Chronic PTSD Research Articles

Physical and psychosocial functioning following motor vehicle trauma: Relationships with chronic pain, posttraumatic stress, and medication use

Chronic pain and PTSD are known to hold substantial comorbidity following traumatic injury. Although pharmacological agents have been examined in the treatment of pain and PTSD individually, little is known regarding the relationship of medication use with functioning in patients with comorbid conditions. This research examined the relationships of pain, PTSD, and medication use across physical and psychosocial functioning in patients with chronic pain following motor vehicle injury ( N = 234). Separate analyses were conducted for opioids, SSRIs, and sedative/anxiolytics, respectively. Several relevant effects were noted: (1) Pain evidenced strong associations with reduced functioning across both physical and psychosocial domains, (2) Opioid use held interactive relationships with PTSD across both functioning domains. Specifically, opioids were associated with greater physical impairment in patients without comorbid PTSD. Opioids also were related to greater psychosocial impairment in patients without PTSD while PTSD was associated with greater impairment in patients not using opioids, (3) Opioid use evidenced a marginal interaction with pain on psychosocial functioning. Opioids were associated with greater psychosocial impairment among patients with high-pain, and high-pain was associated with greater impairment among opioid users, (4) SSRIs held a marginal interaction with PTSD such that PTSD was related to poorer psychosocial functioning only among individuals not using an SSRI, and (5) Anxiolytic use evidenced a marginal interaction with PTSD on physical functioning although no between-group differences were noted. These data suggest that PTSD symptomology may be an important consideration in determining treatment modality for patients experiencing pain subsequent to traumatic injury.

A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians.

The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N 280) and therapist (N 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research.

P03-243 ‘The body keeps the score’ revisited: Changes in lipid levels and coronary disease risk in army veterans suffering from chronic PTSD

Aim:To assess possible differences in plasma cholesterol, triglycerides, LDL-C, HDL-C, VLDLC, Index of arteriosclerosis and Established risk factor for arteriosclerosis and 10 year risk of coronary disease between veterans with combat experience with PTSD and veterans with combat experience without PTSD. To compare and analyze differences between groups in socio-demographic characteristics, trauma exposure, coping strategies and quality of life.Method:Plasma lipid parameters were determined and risk factors calculated for 50 subjects in the PTSD group and 50 subjects in the non-PTSD group. Groups were homogenized in gender, age, BMI, smoking status and somatic or psychiatric co-morbid disorders or the use of medications influencing blood lipid levels. Trauma exposure, coping strategies and quality of life were assessed with referenced psychometric instruments, socio-demographic characteristics with use of questionnaire.Results:Subjects in the PTSD group had significantly higher levels of all plasma lipid parameters except for HDL-C that was significantly lower. Risk factors were significantly higher in PTSD group. There was no significant difference in indices of exposure to combat trauma. Secondary traumatization was significantly more frequent in PTSD group. There were significant differences in socio-economic parameters, quality of life assessment and repertoire of coping strategies.Conclusions:The results of this study provide further evidence for the onnection of chronic PTSD and blood lipids abnormalities and cardiovascular risk factors. The results indicate the importance of posttraumatic environment factors and coping strategies for the occurrence and persistence of PTSD.

Posttraumatic mental health establishment of the Tsunami survivors in Thailand

The natural disaster known as "the Tsunami" occurred in Andaman coast of Thailand in December 2004, and there had been questions whether it could cause PTSD amongst the population who lives in the affected area and how to avoid PTSD condition to occur.The purpose of this study is to establish statistical results of psychosocial factors, and their correlation to PTSD and other mental disorders in order to generate the PTSD database. Cross sectional community surveys had been conducted in two phases from the same sampling group, the first phase is concerned with prevalence of PTSD, depression and related factors. Results were collected from 3,133 samples and shows that 33.6% suffered from PTSD, 14.27% with depression and 11.27% suffered from both. The second phase is focused on chronic PTSD and other mental disorders 2,573 samples were collected and only 21.6% were diagnosed with chronic PTSD.The statistical analysis has identified risks factors that could cause PTSD, and protective actions which could help to prevent PTSD.

