Dimensions Of Posttraumatic Stress Disorder Research Articles

Unravelling The Cause and Consequences of Post Traumatic Stress Disorder: A Comprehensive Review

Post-traumatic stress disorder (PTSD) is a psychiatric disorder caused by experiencing or witnessing traumatic or potentially life-threatening events, that has grown in prevalence due to global conflicts, natural disasters, and domestic violence. When a victim experiences trauma such as death or serious injury, three dimensions of PTSD develop: re-experience the event, Symptoms of trauma may include distressing memories, dreams, flashbacks, and physical distress, as well as avoidance of triggers and increased arousal. Traumatic events cause stress, which leads to a variety of psychosocial and physiological outcomes. PTSD has significant psychobiological correlates that can impair a person's daily life and be life-threatening. Given current events (for example, extended combat, terrorism, and exposure to certain environmental toxins), a significant increase in PTSD diagnoses is expected over the next decade. PTSD is a serious public health concern, necessitating the development of new paradigms and theoretical models to gain a better understanding of the condition and develop new and improved treatment interventions. therefore, understanding the specific causes of PTSD and how it affects patients is critical for both clinical practice and scientific research. To treat PTSD, nonpharmacologic interventions such as cognitive behavioural therapy, antidepressants (selective serotonin reuptake inhibitors), antianxiety medications, mood stabilizers, and antipsychotics are recommended. This review of PTSD will help readers gain a better understanding of the PTSD condition and probable causes that contribute to PTSD disease and explore the influence on the patient himself after suffering from PTSD. It discusses the ways to improve the ability to recognize and treat it, appreciate the internist's role in managing it, and help to enhance the quality of life of people suffering from PTSD.

Sound of sirens, echoes of trauma: unpacking socioeconomic vulnerabilities in the Israel-Hamas conflict

ABSTRACT This article investigates socioeconomic determinants correlated with PostTraumatic Stress Disorder (PTSD) symptoms during the May 2021 Hamas-Israel conflict, primarily the effects of rocket strikes on Israeli civilians. Its findings reveal a stark disparity in PTSD risks across different socioeconomic groups with individuals from lower socioeconomic backgrounds exhibiting a notably higher propensity for PTSD symptoms than people with higher education and stable family backgrounds. The article’s implications extend far beyond the immediate context of the Israel-Hamas conflict. By highlighting the socioeconomic dimensions of PTSD, it advocates for more comprehensive, context-sensitive mental health strategies. Such strategies are crucial for addressing the complex array of factors influencing mental health in conflict zones, ultimately paving the way for more resilient and supportive communities.

Fear of COVID-19, Perceived Stress, and PTSD: The Serial Mediating Role of Sense of Coherence.

The literature has identified that a sense of coherence plays a protective role in the relationship between adverse events and mental health. The current study examines the role of a sense of coherence (SOC) in the relationship between fear of COVID-19, perceived stress, and dimensions of post-traumatic stress disorder (PTSD). Participants (n = 322) were students at a metropolitan university in South Africa who completed the Fear of COVID-19 Scale, the Perceived Stress Scale, the 13-item Sense of Coherence Scale, and the PTSD Checklist. Path analysis was used to conduct a serial mediation analysis. The results show that SOC mediates the relationship between perceived stress and the dimensions of PTSD but does not mediate the relationship between fear of COVID-19 and PTSD. Furthermore, the relationship between fear of COVID-19 and dimensions of PTSD was mediated by serial perceived stress and sense of coherence, supporting the hypothesis that higher levels of fear of COVID-19 leads to higher levels of perceived stress. However, while high levels of fear of COVID-19 increase perceived stress, SOC significantly mediates the subsequent impact on PTSD symptoms.

Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder.

Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants' psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. Our findings also suggest the significance of irritability as a separate hallmark of PTSD and the need to incorporate PTSD dimensions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Memory representation of aversive social experiences in Social Anxiety Disorder

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.

Sparse models for predicting psychosocial impairments in patients with PTSD: An empirical Bayes approach.

