History Of Posttraumatic Stress Disorder Research Articles

Criminal justice involvement, trauma, and negative affect in Iraq and Afghanistan war era veterans.

Although criminal behavior in veterans has been cited as a growing problem, little is known about why some veterans are at increased risk for arrest. Theories of criminal behavior postulate that people who have been exposed to stressful environments or traumatic events and who report negative affect such as anger and irritability are at increased risk of antisocial conduct. We hypothesized veterans with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) who report anger/irritability would show higher rates of criminal arrests. To test this, we examined data in a national survey of N = 1,388 Iraq and Afghanistan war era veterans. We found that 9% of respondents reported arrests since returning home from military service. Most arrests were associated with nonviolent criminal behavior resulting in incarceration for less than 2 weeks. Unadjusted bivariate analyses revealed that veterans with probable PTSD or TBI who reported anger/irritability were more likely to be arrested than were other veterans. In multivariate analyses, arrests were found to be significantly related to younger age, male gender, having witnessed family violence, prior history of arrest, alcohol/drug misuse, and PTSD with high anger/irritability but were not significantly related to combat exposure or TBI. Findings show that a subset of veterans with PTSD and negative affect may be at increased risk of criminal arrest. Because arrests were more strongly linked to substance abuse and criminal history, clinicians should also consider non-PTSD factors when evaluating and treating veterans with criminal justice involvement.

Emasculated by Trauma: A Social History of Post‐Traumatic Stress Disorder, Stigma, and Masculinity

Winner of William M. JonesBest Graduate Student Paper Award at 2012 American Culture Association ConferenceThe suppression of fear and other strong emotions is not demanded only of men in trenches. It is constantly expected in ordinary society.-Elliott Smith and T. H. Pear, 191 71The history of medicine is a social one. Although medical knowledge and its history are often understood as objective fact, divorced from cultural and social context, historians of medicine have recendy begun to undermine these assumptions. Social histories of medicine have put forth a thesis about social nature of knowledge, specifically related to health, disease and medicine. Namely, way a disease is understood, treated and talked about is shaped not only by medical knowledge, but also by broader cultural, social and political climates and ideologies. This social construction of disease is evident across history of medicine but is perhaps most prominent in history of mind-body medicine. The history of post-traumatic stress disorder (PTSD) and other war-related traumatic disorders is a study in evolving American sensibilities, social mores, and gendered cultural expectations. Since its first appearance on battlefield, PTSD and its predecessors were used by Americans to symbolize manifestation of societal concerns surrounding unfulfilled gender roles, tightly bound to concepts of heteronormativity. Trauma-related nervous disorders became mark of someone who had failed to live up to culturally constructed notions of ideal male citizen soldier. Thus, victims were blamed for their unmanly behaviour by way of stigmatizing medical diagnoses.Cultural mores surrounding gendered social roles have long shaped both medical understanding of PTSD (and related predecessors) and way its victims are treated and regarded within societal framework. According to Harvard historian Ann Harrington, a cultural inability to understand non-physical properties that lead to disease and ill health has caused society to explain these health problems through a variety of narratives. Harrington grounds western culture's inability to comprehend mind-body medicine in modern medicine's foundational assumption of physicality of illness. Namely, modern western medicine believes that physical illness must have a physical cause. This assumption is what makes mind-body medicine so complicated. Due to ambiguity and lack of understanding surrounding connections between mind-body, physicalist cultures must turn to narratives as a way of explaining what does not fit into physicalist medical paradigm. These narratives are useful in understanding experiences of bodies and minds and how they have been understood within specific cultural contexts throughout history.Harrington explores six narratives in her book: power of suggestion, body that speaks, power of positive thinking, by modern life, healing ties and eastward journeys.2 While quite expansive in scope, these narratives do not represent an exhaustive list and fail to adequately address stories surrounding battlefield trauma. In light of this, another narrative of mind-body medicine is needed. Within this narrative, entitled emasculated by trauma, male body of trauma it has experienced on modern battlefield, marrying two narratives of the body that speaks and broken by modern life. However, this story is also one of soldiers as failed citizen subjects. Soldiers suffering effects of trauma show an inability to exhibit virtues of ideal male, by failing to meet expected gender norms and fulfil male gender roles. Soldiers are still and have historically been expected to be strong and fearless, but trauma-related nervous disorders such as PTSD serve to expose vulnerabilities and frailty of these men. Therefore, this narrative explains both a soldier's failure to fulfil cultural expectations of men, as well as cultural and institutional notions of good soldier. …

