Combat-induced Posttraumatic Stress Disorder Research Articles

Oral and Dental Considerations of Combat-Induced Post Traumatic Stress Disorder (PTSD)-A Cross-Sectional Study.

Objective: This study compared dental, periodontal, oral, and joint/muscle tenderness among Israeli combat-induced post-traumatic stress disorder (Ci-PTSD) war veterans to non-PTSD patients. Study design: This retrospective three-arm study compared oral and facial manifestations between 100 Israeli veterans with Ci- PTSD (study group) and 103 non-PTSD periodontal patients (Control group). The study group was further divided into two subgroups of individuals who received psychiatric medications (40 patients) or did not (60 patients). All patients underwent complete dental, oral, and periodontal examinations, including assessing signs of parafunction. Results: All PTSD patients had poor oral hygiene. The plaque index (PI) was higher in the PTSD group compared to the control group (0.72 ± 0.28 vs. 0.45 ± 0.29, respectively, p < 0.001). The decayed, missing, and filled teeth score (DMFt) was higher in the PTSD population than in the controls (19.97 ± 8.07 vs. 13.05 ± 6.23 p < 0.05). Severe periodontal disease was more common among the PTSD subgroup taking medications (med -group) (62.5%) compared to the nonmedicated group (non-med group) (30.0%) and the controls (27.2%) (p = 0.001). Heavy smoking was more prevalent in the medicated PTSD patients than in other groups. Conclusions: The present study shows higher morbidities in combat-induced PTSD patients, including oral, dental, and periodontal manifestations, especially in medicated patients.

Oral and dental considerations of combat-induced PTSD: a descriptive study.

Stress experienced as an intense and traumatic event can increase the odds of orofacial morbidities that may affect oral, periodontal, or masticatory system health. The aim of this study was to evaluate the dental, periodontal, oral, and bruxism situation among Israeli posttraumatic stress disorder (PTSD) war veterans. This retrospective cohort pilot study aimed to examine the oral and facial manifestations in 71 Israeli veterans with combat PTSD. All patients underwent full dental, oral, and periodontal examination. Signs of parafunctional activity were also evaluated, accompanied by a full set of periapical and/or panoramic radiographs. The patients were 37 to 77 (mean 60.7 ± 10.15) years of age and presented a poor overall oral hygiene status (Plaque Index 0.75 ± 0.26). All patients (100.0%) suffered from periodontal disease, and most of them (66.0%) were severely affected. A significant correlation was found between signs of parafunctional activity and severe periodontal disease (P = .035). The patients had a high decayed, missing, and filled teeth (DMFT) score (20.06 ± 8.86), which was mainly attributed to the large number of "filled" (F) teeth (11.95 out of 20.06). The DMFT score was significantly lower among light smokers than among heavy, former, or nonsmokers (P = .012). Most patients (90%) had signs and symptoms of parafunctional activities. A significant positive and dose-dependent correlation was found between smoking and periodontal disease (P = .012). An association was found between combat PTSD and oral, dental, and periodontal morbidity.

Intergenerational transmission of captivity trauma and posttraumatic stress symptoms: A twenty three-year longitudinal triadic study.

The aversive, long-term toll of war captivity and fathers' combat-induced posttraumatic stress disorder symptoms (PTSS) on adult offspring's mental health has been recently exemplified. However, studies that have examined the implication of PTSS of both fathers and mothers in the intergenerational transmission of trauma to offspring are still lacking. This prospective study assessed the unique and combined effects of former prisoners of war (ex-POWs) fathers' and mothers' PTSS in adult offspring's PTSS. A sample of 123 Israeli father-mother-offspring triads (79 ex-POW triads and a comparable group of 44 veteran triads) completed self-report measures. Following the 1973 Yom Kippur War, fathers participated in 3 waves of measurements (1991, 2003, 2008), mothers participated in 2 waves of measurements (2004, 2011), while offspring took part in 2014. Both fathers' and mothers' PTSS were positively related to offspring's PTSS. Among ex-POW triads, fathers' PTSS in 2003 and 2008 and mothers' PTSS in 2004 predicted offspring's PTSS in 2014. Interestingly, serial multiple mediation model results showed that mothers' PTSS in 2004 mediated the link between fathers' PTSS in 1991 and offspring's PTSS in 2014. Furthermore, fathers' PTSS in 2008 mediated the link between mothers' PTSS in 2004 and offspring's PTSS in 2014. Over time, both ex-POWs fathers' and mothers' PTSS are implicated in their offspring's PTSS. However, both direct and indirect effects of both parents' posttraumatic reactions contribute to the intergenerational transmission of captivity related trauma. (PsycINFO Database Record