Posttraumatic stress disorder (PTSD) is associated with psychosocial impairments, which represent a relevant focus for therapy. Previous results on the clinical predictors of these psychosocial impairments were inconsistent. The data analyzed in these contexts often suffer from a high number of correlated predictors and small sample sizes, entailing the risk of model overfitting. In Bayesian regression, the problem of overfitting can be mitigated by usage of specific zero-centered (regularizing) prior distributions. In this study, we used the 2 most common Bayesian regression models, the Bayesian Ridge and the Bayesian Lasso, to predict psychosocial impairments in 192 patients of a day clinic for the treatment of PTSD. Predictions were based on specific dimensions of PTSD symptoms previously revealed by factor analyses, as well as posttraumatic cognitions, depressive symptoms, comorbid disorders, and demographics. The variance of the prior distribution was estimated through empirical Bayes (maximum marginal likelihood) and an approximation to the posterior distribution was obtained with stochastic variational inference and with a local approximation (Laplace approximation). Severe psychosocial impairments were mainly related to depressive symptoms and symptoms from the amnesia and numbing dimension of PTSD, while gender, posttraumatic cognitions, and reexperience and avoidance symptoms had no impact. As expected, the model coefficients were shrunken to zero when regularizing prior distributions were used, particularly for the Bayesian Lasso. Depressive and numbing symptoms are the main clinical correlates of psychosocial impairments in patients with PTSD. Usage of Bayesian and regularized regression can contribute to the generalizability and interpretability of research results. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Relationship Between Post-Traumatic Stress Disorder After Childbirth and Social Support and Marital Satisfaction

Background: Childbirth is among the most significant and pleasant events in a woman’s life. This event can be a traumatic event and a threat to the mother’s mental health. This study recognizes the relationship between Post-Traumatic Stress Disorder (PTSD) after childbirth and social support and marital satisfaction. Methods: This Cross-sectional analytical study was performed on a sample of 400 mothers who had delivered at Shohadaye-15-Khordad Hospital in Varamin (in two groups with & without PTSD). The research instruments include the Demographic, Midwifery, Neonatal Factors checklist, Enrich Marital Satisfaction, Weinfeld and Tigman Social Support, and the PTSD Symptoms Scale. We used SPSS to analyze the descriptive and Pearson correlation and logistic regression data. A P<0.05 was considered significant. Results: The prevalence of PTDS in this study was equal to 16.8%. There was no significant correlation between the mean of the total score of PTSD in all dimensions with social support (P>0.05). Marital satisfaction significantly affected the probability of PTSD after childbirth (P=0.001). There was a significant correlation between PTSD total score and dimension of avoidance symptoms and infant gender (P=0.038). There was also a significant correlation between gestational age and avoidance symptoms (P=0.001) and type of nutrition feeding and motivational symptoms (P=0.041) of PTSD dimensions. Conclusion: According to the relationship between marital satisfaction and PTSD, it is recommended to design suitable interventions to improve the marital status and promptly diagnose the susceptible mothers to prevent the spread of this complication.

Altered gene expression and PTSD symptom dimensions in World Trade Center responders.

Despite experiencing a significant trauma, only a subset of World Trade Center (WTC) rescue and recovery workers developed posttraumatic stress disorder (PTSD). Identification of biomarkers is critical to the development of targeted interventions for treating disaster responders and potentially preventing the development of PTSD in this population. Analysis of gene expression from these individuals can help in identifying biomarkers of PTSD. We established a well-phenotyped sample of 371 WTC responders, recruited from a longitudinal WTC responder cohort using stratified random sampling, by obtaining blood, self-reported and clinical interview data. Using bulk RNA-sequencing from whole blood, we examined the association between gene expression and WTC-related PTSD symptom severity on (i) highest lifetime Clinician-Administered PTSD Scale (CAPS) score, (ii) past-month CAPS score, and (iii) PTSD symptom dimensions using a 5-factor model of re-experiencing, avoidance, emotional numbing, dysphoric arousal and anxious arousal symptoms. We corrected for sex, age, genotype-derived principal components and surrogate variables. Finally, we performed a meta-analysis with existing PTSD studies (total N = 1016), using case/control status as the predictor and correcting for these variables. We identified 66 genes significantly associated with total highest lifetime CAPS score (FDR-corrected p < 0.05), and 31 genes associated with total past-month CAPS score. Our more granular analyses of PTSD symptom dimensions identified additional genes that did not reach statistical significance in our analyses with total CAPS scores. In particular, we identified 82 genes significantly associated with lifetime anxious arousal symptoms. Several genes significantly associated with multiple PTSD symptom dimensions and total lifetime CAPS score (SERPINA1, RPS6KA1, and STAT3) have been previously associated with PTSD. Geneset enrichment of these findings has identified pathways significant in metabolism, immune signaling, other psychiatric disorders, neurological signaling, and cellular structure. Our meta-analysis revealed 10 genes that reached genome-wide significance, all of which were downregulated in cases compared to controls (CIRBP, TMSB10, FCGRT, CLIC1, RPS6KB2, HNRNPUL1, ALDOA, NACA, ZNF429 and COPE). Additionally, cellular deconvolution highlighted an enrichment in CD4 T cells and eosinophils in responders with PTSD compared to controls. The distinction in significant genes between total lifetime CAPS score and the anxious arousal symptom dimension of PTSD highlights a potential biological difference in the mechanism underlying the heterogeneity of the PTSD phenotype. Future studies should be clear about methods used to analyze PTSD status, as phenotypes based on PTSD symptom dimensions may yield different gene sets than combined CAPS score analysis. Potential biomarkers implicated from our meta-analysis may help improve therapeutic target development for PTSD.