S49-02 Psychiatric comorbidity and PTSD in addicted prostitutes

In the city of Rotterdam prostitution used to take place not only in sexclubs but also in and around a designated prostitution street-zone in the harbor area outside the city center. The group of sexworkers at this street-zone consisted primarily of severely addicted women. For a long period of time the harm reduction approach had been the major intervention for this socially marginalized group of women. From January 2003 to December 2004 184 of them could be interviewed and diagnosed according to DSM IV. Nearly all of them were addicted to heroin and cocaine and most of them also were dependent on alcohol and benzodiazepines. Psychiatric comorbidity was almost 100 %. Co-morbid conditions existed of cluster B and C personality disorders, psychotic disorders (26 %), affective disorders (31 %), acute PTSD (9 %) and adult-ADHD (8%). In 2006 the government had closed the prostitution street-zone and many of the women could be placed in therapeutic and protected homes. Now, 2 years later, we reinvestigate these women with respect to their actual social situation, their quality of life, psychiatric comorbidity and persisting (acute and chronic) PTSD. During the interviews we use the WHO Quality of life questionnaire and the KIP (clinical interview for PTSD). It is an ongoing study and the (preliminary) results will be presented during the symposium.

MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder

The purpose of this study was to investigate the safety of different doses of MDMA-assisted psychotherapy administered in a psychotherapeutic setting to women with chronic PTSD secondary to a sexual assault, and also to obtain preliminary data regarding efficacy. Although this study was originally planned to include 29 subjects, political pressures led to the closing of the study before it could be finished, at which time only six subjects had been treated. Preliminary results from those six subjects are presented here. We found that low doses of MDMA (between 50 and 75 mg) were both psychologically and physiologically safe for all the subjects. Future studies in larger samples and using larger doses are needed in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.

Integrating Dialectical Behavior Therapy and Prolonged Exposure to Treat Co-Occurring Borderline Personality Disorder and PTSD: Two Case Studies

Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat co-occurring PTSD in BPD clients. Two women with BPD and chronic PTSD were treated and results indicate a significant improvement in PTSD symptoms as well as a variety of secondary outcomes. Despite having recent and extensive histories of suicidal and nonsuicidal self-injurious behavior, as well as ongoing low to moderate urges to engage in these behaviors, neither client self-injured or attempted suicide during the PTSD treatment. These preliminary findings demonstrate the potential efficacy of combining an exposure treatment for PTSD with standard DBT, while also showing that exposure-based PTSD treatments can be implemented safely and effectively with BPD clients.

Hypnotherapy in the Treatment of Chronic Combat-Related PTSD Patients Suffering From Insomnia: A Randomized, Zolpidem-Controlled Clinical Trial

This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD. Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy were randomized to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment. There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale. This effect was preserved at follow-up 1 month later. Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed.

Study on suicidality in veterans of Iraq-Iran war suffering from chronic PTSD

Study on suicidality in veterans of Iraq-Iran war suffering from chronic PTSD

Benefit of hagiotherapy for a war veteran suffering of PTSD: Case-report

There is accumulated evidence indicating a beneficial influence of the usage of spiritual/religious parameters in the therapy of mental illnesses. In Croatia an authentic model of providing spiritual help, called hagiotherapy is used. It is based on the main principle that every human person is a spiritual/existential being, provided with a natural moral law, which differentiates him/her specifically from any other created creature. Its area of activity is the spiritual soul.We present a patient (age 43) who has been in medical treatment for the last five years due to chronic combat-related PTSD. During the war in Croatia (1991 – 1995) he participated in a series of war actions. Before the war he did not have any mental difficulties. After the end of the war, he felt some of the PTSD symptoms. However, because of the fear of being stigmatized he refused to seek for help. He attempted suicide twice. Only when his business and social functioning became severely disturbed, he initiated medical treatment. Due to a higher degree of religious engagement he was sent to the Center for Spiritual Help, where he underwent hagiotherapy. Before hagiotherapy a semi structured interview was conducted with the patient and the data on his spirituality/religiosity (SWB, DUREL, R-COPE), intensity of PTSD (M-PTSD, HAM-D, BDI, BHS, HTQ, SUAS) and biological markers (BMI, blood pressure, glucose, circadian rhythm of cortisol excretion, lipoproteins) were objectified. Some of these parameters were observed after hagiotherapy as well. The comparison of these results is presented in the poster.

Psychometric properties of the Trauma Relevant Assumptions Scale

This article describes the psychometric properties of a novel questionnaire, i.e. the Trauma Relevant Assumptions Scale (TRAS). The added value of the TRAS over previous trauma relevant belief questionnaires is that the TRAS enables measuring valence and rigidity of beliefs simultaneously. Both aspects are thought to be predictive of the development of chronic PTSD symptoms. For the exploratory factor analysis, the TRAS was administered to 309 adult volunteers. Principal components analysis yielded two factors: Assumptions about Self and Assumptions about the World. The two-factor structure was confirmed in a sample of 185 traumatized individuals. The TRAS seems to be a valid and reliable instrument, which is strongly related to post-trauma symptoms and has good discriminative validity. Apart from research settings, the TRAS may also be suitable in therapeutic settings to identify the severity of dysfunctional assumptions, and to assess the progress in change from negative assumptions to more positive assumptions.