A Relational Model for the Intergenerational Transmission of Captivity Trauma: A 23-Year Longitudinal Study

Objectives: The aversive, long-term toll of war captivity and fathers’ combat-induced posttraumatic stress disorder (PTSD) on adult offspring’s secondary traumatization (ST) has been recently exemplified. However, the study of potential mechanisms of the intergenerational transmission of trauma to offspring is still lacking. This prospective study aimed to assess the role of fathers’ PTSD symptoms (PTSS), paternal parenting, and adult offspring’s attachment insecurities in adult offspring’s PTSS. Method: A sample of 124 Israeli father–child dyads (80 ex-POW dyads and a comparison group of 44 veteran dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, T3: 2008), while the offspring took part in T4 (2013). Results: Offspring of ex-POWs with PTSD at T3 reported more PTSS and higher levels of attachment insecurities than offspring of ex-POWs without PTSD and controls at T4. Fathers’ proximity to the children and sensitivity to the children’s needs were negatively related. Offspring’s attachment insecurities were positively related to offspring’s PTSS. Importantly, serial multiple mediation model results show that war captivity increased the level of the fathers’ PTSD at T2 and T3, which in turn decreased the level of the fathers’ parenting at T3, and thereby increased the level of offspring’s attachment avoidance at T4, which by its own merit was related to higher levels of adult offspring’s PTSS. Conclusions: The mechanisms of the intergenerational transmission of captivity-related trauma of veterans’ PTSD and paternal parenting, through offspring’s attachment insecurities and offspring’s PTSS, was exemplified.

The role of fathers' psychopathology in the intergenerational transmission of captivity trauma: A twenty three-year longitudinal study

BackgroundThe aversive impact of combat and parents' combat-induced posttraumatic stress disorder (PTSD) on young children has been examined in a few studies. However, the long-term toll of war captivity on the secondary traumatization (ST) of adult offspring remains unknown. This study aimed to assess the longitudinal associations between former prisoners of war (ex-POWs), PTSD, depressive symptoms and their adult offsprings ST.Method: A sample of 134 Israeli father-child dyads (80 ex-POWs dyads and a comparison group of 44 veterans'dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, and T3: 2008), while the offspring took part in T4 (2013). ResultsOffspring of ex-POWs with PTSD at T3 reported more ST symptoms than offspring of ex-POWs without PTSD and controls. Ex-POWs' PTSD hyper-arousal symptom cluster at T3 was positively related to offsprings ST avoidance symptom cluster. Offspring of ex-POWs with chronic and delayed PTSD trajectories reported more ST symptoms than offspring of ex-POWS and controls with resilient trajectories. Ex-POWs' PTSD and depression symptoms at T1, T2 and T3 mediated the link between war captivity (groups) and offsprings ST in T4. LimitationsThe use of self-report measures that did not cover the entire span of 40 years since the war, might may bias the results. ConclusionsThe intergenerational transmission of captivity related trauma following the Yom Kippur War was exemplified. ST symptoms among ex-POWs' adult offspring are closely related to their father' PTSD and related depressive symptom comorbidity.

Secondary traumatization among ex-POWs' adult children: the mediating role of differentiation of the self.

The aversive impact of combat and parents' combat-induced posttraumatic stress disorder on young children has been examined in a few studies. However, the long-term toll of war captivity on secondary traumatization (ST) and the mediating role of differentiation of the self remain unknown. This study examined ST symptoms and differentiation of the self (DS) among adult children of former prisoners of war (ex-POW's children) who were compared with adult children of comparable veterans (controls' children). Furthermore, I examined the mediating role of DS dimensions in the association between exposure to stress and ST symptoms. Participants were Israeli ex-POW's children (n = 98) and controls' children (n = 90), whose fathers fought in the 1973 Yom Kippur War. Results showed that ex-POW's children reported a higher number of ST symptoms and lower levels of emotional cutoff differentiation compared with controls' children. Emotional cutoff was also found to mediate the association between research group and ST symptoms. Among ex-POW's children, emotional cutoff and emotional reactivity dimensions mediated the association between exposure to stress stemming from fathers' behaviors and ST symptoms. Forty years after the war ended, the experience of living with ex-POWs is associated with ex-POW's children ST symptoms.