The relationship between birth satisfaction, posttraumatic stress disorder and postnatal depression symptoms in Croatian women.

Studies show that a woman's dissatisfaction with her birth experience may affect her well-being. This study aimed to examine: (1) the birth satisfaction in Croatian women and compare it with UK normative data; (2) the association of different dimensions of birth satisfaction with posttraumatic stress disorder (PTSD) and depressive symptoms. In a cross-sectional online study, 603 postnatal Croatian women completed the Birth Satisfaction Scale-Revised (subscales: Stress experienced during labour (SL), Women's personal attributes (WA), and Quality of care provision (QC)); City Birth Trauma Scale (subscales: Birth-related symptoms and General symptoms); and Edinburgh Postnatal Depression Scale. Subscale and total scale scores were calculated. Path analysis tested the model of three aspects of birth satisfaction effect on PTSD dimensions and depressive symptoms. The average birth satisfaction score was significantly lower compared to the UK data on the total scale and all three subscale scores. Path analysis revealed that all three dimensions of birth satisfaction (SL, WA, and QC) had an effect on Birth-related symptoms. However, only Women's personal attributes (i.e., feeling anxiety or being in control during childbirth) had an effect on General symptoms and depressive symptoms, as well. Different aspects of birth satisfaction are important for maternal mental health following childbirth.

Differential Contribution of Alexithymia Factors to PTSD Severity in TBI

<h3>Research Objectives</h3> Traumatic brain injury (TBI) is commonly associated with neuropsychiatric symptoms, such as alexithymia and posttraumatic stress disorder (PTSD). However, the relation between these conditions is not well understood. Alexithymia, a dysfunction of affective and cognitive emotional processing, have been associated with TBI and PTSD. We examined the interaction of alexithymia factors and PTSD dimensions in Veterans with TBI. <h3>Design</h3> Cross-sectional. <h3>Setting</h3> Outpatient research unit. <h3>Participants</h3> Sixty veterans with mild TBI (medical records and clinical evaluation) and chronic cognitive (neuropsychological evaluation) and neuropsychiatric symptoms (clinical interview). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> All participants were administered a series of standardized neuropsychiatric measures, including Toronto Alexithymia Scale-20 (TAS-20), PTSD Checklist (PCL-M), and standardized neuropsychological and functional status measures. <h3>Results</h3> Alexithymia levels were strongly associated with TBI and PTSD severity. PTSD severity was strongly related to alexithymia Factor 1 (difficulty describing feelings, p < .001) and Factor 2 (difficulty identifying feelings, p < .001), but not Factor 3. Alexithymia and PTSD severity were strongly related to cognitive (executive) dysfunction. However, further analyses demonstrated that alexithymia level was the strongest predictor of executive dysfunction. <h3>Conclusions</h3> These findings highlight the prevalence of alexithymia in veterans with TBI. Our results suggest that increased alexithymia level is associated with more severe levels of PTSD in TBI. In this study more severe alexithymia was also associated with cognitive dysfunction. These results underscore the importance of identification and treatment of alexithymia, as it may improve the quality of life and reduce disability in individuals with TBI. <h3>Author(s) Disclosures</h3> No disclosures

Contributions of Astrocyte Specific Glucocorticoid Receptors to Memory Related Dimensions of PTSD

Post-Traumatic Stress Disorder (PTSD) is characterized by pathological fear. Impairments in memory recall contribute to such fear. Glucocorticoid-mediated action via the glucocorticoid receptor (GR) influences memory and perturbation of this pathway may impair memory recall. Studies of GRs in this context have focused on neuronal GRs. Our study seeks to address the role of GRs on cortical astrocytes in memory recall.