Posttraumatic Stress Disorder and Use of Psychiatric and Alcohol Related Services: The Effect of the 2004–2005 Florida Hurricane Seasons on Veterans

The purpose of this study was to document preliminary findings of the association between posttraumatic stress disorder (PTSD), mental health service use, and alcohol related health visits among veterans following 2004-2005 Florida hurricane seasons. A retrospective review of the Veterans Health Administration Medical SAS Outpatient Dataset was conducted to identify veterans residing in Florida during the 2004-2005 hurricane seasons with a history of PTSD and/or PTSD and a substance use disorder. It was found that veterans with PTSD residing in counties affected by hurricanes demonstrated an immediate 28 % increase in use of mental health services following hurricane landfall versus veterans residing in non-hurricane affected counties (+28.0 vs. -6.5 %, p = 0.001). Additionally, veterans residing in affected counties were found to use more group psychotherapy treatment sessions overall (30.3 vs. 27.2 %, p = 0.001). Of note, veterans with PTSD experienced a -0.16 per month (p = 0.114) decrease in alcohol related visits following the 2004 hurricane season. These findings provide insight into the mental health needs of veterans with PTSD following a disaster and can inform delivery of services to veterans with PTSD and alcohol related issues in disaster prone areas.

Donepezil Helps Alleviate Nightmares Associated With Posttraumatic Stress Disorder and Other Psychiatric Conditions

To the Editor: Many patients with the diagnosis of posttraumatic stress disorder (PTSD) or a history of emotional trauma report recurrent nightmares. Though there is a widespread prevalence of nightmares in patients with various psychiatric conditions, there are few treatments available to treat or manage this symptom.1,2 Prazosin has been shown in some studies to help with nightmares related to PTSD.1–7 Donepezil is approved by the US Food and Drug Administration for mild-to-severe Alzheimer’s dementia.8,9 Donepezil is a reversible inhibitor of the acetylcholinesterase enzyme. The enzyme acetylcholinesterase breaks down the neurotransmitter acetylcholine. In this way, donepezil may allow a greater concentration of acetylcholine in the brain, thereby improving cholinergic function.10 The following is a series of cases in which nightmares in patients with various diagnoses responded well to 10 mg of donepezil at bedtime. Case 1. Mr A, a 63-year-old white retired captain of the US Army, had participated in the Vietnam War and Operation Desert Storm. He has a history of PTSD (DSM-IV criteria) and opioid abuse, which started after he was put on treatment with opioids due to war injuries. He had participated in combat several times during his active duty service. Mr A had a history of recurrent nightmares. Most of his nightmares were related to wartime situations and almost always included a situation in which he was not able to escape, could not move during the dream, and felt awake during the dream. At his 1-month outpatient follow-up after he was started on donepezil 10 mg/d, his nightmares were very few, and in fact he reported some pleasant dreams after being placed on donepezil treatment. Case 2. Ms B, a 64-year-old divorced white woman diagnosed with hepatitis C, was admitted as an inpatient for major depressive disorder, recurrent, severe without psychotic features (DSM-IV criteria), and an overdose. She stated she had been depressed for years and had inability to sleep because of recurrent nightmares that she was dying, which woke her up. She was also having nightmares about something terrible happening to her. The day after donepezil 10 mg daily at bedtime was started, she reported that she was having pleasant dreams, including one in which she was walking her dog in her neighborhood. Case 3. Mr C, a 41-year-old Iraqi immigrant, was tortured during Saddam Hussein’s regime and had a diagnosis of PTSD (DSM-IV criteria). He reported waking up screaming and having horrible nightmares. At his 1-month outpatient follow-up after he was started on donepezil 10 mg/d, he reported that his nightmares significantly subsided and his sleep improved. Case 4. Ms D, a 56-year-old white woman, had a history of bipolar I disorder (DSM-IV criteria). She reported repeated nightmares. At her 1-month outpatient follow-up after she was started on donepezil 10 mg/d, she reported significant improvement in her nightmares. Acetylcholine plays an important role in the sleep-wake cycle. Cholinergic projections from the forebrain act as a relay center for the brainstem-cortical arousal system and modulate cortical activity and thus promote wakefulness or rapid eye movement (REM) sleep.11–13 We do not know the exact mechanism of action of donepezil and the improvement in the nightmares. However, considering that most of the nightmares are associated with REM sleep, there could be an intimate association of level of acetylcholine available and nightmares. On the basis of successful management of nightmares in these few cases with donepezil, we hypothesize that the low levels of acetylcholine could lead to sleep disturbance and nightmares. These results are only preliminary, and more controlled studies are needed to validate or reject this hypothesis and address the problem of nightmares in the population of psychiatric patients.