Secondary traumatization among former prisoners of wars' adult children: the mediating role of parental bonding

Background and Objectives: The aversive impact of combat and parents' combat-induced posttraumatic stress disorder (PTSD) on young children has been examined in a few studies. However, the long-term toll of war captivity on secondary traumatization (ST) and the parental bonding of adult children remain unknown. This study examined ST symptoms and parental bonding among adult children of former prisoners of war (ex-POWs' children) that were compared to adult children of comparable veterans (controls' children). Furthermore, we examined the mediating role of parental bonding and exposure to stress in the association between group and ST symptoms. Design: A correlative, cross-sectional study. Methods: Participants were Israeli ex-POWs' children (N = 98) and controls' children (N = 90), whose fathers fought in the 1973 Yom Kippur War. All participants completed a battery of self-reported questionnaires. Results: Ex-POWs' children reported a higher number of ST symptoms and lower levels of fathers' care, as compared to controls' children. Importantly, exposure to stress stemming from fathers' behaviors and fathers' care was found to mediate the association between research group and ST. Conclusions: Forty years after the war ended, the experience of living with ex-POWs is associated with ex-POWs' children psychological outcome.

Long-Term Trajectories of Posttraumatic Stress Disorder in Veterans

Article AbstractObjective: To (1) identify long-term trajectories of combat-induced posttraumatic stress disorder (PTSD) symptoms over a 20-year period from 1983 to 2002 in veterans with and without combat stress reaction (CSR) and (2) identify social predictors of these trajectories.Method: A latent growth mixture modeling analysis on PTSD symptoms was conducted to identify PTSD trajectories and predictors. PTSD was defined according to DSM-III and assessed through the PTSD Inventory. Israeli male veterans with (n = 369) and without (n = 306) CSR were queried at 1, 2, and 20 years after war about combat exposure, military unit support, family environment, and social reintegration.Results: For both study groups, we identified 4 distinct trajectories with varying prevalence across groups: resilience (CSR = 34.4%, non-CSR = 76.5%), recovery (CSR = 36.3%, non-CSR = 10.5%), delayed onset (CSR = 8.4%, non-CSR = 6.9%), and chronicity (CSR = 20.9%, non-CSR = 6.2%). Predictors of trajectories in both groups included perception of war threat (ORs = 1.59-2.47, P values ≤ .30), and negative social reintegration (ORs = 0.24-0.51, P values ≤ .047). Social support was associated with symptomatology only in the CSR group (ORs = 0.40-0.61, P values ≤ .045), while family coherence was predictive of symptomatology in the non-CSR group (OR = 0.76, P = .015) but not in the CSR group.Conclusions: Findings confirmed heterogeneity of long-term sequelae of combat, revealing 4 trajectories of resilience, recovery, delay, and chronicity in veterans with and without CSR. Symptomatic trajectories were more prevalent for the CSR group, suggesting that acute functional impairment predicts pathological outcomes. Predictors of symptomatic trajectories included perceived threat and social resources at the family, network, and societal levels.J Clin Psychiatry 2013;74(12):e1163-e1168© Copyright 2013 Physicians Postgraduate Press, Inc.Submitted: March 20, 2013; accepted August 6, 2013 (doi:10.4088/JCP.13.m08482).Corresponding author: Karen-Inge Karstoft, MSc, The National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, Odense, Funen, Denmark (kikarstoft@health.sdu.dk).

