanism of acute PTSD symptoms. These data also reveal that CNS substance P responds acutely to psychological stress in humans.

The organisation and content of trauma memories in survivors of road traffic accidents

We investigated the trauma narratives of 131 road traffic accident survivors prospectively, at 1 week, 6 weeks, and 3 months post-trauma. At 1 and 6 weeks, narratives of survivors with acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) were less coherent and included more dissociation content. By 3 months, their narratives also contained more repetition, more non-consecutive chunks, and more sensory words. Traumatic brain injury was associated with a separate characteristic, confusion, at all three time points. Three aspects of narrative organisation at 1 week—repetition, non-consecutive chunks, and coherence—predicted PTSD severity at 3 months after controlling for initial symptoms. The results suggest both a strong concurrent and predictive relationship between narrative disorganisation and ASD/PTSD but that as people recover from ASD, their narratives do not necessarily become less disorganised.

The Scripto-Trauma Genogram: An Innovative Technique for Working with Trauma Survivors' Intrusive Memories

This article focuses on how to construct the Scripto-Trauma Genogram and how to use it with trauma survivors who struggle with intrusive memories. Clients develop Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) after a traumatic event, based upon personal factors, predisposing factors, peridisposing factors, postdisposing factors and resiliency factors. Clients with ASD or PTSD, as well as trauma survivors who do not quite meet all the diagnostic criteria for ASD or PTSD, often report struggling with intrusive memories, which are believed to be brief sensory fragments of the traumatic event and are experienced as intensely as they were during the traumatic event. [Brief Treatment and Crisis Intervention 6:36–51 (2006)]