The effects of temporal unpredictability in anticipation of negative events in combat veterans with PTSD

BackgroundExposure to psychological stress during combat can lead to posttraumatic stress disorder (PTSD). Anticipation of aversive events is often associated with an intense emotional state in individuals with PTSD. Both the valence (i.e., positive or negative) of the anticipated event and the degree of temporal predictability (i.e., one’s ability to predict when an event will occur) have profound effects on an individual’s emotional experience. This investigation tested the hypothesis that individuals with combat-related PTSD would show increased activation in the insula and related emotion-processing circuitry when anticipating emotionally significant events such as portrayed in combat-related images, and this heighted response within the insula would be particularly enhanced during temporal unpredictability. MethodsAbout 15 male veterans with PTSD and 15 male veterans with combat-exposure but no current or lifetime history of PTSD (combat exposed controls/CEC) performed a temporal unpredictability anticipation task of unpleasant (combat-related) and pleasant images during fMRI. ResultsAs expected, greater activation in the bilateral anterior insulae was observed in the PTSD versus the CEC subjects during anticipation of combat-related images when the anticipatory period was of uncertain duration (p<0.05). Furthermore, activation in the right anterior insula was related to greater perceived threat in the CEC group (ρ=0.619). LimitationsThe current study looks only at combat-related PTSD in a modest preliminary sized sample. ConclusionsThese findings suggest that an excessive anticipatory reaction in individuals with PTSD to temporally unpredictable aversive stimulus may relate to greater perceived threat. These findings are concordant with psychological models of PTSD that focus on the association of PTSD with the experience of decreased predictability and control.

Mild Traumatic Brain Injury and Posttraumatic Stress Disorder: Clinical and Conceptual Complexities

The wars in Iraq and Afghanistan have raised public con-sciousness of traumatic brain injury (TBI) and posttraumaticstress disorder (PTSD), two of the most common healthconsequences of contemporary military deployment. TBI andPTSD may each in their own right exert a toll on affectedindividuals. Within the war zone, however, brain injury oftenoccurs within a broader context of extreme psychologicalstress (i.e., traumatic stress). Th e same dangerous circumstances(e.g., combat, encounters with improvised explosive devices)that lead to increased risk of TBI also place service membersat increased risk for PTSD. Therefore, the prevalence ofPTSD in returning war-zone veterans who have a history ofdeployment-related TBI are elevated, especially when thebrain injury falls at the milder end of the severity range,as is the case with the majority of deployment-relatedTBIs. For example, a RAND study estimated that almost20% of a representative sample of Operation EnduringFreedom/Operation Iraqi Freedom veterans screened positivefor history of mild TBI (mTBI), and that of those reportinga deployment mTBI, approximately 34% also screenedpositive for PTSD (Tanielian & Jaycox, 2008).The comorbidity of mTBI and PTSD is not limited, however,to war-zone veterans. Civilian events such as motor vehicleaccidents and interpersonal ass ault may also be associated withboth TBI and psychological traum a sufficiently severe to lead toPTSD. The prevalence of comorbid mTBI and PTSD is notwell-documented in civilians, but mTBI and/or PTSD eachaffect many civilians. The Centers for Disease Control andPrevention (2010) estimate that over 1.7 million people sustaina TBI each year, and that over 75% of these injuries are mild.A U.S. population-based survey estimated the prevalenceof PTSD in the general population to be at 7–8% (Kessler,Sonnega, Bromet, Hughes, & Nelson, 1995).Despite the relatively high rates of mTBI and PTSD inat-risk populations, much remains unknown about the clinicalconsequences in individuals who have both incurred anmTBI and experience PTSD. The sequelae of mTBI are oftenreferred to as post traumatic or post concussive symptoms.Some post traumatic symptoms (e.g., irritability, neurocog-nitive complaints) overlap with PTSD symptoms, makingdifferential diagnosis difficult. Other conditions commonlyco-occurring with TBI history and PTSD, such as chronicpain, depression, and substance abuse, may further complicatethe clinical presentation of patients with both history of mTBIand PTSD. As a result, considerablechallengesarise inregardsto both the assessment and clinical management of patientswith co-morbid mTBI and PTSD.The field of neuropsychology is well-positioned to tacklemany of the clinical and conceptual challenges posed bycomorbid mTBI and PTSD. This virtual special issue of theJournal of the International Neuropsychological Society (JINS)compiles eight papers on the topic of TBI and/or PTSD thatwere previously published in regular issues of JINS. The papersare for the first time grouped together with the goal of collec-tively addressing the issues con fronting clinicians who assessand care for patients with history of mTBI and PTSD.