Incerto-thalamic modulation of fear via GABA and dopamine

Fear generalization and deficits in extinction learning are debilitating dimensions of Post-Traumatic Stress Disorder (PTSD). Most understanding of the neurobiology underlying these dimensions comes from studies of cortical and limbic brain regions. While thalamic and subthalamic regions have been implicated in modulating fear, the potential for incerto-thalamic pathways to suppress fear generalization and rescue deficits in extinction recall remains unexplored. We first used patch-clamp electrophysiology to examine functional connections between the subthalamic zona incerta and thalamic reuniens (RE). Optogenetic stimulation of GABAergic ZI → RE cell terminals in vitro induced inhibitory post-synaptic currents (IPSCs) in the RE. We then combined high-intensity discriminative auditory fear conditioning with cell-type-specific and projection-specific optogenetics in mice to assess functional roles of GABAergic ZI → RE cell projections in modulating fear generalization and extinction recall. In addition, we used a similar approach to test the possibility of fear generalization and extinction recall being modulated by a smaller subset of GABAergic ZI → RE cells, the A13 dopaminergic cell population. Optogenetic stimulation of GABAergic ZI → RE cell terminals attenuated fear generalization and enhanced extinction recall. In contrast, optogenetic stimulation of dopaminergic ZI → RE cell terminals had no effect on fear generalization but enhanced extinction recall in a dopamine receptor D1-dependent manner. Our findings shed new light on the neuroanatomy and neurochemistry of ZI-located cells that contribute to adaptive fear by increasing the precision and extinction of learned associations. In so doing, these data reveal novel neuroanatomical substrates that could be therapeutically targeted for treatment of PTSD.

Post-traumatic Stress Disorder,Social Support,and Quality of Life in Patients with Spinal Cord Injury

Objective To explore the relationship among post-traumatic stress disorder(PTSD),social support and quality of life in patients with spinal cord injury(SCI)after a long recovery in China and investigate the factors influencing the quality of life. Methods In this cross-sectional study,206 SCI patients who were hospitalized in 9 hospitals were enrolled.Data collection was performed using general information,the Post-Traumatic Stress Disorder Checklist-Civilian version,the social support scales,and the World Health Organization Quality of Life-Abbreviated version.The data were statistically analyzed using t test,multivariate linear regression,and adjustment effect analysis. Results PTSD was negatively correlated with quality of life(r=-0.337,P <0.001).Social support was positively correlated with quality of life(r=0.318,P<0.001).Social support showed a positive regulatory role between the heightened sense of threat dimension of PTSD and the overall quality of life(β=0.324,P=0.032)or its environmental domain(β=0.227,P=0.004)but showed a negative regulatory effect on the re-experiencing dimension of PTSD and the environmental domain of quality of life(β=-0.125,P=0.017).PTSD,social support,gender,marital status,and economic status were significant predictors of quality of life. Conclusion Reducing PTSD and improving social support can improve long-term quality of life in SCI patients.

Factor structure of posttraumatic stress disorder (PTSD) in Australian Vietnam Veterans: Confirmatory factor analysis of the Clinician-Administered PTSD Scale for DSM–5

Introduction: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) brought a change to the symptom clusters of posttraumatic stress disorder (PTSD). In line with the DSM–5 changes, an updated version of the Clinician-Administered PTSD Scale (CAPS–5) was released. The CAPS–5 is considered to be the gold-standard measure of PTSD; however, examinations of the psychometric properties and optimal factor structure of this scale are underrepresented in PTSD studies. Methods: This study used confirmatory factor analysis (CFA) to assess the factor structure of the CAPS–5 using a sample of 267 male Australian Vietnam Veterans. Models drawn from the PTSD CFA literature were used to test the underlying dimensions of PTSD: the four-factor DSM–5 model, six-factor externalizing behaviour and anhedonia models, and seven-factor hybrid model. Results: The results found that the DSM–5 model showed slightly less than adequate fit (comparative fit index [CFI] = 0.90, Tucker–Lewis index [TLI] = 0.88, root mean square error of approximation [RMSEA] = 0.064), however, other models showed acceptable fit. The anhedonia model provided a significantly better fit than the other models (CFI = 0.92, TLI = 0.90, RMSEA = 0.059). Discussion: Overall, the results supported the anhedonia model. This result may indicate that the underlying dimensions of PTSD in Australian Vietnam Veterans may best be represented by six distinct factors.

