Later Development Of Posttraumatic Stress Disorder Research Articles

Psychological First Aid for Wilderness Trauma: Interventions for Expedition or Search and Rescue Team Members

When exposed to actual or threatened death or serious injury in austere settings, expedition members are at risk of acute stress reactions, as are search and rescue members involved with extricating the patient. Acute stress reactions are a normal response to significant trauma and commonly resolve on their own. If they do not, they can lead to post-traumatic stress disorder (PTSD), a set of persistent symptoms that cause significant effects on the person's life. Medication has a limited preventive role in the field for treatment of stress partly because so few are trained to administer it. Contrastingly, psychological first aid can be performed by lay team members with minimal training. Psychological first aid consists of interventions attempting to encourage feelings of safety, calm, self-efficacy, connection, and hope. These are interventions that provide guidance to not make the situation emotionally worse and might have a preventive effect on later development of PTSD. They are valuable in the field not only for the patient but also for affected team members as well as for search and rescue team members who may be indirectly affected by the trauma and experience repercussions later.

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

Screening of Acute Traumatic Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients: A Pilot Study.

Children who experience traumatic physical injuries are at risk of developing acute stress disorder and posttraumatic stress disorder (PTSD). Early identification and treatment of these high-risk children can lead to improved mental health outcomes in this population. This study assesses the feasibility of a study protocol that compares 3 screening tools for identifying patients at a high risk of later development of acute stress disorder or PTSD among pediatric trauma patients. This pilot study compared 3 questionnaires used as screening tools for predictors of later development of PTSD in a convenience sample of pediatric trauma patients aged 7-17 years. Patients were randomized to one of 3 screening tools. Families were contacted at 30, 60, and 90-120 days postinjury to complete the Child Report of Post-Traumatic Symptoms questionnaire. The sensitivity and negative predictive value of the screening tools were compared for the diagnosis of PTSD defined using the Child Report of Post-Traumatic Symptoms questionnaire. Of the 263 patients identified for possible enrollment, 52 patients met full inclusion criteria and agreed to participate. Only 29 (55.7%) patients completed at least one follow-up questionnaire. The prevalence of acute stress disorder and PTSD in our population was 41% (95% CI [24, 61]) and 31% (95% CI [15, 51]), respectively. In this pilot study, we sought to determine the utility of the 3 commonly used screening instruments for measuring traumatic stress symptoms in pediatric trauma patients to predict the diagnosis of acute stress disorder or PTSD. Limitations include the use of the Child Report of Post-Traumatic Symptoms screening tool as the gold standard for calculating test characteristics and lack of 24/7 enrollment capabilities. As such, a significant portion of patients were discharged prior to our teams' engagement for enrollment.

Aberrant intrinsic connectivity in women victims of sexual assault.

This study aims to determine if resting-state functional connectivity may represent a marker for the progression of posttraumatic stress disorder (PTSD) in women victims of sexual assault. Participants were 25 adult women recruited three weeks following exposure to sexual assault (T1) and 19 age-matched healthy, non trauma-exposed controls (HC). Among the victims, 10 participants met (PTSD) and 15 did not meet (trauma-exposed controls, TEC) DSM-IV criteria for PTSD six months post-trauma (T2). At both visits, patterns of intrinsic connectivity, a measure of network centrality at each voxel of the brain, were derived from resting-state functional magnetic resonance imaging. Compared to both the HC and TEC groups, victims who developed PTSD at T2 showed higher centrality in the right middle/superior occipital gyrus at T1, while reduced centrality of the posterior cingulate cortex (PCC)/precuneus at T1 was found for the TEC group, compared to the HC group only. There were no differences in intrinsic connectivity at T1 between the TEC and PTSD groups. There were no significant between-group differences in intrinsic connectivity at T2, and no significant group-by-time interaction. This study indicates that increased occipital centrality three weeks post-trauma exposure may represent a marker of the later development of PTSD. On the other hand, reduced centrality of the PCC/precuneus may represent a marker of resilience to trauma exposure.

Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast.

IntroductionTraumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2–30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure.Materials and MethodsRecruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician.ResultsA total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05).ConclusionsThis paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.

Exposure to a Predator Scent Induces Chronic Behavioral Changes in Rats Previously Exposed to Low-level Blast: Implications for the Relationship of Blast-Related TBI to PTSD.

Blast-related mild traumatic brain injury (mTBI) has been unfortunately common in veterans who served in the recent conflicts in Iraq and Afghanistan. The postconcussion syndrome associated with these mTBIs has frequently appeared in combination with post-traumatic stress disorder (PTSD). The presence of PTSD has complicated diagnosis, since clinically, PTSD and the postconcussion syndrome of mTBI have many overlapping symptoms. In particular, establishing how much of the symptom complex can be attributed to the psychological trauma associated with PTSD in contrast to the physical injury of traumatic brain injury has proven difficult. Indeed, some have suggested that much of what is now being called blast-related postconcussion syndrome is better explained by PTSD. The relationship between the postconcussion syndrome of mTBI and PTSD is complex. Association of the two disorders might be viewed as additive effects of independent psychological and physical traumas suffered in a war zone. However, we previously found that rats exposed to repetitive low-level blast exposure in the absence of a psychological stressor developed a variety of anxiety and PTSD-related behavioral traits that were present months following the last blast exposure. Here, we show that a single predator scent challenge delivered 8 months after the last blast exposure induces chronic anxiety related changes in blast-exposed rats that are still present 45 days later. These observations suggest that in addition to independently inducing PTSD-related traits, blast exposure sensitizes the brain to react abnormally to a subsequent psychological stressor. These studies have implications for conceptualizing the relationship between blast-related mTBI and PTSD and suggest that blast-related mTBI in humans may predispose to the later development of PTSD in reaction to subsequent psychological stressors.