Social Disadvantage and the Mental Health of Military Personnel Returning from Iraq and Afghanistan

With attention in the United States now focused on the mental health of military personnel returning from Iraq and Afghanistan (Hoge et al. 2004, 2006) clinical experience with Vietnam era veterans with PTSD should offer a cautionary tale. Frueh et al. (Frueh et al. 2007) have made the case that unlike other PTSD populations, Vietnam era veterans with PTSD are not only less responsive to psychotherapy, but also that their self reported symptoms get worse, not better with time. In addition, once they reach 100% disability there is a dramatic drop off in participation in treatment. They attribute these outcomes, in part, to flaws in the Department of Veterans Affairs disability compensation system that encourage dependence. But this unfortunate situation may be better understood in the context of the social disadvantage experienced by many of these veterans. From such a perspective, an increased pension, not mental health treatment addresses many veterans’ more pressing needs. The poor outcomes during treatment and withdrawal from treatment after maximizing pensions show what we already know, that mental health treatment has a limited ability to overcome social disadvantage (Draine et al. 2002). Social disadvantage has been strongly linked to PTSD in Vietnam era vets. The Vietnam Veterans Readjustment Study (Kulka et al. 1990) found that rates of PTSD were roughly doubled in those who lacked a high school degree were unemployed, or had a low income with pre-military factors such as coming from a poor family, having childhood behavioral problems, and abuse of substance before entering the military, being strong predictors of subsequently developing PTSD. How much PTSD causes poverty or how much poverty causes PTSD will remain a subject of debate (Hudson 2005). But, without getting caught up in the chicken and egg conundrum we probably can all agree that at some point in their lives, for many Vietnam era veterans with chronic PTSD, psychiatric symptoms may be a lesser problem than their social disadvantage: years of homelessness, unemployment, erratic or non-existent relationships, and involvement in the criminal justice system. Not surprisingly, patients seek access to those interventions that at least indirectly address their needs (safety, housing, etc.,). But these are provided only as long as one remains in treatment. In lieu of a means test mental health workers are using DSM-IV criteria and willingness to participate in treatment to determine who should have their social disadvantage mitigated. Professionals have the choice of providing treatment, and therefore meeting the socially disadvantaged veterans’ needs in an indirect, expensive and temporary fashion or not providing treatment and not addressing these needs at all. This dilemma can be resolved by separating the provision of basic resources (such as safe housing) from participation in treatment. An example of this is the ‘‘Housing First’’ model in which mentally ill, substance abusing; homeless people are offered an apartment that is not contingent on their participation in treatment or staying abstinent. Assertive Community Treatment is readily available to those who might want it but is not a condition of participation. A randomized controlled study of this approach in New York City showed greater housing stability and no difference on D. J. Luchins (&) Jesse Brown VAMC, 820 S. Damen Ave, Chicago, IL 60612, USA e-mail: daniel.luchins@va.gov; danl@yoda.bsd.uchicago.edu

Paroxetine in the Treatment of Post Traumatic Stress Disorder: Our Experiences

Posttraumatic stress disorder can develop after individual's exposure or witnessing of life threatening events. It is characterized by three clusters of symptoms. The course of PTSD is often chronic and impedes individual's functioning. Studies of PTSD treatment with paroxetine provide evidence for its efficacy in reducing symptoms and its favorable profile of side-effects. The objective of this work was to determine the efficacy of paroxetine in the treatment of PTSD. The sample consisted of 30 subjects with chronic PTSD. All subjects received treatment with paroxetine in therapeutic dose range for six months. Subjects were assessed prior to therapy and following six months of treatment with paroxetine with the use of following instruments: SCL 90-R, Mississippi Questionnaire, and CGI. The results indicate statistically significant reduction on all subscales of SCL 90-R following six months of treatment, P<0,05. The difference between two assessments with Mississippi Questionnaire was statistically significant, P< 0,05. PTSD rate in our sample was reduced from 100% before treatment to 64% after treatment. Paroxetine was administered in daily dose of 20 mg in 88% of the subjects, and 40 mg in the remaining 12%. Unwanted effects were registered in 16,7% of the subjects and they were mild. Objective improvement was registered in 84% of the sample, and subjective improvement was registered in 80%. Reduction of relapse symptoms was registered in 24% of the subjects. Paroxetine proved to be efficient and safe in treatment of symptoms of PTSD in this study.