Gene expression analysis in combat veterans with and without post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a common, debilitating and complex disorder. Numerous genetic and environmental factors are important in the genesis and maintenance of PTSD. Thus, gene expression analysis (GEA) is a critical technology for PTSD research since it detects essential genetic output affected by gene-environment interactions. Quality control methods are rarely reported in gene expression studies. The present study aimed to identify reliably expressed genes in whole blood samples from subjects with combat-induced PTSD (n=6) and, secondly, to investigate the expression of genes that may be differentially expressed in PTSD compared with an appropriate control group (n=11). Strict quality control methods were used. From a theoretically driven set of 42genes, 17 were reliably detected using quantitative PCR on samples from 17combat-exposed veterans. Four of these 17genes were consistently and modestly correlated with clinical phenotypes and had significant expression effects on phenotypes. These genes regulate inflammatory systems and are regulated by the adrenergic system, consistent with peripheral markers important in PTSD. Inflammatory disinhibition may be involved in combat-induced PTSD, and may be responsible for the increased prevalence of inflammatory‑related illnesses observed in PTSD. This is a preliminary study with a small sample size. A number of genes are not reliably detected by the current methodology. Improved detection methods are important to extend the current study and to further understand mechanisms in PTSD.

The relationship between posttraumatic stress disorder symptoms and paternal parenting of adult children among ex-prisoners of war: A longitudinal study.

The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on parenting of young children has been examined in a few studies. Nevertheless, the toll of war captivity on parenting and the long-term relations between posttraumatic symptoms and paternal parenting of adult children remains unknown. This longitudinal study examined paternal parenting of adult children among war veterans, some of whom were held in captivity. Furthermore, we examined the mediating role of PTSD symptoms in the association between captivity and parenting. The sample included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who had not been held captive. Both groups were assessed via self-report measures of PTSD at three time points: Time 1 (18 after the war), Time 2 (30 after the war), and Time 3 (35 after the war) years after the war. Results shows that ex-POWs reported lower levels of positive parenting compared to comparison group veterans at Time 3. Furthermore, PTSD symptoms at Time 1, Time 2, and Time 3 mediated the association between captivity experience and parenting at Time 3. In addition, it was found that increases in the levels of PTSD symptom clusters over time were associated with lower levels of positive parenting at Time 3.

A review of atypical antipsychotic medications for posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) can be a chronic and disabling illness with a limited response to antidepressant treatment, particularly in the case of combat-induced PTSD. The purpose of this study is to review randomized controlled and open-label trials of atypical antipsychotics for the treatment of PTSD. We conducted PUBMED and PILOTS database searches for clinical trials of atypical antipsychotic medications for PTSD in May 2010. Eighteen clinical trials (10 double-blind placebo-controlled, eight open-label) of atypical antipsychotics for PTSD were found and reviewed. Effect sizes of double-blind placebo-controlled trials were small, but were positive for risperidone and quetiapine. Intrusive and hypervigilance symptom subscales showed the most improvement. We concluded that atypical antipsychotic medications have a modest benefit for the treatment of PTSD. Larger randomized controlled trials are needed to clarify the potential utility of these medications in the treatment of PTSD and more rigorous examination of metabolic side effects is warranted.

The Psychological Costs of War: Military Combat and Mental Health

While descriptive evidence suggests that deployment in the Global War on Terrorism is associated with adverse mental health, the causal effect of combat is not well established. Using data drawn from the National Longitudinal Study of Adolescent Health, we exploit exogenous variation in deployment assignment and find that soldiers deployed to combat zones where they engage in frequent enemy firefight or witness allied or civilian deaths are at substantially increased risk for suicidal ideation, psychological counseling, and post-traumatic stress disorder (PTSD). Our estimates imply lower-bound health care costs of $1.5 to $2.7 billion for combat-induced PTSD.

Posttraumatic Symptoms, Marital Intimacy, Dyadic Adjustment, and Sexual Satisfaction among Ex-Prisoners of War

The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on marital intimacy and sexual satisfaction has been examined in several studies. Nevertheless, the toll of war captivity on marital intimacy in relation to dyadic adjustment and sexual satisfaction remains unknown. In particular, the mediating role of marital intimacy in the relationship between PTSD symptoms and dyadic adjustment and between PTSD symptoms and sexual satisfaction has not yet been systematically explored thus far. Aims. This study aimed to examine the interrelationships of PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy among ex-prisoners of war (ex-POWs). A sample of Israeli veterans ex-POWs (ex-POWs: N = 105) from the 1973 Yom Kippur War and a matched comparison group of veterans who participated in the same war but were not held captive (control: N = 94) were compared in the study variables. The PTSD inventory, dyadic adjustment scale, index of sexual satisfaction, and capacity for intimacy questionnaire. Results. Findings revealed that ex-POWs reported higher levels of PTSD symptoms and lower levels of dyadic adjustment and sexual satisfaction than comparable controls. There were also differences between the groups in the pattern of relations between PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy. Finally, for ex-POWs, marital intimacy partially mediated the relationships between PTSD symptoms and dyadic adjustment and sexual satisfaction outcome measures. PTSD symptoms are implicated in marital problems of ex-POWs. A significant relationship was found between the traumatized ex-POW's capacity for intimacy and both their sexual satisfaction and dyadic adjustment.