Premature to Draw Conclusions on Hyperbaric Oxygen for TBI, PTSD

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPremature to Draw Conclusions on Hyperbaric Oxygen for TBI, PTSDJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:2 Mar 2012https://doi.org/10.1176/pn.47.5.psychnews_47_5_15-bAbstractThere is symptomatic treatment for traumatic brain injury—notably rest, recovery, and avoiding exposure. There are evidence-based treatments for posttraumatic stress disorder (PTSD). Yet the best treatment for individuals who have both traumatic brain injury and PTSD remains to be identified.Now a small proof-of-concept study suggests that the best treatment might be hyperbaric oxygen therapy. It was headed by Paul Harch, M.D., an associate clinical professor of medicine at Louisiana State University. The findings were published November 28, 2011, in the Journal of Neurotrauma.The study included 16 active-duty or recently retired American service members who had received a mild to moderate traumatic brain injury/postconcussion syndrome on average three years earlier and who were also experiencing PTSD. They received 40 one-hour hyperbaric oxygen sessions during a 30-day period. Each hyperbaric oxygen session was delivered at 1.5 ATA (atmospheres absolute), which is considered low pressure. The subjects were given physical and neurological exams, SPECT brain blood flow imaging, and neuropsychological and psychological testing before treatment and within one week after treatment.The researchers found that the subjects experienced not only a significant improvement in brain blood flow, but a significant reduction in various symptoms purportedly stemming from traumatic brain injury/postconcussion syndrome or PTSD. For example, on the PTSD Checklist-Military, the average score dropped 20 points, from 67 to 47, which was a highly significant difference. The Rivermead Post Concussion Symptoms Questionnaire average score dropped 16 points, from 40 before treatment to 24 after, also a highly significant difference.“Together, these two measurements indicated a major improvement in the symptoms of PTSD and postconcussion syndrome,” the researchers wrote.“These findings,” they continued, “were mirrored by a reciprocal reduction or elimination of psychoactive and narcotic-prescription-medication usage in 64 percent of those subjects for whom they were prescribed. Spontaneous improvement as an explanation for all of these findings is inconsistent with the natural history of postconcussion syndrome and PTSD 2.8 years after injury.”“There has been a tremendous amount of controversy about hyperbaric oxygen therapy,” Elspeth Cameron Ritchie, M.D., chief clinical officer of the District of Columbia Department of Mental Health and a former military psychiatrist, told Psychiatric News. “It is one of the treatments that have very strong proponents, and it is a treatment that the military has been very interested in. … So when I read this paper, initially I was very excited, thinking, here are some data. But as I went through it, I was [neither able to figure out] the time course of symptoms [nor to distinguish] between what they called postconcussion syndrome and PTSD. Most of the work with hyperbaric oxygen has been done on the post-concussion syndrome, the traumatic brain injury. But here they seem to say, this helps with PTSD as well. Yet I don’t know whether it really does.”“I am very familiar with Dr. Harch and his work,” Brent Masel, M.D., president and medical director of the Transitional Learning Center at Galveston and national medical director of the Brain Injury Association of America, told Psychiatric News. “We collaborated on a study many years ago. … The big, big weakness [of this current study] is that neither the subjects nor the examiners (except for part of the SPECT studies) were blinded. I think there was an enormous opportunity for a placebo effect. This [weakness] was well addressed in the paper. Nevertheless, it remains a weakness.”The bottom line, Masel continued, is that “research on hyperbaric oxygen treatment is very difficult: it’s expensive and very time-consuming. [And while] this study is exciting and promising, … the reader is left puzzled over whether or not it should be incorporated into one’s clinical practice.”The study was funded by the Marine Corps Law Enforcement Foundation, the Coalition to Salute America’s Heroes, the Harch Hyperbaric Research Fund, and other groups.“A Phase I Study of Low-Pressure Hyperbaric Oxygen Therapy for Blast-Induced Post-Concussion Syndrome and Posttraumatic Stress Disorder” can be accessed at www.liebertonline.com/toc/neu/27/5 by entering “Paul Harch” into the search box. ISSUES NewArchived