Chronic PTSD Treated With Metacognitive Therapy: An Open Trial

This paper reports on an open trial of metacognitive therapy (MCT) for chronic PTSD. MCT does not require imaginal reliving, prolonged exposure, or challenging of thoughts about trauma. It is based on an information-processing model of factors that impede normal and in-built recovery processes. It is targeted at modifying maladaptive styles of worry/rumination and attention so that emotional processing can proceed spontaneously. Eleven out of 13 patients with a mean duration of PTSD of 19.5 months completed treatment. Therapists followed the treatment manual by Wells and Sembi (2004b). Self-report measures of PTSD symptoms, anxiety and depression, and assessor ratings of PTSD were administered at pre- and posttreatment, and at 3- and 6-month follow-up. Treatment appeared to result in large and significant improvements on all measures of PTSD and general measures of anxiety and depression. Statistically significant treatment gains were maintained at 3- and 6-month follow-up. Jacobson's criteria for recovery showed that 90% of patients were recovered at posttreatment. At 6-month follow-up approximately 89% were recovered or reliably improved. Results suggest that MCT could be highly effective and extend evidence of its applicability to more treatment-resistant chronic PTSD cases. Comparisons against other active interventions are now clearly indicated.

Psychosocial interventions for adults with crime-related PTSD.

Summary Crime affects more than half of all adults in the United States atsome time during their lifetime. In some instances, this involvesdirect victimization in the form of robbery, physical assault, rape,or other events. In other cases, crime can affect individuals indi-rectly, such as when a person witnesses homicide or seriouscommunity violence or when a child repeatedly witnesses seriousdomestic violence in the home. Epidemiological research clearlydemonstrates that individuals who directly or indirectly experiencecrime are at risk for PTSD and other mental health and health-riskproblems. Whereas most crime victims are resilient or experiencerapid recovery of symptoms after short-term distress or impair-ment, some experience chronic mental health problems that arerelated to the victimization incident and require formal treatment.PTSD is the most prevalent mental health problem endorsed bycrime victims, and several interventions exist for this populationthat practitioners would likely find valuable to have in their toolkit. However, we recognize that other disorders are also prevalentfollowing criminal victimization, and therefore the fact that wehave limited our review to PTSD is a drawback. Despite thislimitation, several conclusions can be drawn from the literature.Cognitive–behavioral treatment protocols developed by Bryantet al. (1998, 1999, 2006; Bryant, Moulds, & Nixon, 2003) and Foa,Hearst-Ikeda, et al. (1995; Foa et al., 2006) may be beneficial tocrime victims who have high levels of distress and present fortreatment within 2–6 weeks of their victimization. Crime victimswith chronic PTSD, conversely, may benefit from a treatmentpackage such as PE, CPT, and SIT. All three of these treatmentapproaches are supported by multiple RCTs, and evidence forefficacy is strong. Unfortunately, however, little is known aboutthe use and success of these interventions in traditional mentalhealth settings, where front-line practitioners do not have access tothe intensive supervision that is available in tightly controlledresearch. Also, even in rigorously controlled research, when cli-nicians have high levels of fidelity to these protocols, a meaningfulpercentage of patients do not recover. Some patients continue tohave significant symptoms and functional impairment and evenmeet full diagnostic criteria for PTSD after treatment has beencompleted. More research is needed to learn how to reach thesetreatment nonresponders. Efforts in product development also areneeded to ensure that practitioners have access to resources thatenable them to implement these promising interventions whenserving patients who are likely to benefit from them.

P.1.e.007 Decreased cerebellar blood volume in schizophrenia: a perfusion weighted imaging study

Most brain imaging studies have showed smaller hippocampal volume in adults with chronic PTSD; however, some other studies have not replicated this finding. Most of these investigations included subjects with other psychiatric comorbidities, such as major depression or alcohol abuse.The prevalence of psychiatric comorbidities in PTSD is generally high and this makes it difficult, if not impossible, to disentangle the contribution of other disorders to hippocampal volume.Therefore, the main goal of the current study is to compare hippocampal volumes of healthy subjects and drug-naïve patients with PTSD caused by different types of mixed civilian traumas (i.e. car accident, physical abuse, sudden death of a family member, assault or robbery, natural disaster and traumatic abortion) and without comorbidity conditions.Magnetic resonance imaging (MRI) was used to measure the hippocampi, total cerebrum, gray matter, white matter and cerebrospinal fluid volumes in 34 patients with single diagnosis of PTSD, and 34 case-matched non-PTSD comparison subjects.The patients with single diagnosis of PTSD had an 11.8% smaller left hippocampus (p < 0.001) and an 8.7% smaller right hippocampus (p = 0.003) than the healthy controls. The results were controlled for the total brain volume and for gray matter volumes. Subjects with PTSD also displayed lower overall gray matter volume (p = 0.006).There were no significant correlations between hippocampal volumes and illness duration or severity of PTSD. The findings indicate the presence of smaller hippocampal volumes in drug-naïve patients with single diagnosis of PTSD, compared with healthy subjects.