Analysis of extinction acquisition to attenuated tones in prenatally stressed and non-stressed offspring following auditory fear conditioning

Stimulus generalization occurs when stimuli with characteristics similar to a previously conditioned stimulus (CS) become able to evoke a previously conditioned response. Experimental data (Lissek et al., 2005) indicate that patients with post-traumatic stress disorder (PTSD), more often show stimulus generalization following fear conditioning when tested under laboratory conditions. Factors surrounding this observation may contribute to two common features of PTSD: 1) hyper-responsiveness to sensory stimuli reminiscent of those associated with the original trauma, and 2) resistance of PTSD to extinction-based therapies. Adverse early experience is considered a risk factor for the later development of PTSD and in the present experiments we hypothesized that stimulus generalization would occur in an animal model of adverse early experience, the prenatally stressed (PS) rat. Adult PS and control (CON) rats underwent extensive pre-habituation to a conditioning chamber followed by conventional auditory fear conditioning. The next day both groups began an extinction regimen where a series of quieter (attenuated), CSs were administered prior to the full 75dB training CS. When tested in this manner, PS rats froze at significantly lower tone amplitudes than did CON offspring on the first day of extinction training. This suggests that the PS rats had stimulus-generalized the CS to lower decibel tones. In addition to this finding, we also observed that PS rats froze more often and longer during three ensuing days of extinction training to attenuated tones. Group differences vanished when PS and CON rats were extinguished under conventional conditions. Thus, it appears that the two extinction regimens differed in their aversive cue saliency for the PS vs. CON rats. Follow-up prefrontal cortex transcriptome probing suggests that cholinergic and dopaminergic alterations may be involved.

Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.

Developmental Considerations for Diagnosing PTSD and Acute Stress Disorder in Preschool and School-Age Children

Developmental Considerations for Diagnosing PTSD and Acute Stress Disorder in Preschool and School-Age Children

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.

The Effect of Prior Trauma Exposure on the Development of PTSD Following Spinal Cord Injury

Posttraumatic stress disorder (PTSD) occurs in only a subset of individuals who sustain traumatic spinal cord injuries (SCIs). Several previous studies have examined the effects of additive trauma on the development of PTSD and found that a history of prior trauma increases the risk for later development of PTSD. The present study examines additive trauma by investigating the effects of previous combat exposure on the development of PTSD following spinal cord injury. Significant differences in prevalence rates for current PTSD were found for the comparisons of war theater (both combat and noncombat) versus non-war theater veterans but not for the comparison between combat and noncombat war theater veterans. Moreover, for all the comparisons, no significant differences were found in lifetime PTSD diagnoses. This implies that veterans with SCI who served in a war zone have increased difficulty recovering from their PTSD following a spinal cord injury than do non-war theater veterans.

Predictors of PTSD in injured trauma survivors: a prospective study.

The aim of this study was to prospectively examine the relationship between immediate and short-term responses to a trauma and the subsequent development of posttraumatic stress disorder (PTSD). All patients consecutively admitted to a general hospital were screened for the presence of physical injury due to a traumatic event. Fifty-one eligible subjects were assessed 1 week and 6 months after the trauma. The initial assessment included measures of event severity, peritraumatic dissociation, and symptoms of intrusion, avoidance, depression, and anxiety. The follow-up assessments added the PTSD module of the Structured Clinical Interview for DSM-III-R--Non-Patient Version and the civilian trauma version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. Thirteen subjects (25.5%) met PTSD diagnostic criteria at follow-up. Subjects who developed PTSD had higher levels of peritraumatic dissociation and more severe depression, anxiety, and intrusive symptoms at the 1-week assessment. Peritraumatic dissociation predicted a diagnosis of PTSD after 6 months over and above the contribution of other variables and explained 29.4% of the variance of PTSD symptom intensity. Initial scores on the Impact of Event Scale predicted PTSD status with 92.3% sensitivity and 34.2% specificity. Symptoms of avoidance that were initially very mild intensified in the subjects who developed PTSD. Peritraumatic dissociation is strongly associated with the later development of PTSD. Early dissociation and PTSD symptoms can help the clinician identify subjects at higher risk for developing PTSD.

Posttraumatic stress disorder in patients with burns.

Among 39 patients with burns evaluated a mean of 12 months after hospital discharge, 38% met DSM-III-R criteria for post-traumatic stress disorder (PTSD) for at least 1 month. With proposed DSM-IV criteria, 43% met criteria for past or current PTSD. Analysis of specific symptom clusters of PTSD revealed that 74% of patients had been affected by a reexperience symptom for at least 1 month, but only 30% were currently experiencing flashbacks. No correlation was found between several clinical correlates (TBSA, length of hospitalization, and age) and development of PTSD. There was no correlation between presence of a DSM-III-R psychiatric diagnosis at the time of hospitalization and later development of PTSD and no correlation between whether or not a psychiatric diagnosis emerged during hospitalization and later development of PTSD. Finally, patients who had injuries that they could not prevent were no more likely to experience PTSD.