Common Heritable Contributions to Low-Risk Trauma, High-Risk Trauma, Posttraumatic Stress Disorder, and Major Depression

Understanding the relative contributions of genetic and environmental factors to trauma exposure, posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) is critical to developing etiologic models of these conditions and their co-occurrence. To quantify heritable influences on low-risk trauma, high-risk trauma, PTSD, and MDD and to estimate the degree of overlap between genetic and environmental sources of variance in these 4 phenotypes. Adult twins and their siblings were ascertained from a large population-based sample of female and male twin pairs on the basis of screening items for childhood sexual abuse and physical abuse obtained in a previous assessment of this cohort. Structured psychiatric telephone interviews. Total sample size of 2591: 996 female and 536 male twins; 625 female and 434 male nontwin siblings. Lifetime low- and high-risk trauma exposure, PTSD, and MDD. In the best-fitting genetic model, 47% of the variance in low-risk trauma exposure and 60% of the variance in high-risk trauma exposure was attributable to additive genetic factors. Heritable influences accounted for 46% of the variance in PTSD and 27% of the variance in MDD. An extremely high degree of genetic overlap was observed between high-risk trauma exposure and both PTSD (r = 0.89; 95% CI, 0.78-0.99) and MDD (r = 0.89; 95% CI, 0.77-0.98). Complete correlation of genetic factors contributing to PTSD and to MDD (r = 1.00) was observed. The evidence suggests that almost all the heritable influences on high-risk trauma exposure, PTSD, and MDD, can be traced to the same sources; that is, genetic risk is not disorder specific. Individuals with a positive family history of either PTSD or MDD are at elevated risk for both disorders and should be closely monitored after a traumatic experience for symptoms of PTSD and MDD.

Mild Traumatic Brain Injury (Concussion), Posttraumatic Stress Disorder, and Depression in U.S. Soldiers Involved in Combat Deployments

Several studies have examined the relationship between concussion/mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), depression, and postdeployment symptoms. These studies indicate that the multiple factors involved in postdeployment symptoms are not accounted for in the screening processes of the Department of Defense/Veteran's Affairs months after concussion injuries. This study examined the associations of single and multiple deployment-related mTBIs on postdeployment health. A total of 1502 U.S. Army soldiers were administered anonymous surveys 4 to 6 months after returning from deployment to Iraq or Afghanistan assessing history of deployment-related concussions, current PTSD, depression, and presence of postdeployment physical and neurocognitive symptoms. Of these soldiers, 17% reported an mTBI during their previous deployment. Of these, 59% reported having more than one. After adjustment for PTSD, depression, and other factors, loss of consciousness was significantly associated with three postconcussive symptoms, including headaches (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1-2.3). However, these symptoms were more strongly associated with PTSD and depression than with a history of mTBI. Multiple mTBIs with loss of consciousness increased the risk of headache (OR = 4.0, 95% CI = 2.4-6.8) compared with a single occurrence, although depression (OR = 4.2, 95% CI = 2.6-6.8) remained as strong a predictor. These data indicate that current screening tools for mTBI being used by the Department of Defense/Veteran's Affairs do not optimally distinguish persistent postdeployment symptoms attributed to mTBI from other causes such as PTSD and depression. Accumulating evidence strongly supports the need for multidisciplinary collaborative care models of treatment in primary care to collectively address the full spectrum of postwar physical and neurocognitive health concerns.