Neuroanatomical Changes After Eye Movement Desensitization and Reprocessing (EMDR) Treatment in Posttraumatic Stress Disorder

Neuroanatomical Changes After Eye Movement Desensitization and Reprocessing (EMDR) Treatment in Posttraumatic Stress Disorder

Magnetic resonance imaging volumes of the hippocampus in drug-naïve patients with post-traumatic stress disorder without comorbidity conditions

Most brain imaging studies have showed smaller hippocampal volume in adults with chronic PTSD; however, some other studies have not replicated this finding. Most of these investigations included subjects with other psychiatric comorbidities, such as major depression or alcohol abuse. The prevalence of psychiatric comorbidities in PTSD is generally high and this makes it difficult, if not impossible, to disentangle the contribution of other disorders to hippocampal volume. Therefore, the main goal of the current study is to compare hippocampal volumes of healthy subjects and drug-naïve patients with PTSD caused by different types of mixed civilian traumas (i.e. car accident, physical abuse, sudden death of a family member, assault or robbery, natural disaster and traumatic abortion) and without comorbidity conditions. Magnetic resonance imaging (MRI) was used to measure the hippocampi, total cerebrum, gray matter, white matter and cerebrospinal fluid volumes in 34 patients with single diagnosis of PTSD, and 34 case-matched non-PTSD comparison subjects. The patients with single diagnosis of PTSD had an 11.8% smaller left hippocampus ( p < 0.001) and an 8.7% smaller right hippocampus ( p = 0.003) than the healthy controls. The results were controlled for the total brain volume and for gray matter volumes. Subjects with PTSD also displayed lower overall gray matter volume ( p = 0.006). There were no significant correlations between hippocampal volumes and illness duration or severity of PTSD. The findings indicate the presence of smaller hippocampal volumes in drug-naïve patients with single diagnosis of PTSD, compared with healthy subjects.

A combined dexamethasone/corticotropin-releasing hormone test in patients with chronic PTSD

A combined dexamethasone/corticotropin-releasing hormone test in patients with chronic PTSD

Drs. Sijbrandij and Olff Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDrs. Sijbrandij and Olff ReplyMARIT SIJBRANDIJ Ph.D.MIRANDA OLFF Ph.D.,MARIT SIJBRANDIJ Ph.D.Search for more papers by this authorMIRANDA OLFF Ph.D.Search for more papers by this author,Published Online:1 Jun 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: Drs. Varma and Parashar comment on our randomized controlled trial in which we compared the administration of four sessions of CBT in patients with acute PTSD with a comparison group on a waiting list. Drs. Varma and Parashar argue that placing the comparison group on a waiting list did not adequately control for nonspecific factors that might have influenced outcome. We assume that they are suggesting that we should have included a treatment group that received only supportive counseling without specific CBT contents. However, we feel that an untreated comparison group on a waiting list is the best comparison group because it is the closest to studying natural recovery. Since it has been repeatedly shown that some early interventions impede natural recovery rather than promote it (1) , comparison with an untreated comparison group is essential in trials evaluating the efficacy of early interventions. Moreover, since randomized controlled trials comparing early treatment of PTSD relative to a natural recovery comparison group are somewhat scarce (e.g., 2 , 3) , studies evaluating the potential benefits or risks of any intervention relative to no intervention at all in the immediate aftermath following trauma are still necessary. Second, the authors comment that we did not perform screening for axis II disorders, specifically for borderline personality disorder. Indeed, performing extensive screening for personality disorder would have meant a significant burden for participants in our trial. We did, however, exclude patients with complex or chronic PTSD and risk for suicide. Therefore, the possibility of inclusion of many patients with borderline personality disorder influencing treatment outcome is implausible. Furthermore, we did not find an interaction effect between prior traumatic experiences—known to be present in many patients with borderline personality disorder—and treatment response in our exploratory subgroup analyses. In conclusion, we feel that any influence of the presence of borderline personality disorder on the efficacy of CBT in our study is highly unlikely.Amsterdam, the NetherlandsThe authors’ disclosures accompany the original article.