Israeli Military Helps Medics Cope With Combat Stress

Israeli Military Helps Medics Cope With Combat Stress

Pharmacological treatment of combatinduced PTSD: a literature review

Historically, soldiers have returned from war changed men. Over the years there has been an increase in awareness of post-traumatic stress disorder (PTSD) and the impact of diagnosis. Treatment of PTSD presents a challenge on every level. This literature review provides some insight into the risks and benefits of three groups of drugs commonly prescribed for combat-induced PTSD: beta-blockers, selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines (BZDs). When prescribed in conjunction with other non-pharmacological treatments, these drugs help to minimize, and in some cases eliminate, the signs and symptoms of PTSD. Combination therapy would ideally result in better compliance and eventual completion of treatment programmes provided for PTSD sufferers. Healthcare professionals strive to provide patients with holistic care. Patients present with unique mental and physical intricacies, and nurses and health professionals must peel away the layers to uncover the nature of the PTSD. While there are many aspects to PTSD treatment, this literature review focuses on pharmacological treatment, specifically beta-blockers, SSRIs and BZDs.

Hypnotherapeutic Olfactory Conditioning (HOC): Case Studies of Needle Phobia, Panic Disorder, and Combat-Induced PTSD

The authors developed a technique, which they call hypnotherapeutic olfactory conditioning (HOC), for exploiting the ability of scents to arouse potent emotional reactions. During hypnosis, the patient learns to associate pleasant scents with a sense of security and self-control. The patient can subsequently use this newfound association to overcome phobias and prevent panic attacks. This may be especially effective for posttraumatic stress disorder (PTSD) with episodes of anxiety, flashbacks, and dissociation triggered by smells. The authors present 3 cases, patients with needle phobia, panic disorder, and combat-induced PTSD who were successfully treated with the HOC technique.

Treatment of Chronic Posttraumatic Stress Disorder in Combat Veterans With Citalopram

Posttraumatic stress disorder (PTSD) is a serious mental illness which exhibits significant impairment of psychosocial and occupational function. At present, serotonin reuptake inhibitors (SRIs) show therapeutic promise for the treatment of PTSD. However, results in the veteran population have been less robust or often negative. In this study, a relatively new and the most selective SRI, citalopram, was evaluated for the treatment of PTSD. Veterans with chronic PTSD (N = 18) were enrolled in an 8-week open trial of citalopram after providing written informed consent. The primary outcome measures were the Clinician-Administered PTSD Scale (CAPS), the Hamilton Rating Scale for Anxiety (HAM-A), and the Clinical Global Impression Scale (CGI). Seventeen patients completed at least 4 weeks of the 8-week trial. During treatment, there was a moderate response with 42% of patients demonstrating a > or =30% reduction in total CAPS score at week 8. Comparable results were demonstrated in the Hamilton Depression Rating Scale (HAM-D), HAM-A, Global Assessment of Function (GAF), and CGI rating scales. In a follow-up analysis, a treatment effect was shown for CAPS B at week 4, but was not sustained at week 8. Overall, citalopram was generally well tolerated with reported adverse events being benign in nature. These pilot results demonstrate a moderate effect of citalopram in the treatment of combat-induced PTSD. However, the sample size was small and patient population is limited to veterans with combat-induced PTSD. Further study in a larger and more diverse patient sample is warranted prior to final conclusions on efficacy of citalopram for the treatment of PTSD.