Smokeless Tobacco Use and Its Relation to Panic Disorder, Major Depression, and Posttraumatic Stress Disorder in American Indians

Rates of nicotine use are high in American Indians. Anxiety and depression tend to be associated with cigarette use, but the association of anxiety and depression with smokeless tobacco (ST) is less clear. We asked if panic disorder, major depression, and posttraumatic stress disorder (PTSD) are related to lifetime ST use in 2 American Indian tribes. Logistic regression analyses examined the association between lifetime panic disorder, major depression, and PTSD and the odds of lifetime ST use status after controlling for sociodemographic characteristics, smoking status, and alcohol use disorders in 1,506 Northern Plains and 1,268 Southwest tribal members. Odds of lifetime ST use was 1.6 times higher in Northern Plains tribal members with a lifetime history of PTSD after controlling for sociodemographic variables and smoking (95% CI: 1.1, 2.3; p = .01). This association remained significant after further adjustment for panic disorder and major depression (odds ratio [OR] = 1.5; 95% CI: 1.0, 2.2; p = .04) but was diminished after accounting for alcohol use (OR = 1.3; 95% CI: 0.9, 1.9; p = .23). In the Southwest, lifetime psychiatric disorders were not associated with lifetime ST use status. Increasing psychiatric comorbidity was significantly linked to increased odds of ST use in both tribes. This study is the first to examine psychiatric conditions and lifetime ST use in a large, geographically diverse American Indian community sample. Although approximately 30% of tribal members were lifetime users of ST, the association with lifetime psychiatric disorders was not as strong as those observed with cigarette smoking. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation.

The Comorbidity of Self-Reported Chronic Fatigue Syndrome, Post-Traumatic Stress Disorder, and Traumatic Symptoms

Data from primary care and community samples suggest higher rates of post-traumatic stress disorder (PTSD) among individuals with chronic fatigue syndrome (CFS). This study investigated the co-occurrence of CFS, PTSD, and trauma symptoms and assessed the contribution of familial factors to the association of CFS with lifetime PTSD and current traumatic symptoms. Data on lifetime CFS and PTSD, as measured by self-report of a doctor's diagnosis of the disorder, and standardized questionnaire data on traumatic symptoms, using the Impact of Events Scale (IES), were obtained from 8544 female and male twins from the community-based University of Washington Twin Registry. Lifetime prevalence of CFS was 2% and lifetime prevalence of PTSD was 4%. Participants who reported a history of PTSD were over eight times more likely to report a history of CFS. Participants with scores ≥ 26 on the IES were over four times more likely to report CFS than those who had scores ≤ 25. These associations were attenuated but remained significant after adjusting for familial factors through within-twin pair analyses. These results support similar findings that a lifetime diagnosis of CFS is strongly associated with both lifetime PTSD and current traumatic symptoms, although familial factors, such as shared genetic and environmental contributions, played a limited role in the relationship between CFS, PTSD, and traumatic symptoms. These findings suggest that future research should investigate both the familial and the unique environmental factors that may give rise to both CFS and PTSD.

Posttraumatic stress disorder, depression, and perceived needs for psychological care in older persons affected by Hurricane Ike

To examine the prevalence and correlates of disaster-related posttraumatic stress disorder (PTSD), depression, and needs for psychological care in older persons affected by Hurricane Ike. A total of 193 adults aged 60 or older who resided in the Galveston Bay area were interviewed 2-5 months following Hurricane Ike. Pre-, peri-, and post-disaster variables hypothesized to be related to PTSD and depressive symptoms, and perceived needs for psychological care were assessed. Weighted prevalences of past-month Ike-related PTSD and depression were 7.6% and 8.6%, respectively. Risk factors for Ike-related PTSD symptoms were predominantly peri-disaster in nature, with greater hurricane exposure, and peri-event dissociative and autonomic activation symptoms associated positively with these symptoms. Risk factors for depressive symptoms were predominantly pre-disaster in nature, with being married/living with partner associated negatively, and prior disaster exposure and pre-disaster PTSD or depression associated positively with these symptoms. 27.2% of the sample endorsed at least one of the perceived needs for psychological care assessed. A history of PTSD or depression, greater peri-event autonomic activation, and Ike-related PTSD and depressive symptoms were associated with greater need for psychological care. This study is limited by its cross-sectional design and employment of psychiatric screening instruments. A substantial proportion of older adults may have PTSD and depression, as well as perceived needs for psychological care, after a disaster. Assessment of disaster exposures, and peri-event dissociative and autonomic symptoms may help identify older adults at risk for disaster-related psychopathology. Older adults with a history of PTSD or depression, and greater peri-event autonomic activation and PTSD symptoms may be more likely to have needs for psychological care.