Distress Variance and Specificity of Symptom Dimensions in Posttraumatic Stress Disorder: a Quadripartite Perspective

The relation of posttraumatic stress disorder (PTSD) to other forms of psychopathology is complex as diagnostic criteria include symptoms of both mood- and anxiety-related conditions. Drawing from Watson’s (2009) quadripartite model of comorbidity, the current study examined (a) the association of PTSD symptom dimensions with indices of generalized distress, (b) the specificity of PTSD symptom dimensions for core aspects of anxiety and depression, and (c) the unique associations of symptom dimensions with markers of positive emotionality, somatic arousal, generalized distress, and cumulative trauma history. Confirmatory analyses were used to model symptom dimensions in help-seeking survivors of intimate partner violence (N = 238; 51.7% White/Non-Hispanic). Latent markers of positive emotionality, somatic arousal, and generalized distress were also estimated. A 3-factor version of the Simms et al. (2002) Dysphoria model was identified as a preferred solution, with Intrusion and Avoidance criteria collapsed on a common dimension. Analyses revealed moderate correlations of generalized distress with Intrusion-Avoidance, Dysphoria, and Hyperarousal dimensions (r = .30–.38). Intrusion-Avoidance and Hyperarousal factors evidenced specificity for the core aspects of anxiety while Dysphoria demonstrated an association with the characteristic features of depression when controlling for nonspecific distress. Hyperarousal was the only symptom dimension holding a unique association with cumulative trauma controlling for somatic arousal, positive emotionality, and generalized distress. Results offer preliminary support for the specificity of core dimensions of PTSD above and beyond the influence of nonspecific distress.

Investigating the latent dimensions of posttraumatic stress disorder and the role of anxiety sensitivity in combat-exposed Filipino soldiers

ABSTRACTIdentifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study’s objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.

Modeling the Relationships Between Combat Experiences and Posttraumatic Stress Disorder Factors

Evidence suggests specific types of combat can influence different posttraumatic stress disorder (PTSD) symptom presentations. This study applied structural equation modeling to extend this line of research in a cross-sectional sample of 2,159 U.S. Navy Sailors deployed to Iraq and Afghanistan between 2007 and 2008. Generally, support was for a model which specified direct relationships between the latent factors of combat experience and PTSD (χ2(881) = 4,015.82, p < .001, CFI = .956, TLI = .953, RMSEA = .040, 90%CI = .038, .041). Specifically, exposure to a combat environment predicted only the reeexperiencing and hyperarousal dimensions of PTSD, close physical engagement predicted all but the hyperarousal dimension, and nearness to serious injury or death predicted only reeexperiencing. While exploratory in nature, these findings support the hypothesis that an individual’s unique combat experience may also produce unique expressions of PTSD symptoms, implying that PTSD prevention, diagnosis, and treatment may need to be tailored to specific types of trauma and combat experiences.

Factor structure of posttraumatic stress disorder (PTSD) in Australian Vietnam Veterans: confirmatory factor analysis of the Clinician-Administered PTSD Scale for DSM–5