Sertraline

Sertraline is a selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) that inhibits the serotonin transporter with only minor inhibition of the noradrenaline (norepinephrine) and dopamine transporters. It has recently shown efficacy in most, although not all, clinical trials in patients with post-traumatic stress disorder (PTSD). In 2 of 3 randomised, double-blind trials in civilian patients, once daily oral sertraline 50 to 200mg significantly reduced symptoms of PTSD compared with placebo over 12 weeks. Response rates were 53 and 60% for sertraline compared with 32 and 39% for placebo. The quality of life of patients receiving sertraline was significantly improved compared with those receiving placebo in I trial Post-hoc subgroup analysis of pooled results from the 2 trials showed that sertraline has significant efficacy in women with PTSD but efficacy in men was not clearly established. The efficacy of sertraline in combat-induced PTSD has not been clearly established. Sertraline has shown efficacy in 2 longer-term trials of 24 (nonblind, noncomparative) and 28 (double-blind, placebo-controlled) weeks' duration. Sertraline is generally well tolerated. Adverse events associated significantly more frequently with sertraline than placebo in clinical trials of patients with PTSD were insomnia, diarrhoea and nausea. Discontinuation of treatment occurred in approximately the same number of sertraline- and placebo-treated patients, Conclusions: Sertraline has demonstrated efficacy in the treatment of PTSD, particularly in female patients and in non-combat-induced PTSD, and is generally well tolerated. It appears to have a lower potential for drug interactions than other SSRIs, although direct comparisons are lacking. Sertraline is currently the only SSRI approved for the treatment of PTSD. As SSRIs are recommended as the first-line pharmacological agents when drug treatment is indicated in patients with PTSD. sertraline may be considered the present drug of choice for PTSD, particularly in females from the civilian population. Sertraline, a naphthylamine derivative, is a selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) that has previously demonstrated efficacy in the treatment of patients with depression, panic disorder and obsessive-compulsive disorder, and more recently in the treatment of patients with post-traumatic stress disorder (PTSD). The causes of PTSD have yet to be established clearly. Nervous system pathways implicated in PTSD include the serotonergic and adrenergic systems, increased sympathetic nervous system activation and decreased corticotropin-releasing factor and ambient cortisol levels. Sertraline selectively inhibits the serotonin transporter with only minor inhibition of the noradrenaline (norepinephrine) and dopamine transporters, Sertraline showed no appreciable affinity for σ2, serotonergic 5-HT 1A , 5-HT 1B , 5-HT 2A , histaminergic H 1 , dopaminergic D 1 and D 2 , and muscarinic receptors, and α 2 -and β-adrenoceptors in vitro, In 1 study sertraline showed a moderate affinity for α-adrenoceptors, but under normal clinical conditions sertraline is unlikely to block these receptors as the sertraline concentration required to antagonise them is considerably more than that required to inhibit serotonin reuptake. Sertraline also has some affinity for σ 1 receptors, but the clinical implications of this have not yet been determined.

D-fenfluramine challenge in posttraumatic stress disorder

Background: Much progress has been made in understanding the role of catecholamines in the pathophysiology of posttraumatic stress disorder (PTSD). Recent research has broadened the scope of neuroregulation of PTSD to include serotonin. Methods: We used the serotonin-releasing agent and reuptake inhibitor, d-fenfluramine, to assess the integrity of the serotonin-mediated prolactin release in 8 men with combat-induced PTSD and 8 healthy men. Results: The veterans with PTSD had a significantly lower prolactin response to d-fenfluramine as compared to healthy control subjects. The prolactin response to d-fenfluramine was inversely correlated with the patient’s level of PTSD symptomatology and measures of aggression. Conclusions: This study demonstrates a central serotonin dysfunction, as reflected in a lower prolactin response to d-fenfluramine, in patients with PTSD.

Clinical Characteristics of Delayed and Immediate-Onset Combat-Induced Post-Traumatic Stress Disorder

The aim of the current study is to examine the clinical characteristics of war-related disturbances among veterans with delayed and immediate-onset post-traumatic stress disorder (PTSD). One hundred twenty-five veterans who sought help for war-related disturbances, 8 years after the 1982 Lebanon War, filled out the PTSD Inventory, Impact of Event Scale, and SCL-90. Their scores were compared with those of 370 treated combat stress reaction casualties who filled out the questionnaires a year after the same war. Findings indicate that veterans from the delayed-helpseeking group suffer from a higher rate (92 vs. 59%) and a greater intensity of PTSD, more intrusive tendencies, and more severe general psychiatric symptomatology than those of the immediate-helpseeking group. These findings indicate that a fair number of combatants still seek help for war-related disturbances almost a decade after the war. The complex relationship between delayed-helpseeking and delayed-onset PTSD is discussed.