Introduction: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) brought a change to the symptom clusters of posttraumatic stress disorder (PTSD). In line with the DSM–5 changes, an updated version of the Clinician-Administered PTSD Scale (CAPS–5) was released. The CAPS–5 is considered to be the gold-standard measure of PTSD; however, examinations of the psychometric properties and optimal factor structure of this scale are underrepresented in PTSD studies. Methods: This study used confirmatory factor analysis (CFA) to assess the factor structure of the CAPS–5 using a sample of 267 male Australian Vietnam Veterans. Models drawn from the PTSD CFA literature were used to test the underlying dimensions of PTSD: the four-factor DSM–5 model, six-factor externalizing behaviour and anhedonia models, and seven-factor hybrid model. Results: The results found that the DSM–5 model showed slightly less than adequate fit (comparative fit index [CFI] = 0.90, Tucker–Lewis index [TLI] = 0.88, root mean square error of approximation [RMSEA] = 0.064), however, other models showed acceptable fit. The anhedonia model provided a significantly better fit than the other models (CFI = 0.92, TLI = 0.90, RMSEA = 0.059). Discussion: Overall, the results supported the anhedonia model. This result may indicate that the underlying dimensions of PTSD in Australian Vietnam Veterans may best be represented by six distinct factors.

Changes in Posttraumatic Cognitions Mediate the Effects of Trauma-Focused Therapy on Paranoia

Abstract Background Evidence suggests that in individuals with psychosis, paranoia is reduced after trauma-focused therapy (TFT) aimed at comorbid posttraumatic stress disorder (PTSD). Objective To identify mediators of the effect of TFT on paranoia. Method In a multicenter single-blind randomized controlled trial 155 outpatients in treatment for psychosis were allocated to 8 sessions Prolonged Exposure (PE; n = 53), 8 sessions Eye Movement Desensitization and Reprocessing (EMDR) therapy (n = 55), or a waiting-list condition (WL; n = 47) for treatment of comorbid PTSD. Measures were performed on (1) paranoia (GPTS); (2) DSM-IV-TR PTSD symptom clusters (CAPS-IV; ie, intrusions, avoidance, and hyperarousal); (3) negative posttraumatic cognitions (PTCI; ie, negative self posttraumatic cognitions, negative world posttraumatic cognitions and self-blame); (4) depression (BDI-II); and (5) cognitive biases (ie, jumping to conclusion, attention to threat, belief inflexibility, and external attribution), cognitive limitations (ie, social cognition problems and subjective cognitive problems), and safety behaviors (DACOBS). Outcome in terms of symptoms of paranoia (1) and potential mediators (2–5) were evaluated at posttreatment, controlling for baseline scores. Results The effects of TFT on paranoia were primarily mediated by negative self and negative world posttraumatic cognitions, representing almost 70% of the total indirect effect. Safety behaviors and social cognition problems were involved in the second step mediational pathway models. Conclusions Targeting the cognitive dimension of PTSD in TFT in psychosis could be an effective way to influence paranoia, whereas addressing safety behaviors and social cognition problems might enhance the impact of TFT on paranoia.

BIOLOGICAL MARKERS OF AGING: CHRONIC STRESS AND COGNITIVE IMPAIRMENT IN RESPONDERS FROM THE WORLD TRADE CENTER

Post-traumatic Stress Disorder (PTSD) is a stress related syndrome. Chronic PTSD has increasingly been associated with poor health outcomes, neurodegeneration and risk for cognitive impairment (CI). However, the biological mechanisms underlying the development and maintenance of symptoms and potential associations in accelerating aging are not well understood. The aim of this study was to evaluate whether specific biomarkers influence functional limitations and cognitive impairment in rescue and recovery workers (i.e. responders) from the attacks on the World Trade Center (WTC) in New York. Plasma biomarkers were collected during annual health and wellness visits at the WTC responder clinic between 2012 and 2014. Short Physical Performance Battery (SPPB) and clinical data were examined with prospective PTSD symptom scores collected during participant’s initial enrollment into the parent study as early as 2002. We examined the relationship between cardiovascular (Diastolic Blood Pressure, Systolic Blood Pressure, pulse rate), metabolic (Total Cholesterol, HDL cholesterol, Triglycerides, Glucose, Body Mass Index) and inflammation markers (Albumin, White Blood Count) with Post-traumatic Stress Disorder (PTSD), cognitive functioning (Montreal Cognitive Assessment) and frailty (Short Physical Performance Battery) in responders from the World Trade Center (WTC). We first examined correlations between biomarkers, PTSD symptom severity, PTSD dimensions, cognitive functioning and frailty. We then conducted multivariate regression analyses. In models adjusted for potential confounders, among N=1,045 responders, elevated PTSD was strongly associated with increased frailty, cardiovascular dysregulation and mild cognitive impairment. Current work is ongoing to identify trajectories of change in cognition with frailty and biological factors.