Association of Post‐Traumatic Stress Disorder and Obesity in a Nationally Representative Sample

Recent studies suggest a possible link between post-traumatic stress disorder (PTSD) and obesity risk, which would have implications for the development of obesity-related diseases in this population. The present study examined the association between PTSD and obesity and whether this association differed by sex in a representative sample of the US population. A secondary objective was to determine whether the association between PTSD and obesity was mediated by binge eating disorder (BED). Data were from the Collaborative Psychiatric Epidemiology Surveys (CPES), which comprises three nationally representative cross-sectional surveys that were conducted between 2001 and 2003. Logistic regression analyses weighted to represent the general US adult population were performed. In the total sample of 20,013 participants, rates of obesity were 24.1% for persons without a lifetime history of PTSD and 32.6% among persons with PTSD in the past year. Adjusting for socio-demographic characteristics, depression, substance and alcohol abuse/dependence, and psychotropic medication status, past year PTSD was associated with greater likelihood of obesity (odds ratio (OR) = 1.51; 95% confidence interval (CI) = 1.18, 1.95), with no differences by gender. BED did not statistically mediate the relationship between PTSD and obesity. The present study provides support for a link between PTSD and obesity. Findings further existing literature by indicating that the association is consistent across sexes and is not statistically mediated by BED.

Adolescent suicide in New York City: plenty of room for new research

The act of adolescent suicide continues to threaten adolescent populations in New York City (NYC). Consistent positive correlations have been found between a plethora of risk factors present in NYC adolescent populations and suicidal ideations and behaviors. Psychiatric conditions that may contribute to the rate of adolescent suicide in NYC include depression, bipolar disorder, substance abuse and schizophrenia. Unique factors that have been found to contribute to increased rates of completed suicides in NYC include the phenomena of railway suicides and suicide tourism. Homelessness and income inequality in NYC have also been consistently correlated with increased suicidality; with one study finding suicide attempts reported by a significant percentage of new admissions to homeless shelters. Adolescent populations in NYC that have been identified as particularly vulnerable to suicidality include runaway youth, homosexual youth, victimized adolescents and adolescents with a recent history of posttraumatic stress disorder (PTSD). Longitudinal studies in NYC have found that physical and sexual abuse is highly predictive of adolescent suicidality, with variations by ethnic group. Currently, there is a disturbing lack of sufficient research on adolescent suicide in NYC, specifically regarding causal factors, the effects of television on suicide, comorbid suicidality and drug abuse, and cultural factors contributing to suicide. This dearth of literature may be related to the ethical problems inherent in suicide research, self reports and/or post mortem analyses.

Project VALOR: design and methods of a longitudinal registry of post‐traumatic stress disorder (PTSD) in combat‐exposed Veterans in the Afghanistan and Iraqi military theaters of operations

Few studies have investigated the natural history of post-traumatic stress disorder (PTSD). Project VALOR (Veterans' After-discharge Longitudinal Registry) was designed as a longitudinal patient registry assessing the course of combat-related PTSD among 1600 male and female Veterans who served in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF). Aims of the study include investigating patterns and predictors of progression or remission of PTSD and treatment utilization. The study design was based on recommendations from the Agency for Healthcare Quality and Research for longitudinal disease registries and used a pre-specified theoretical model to select the measurement domains for data collection and interpretation of forthcoming results. The registry will include 1200 male and female Veterans with a recent diagnosis of PTSD in the Department of Veteran Affairs (VA) electronic medical record and a comparison group of 400 Veterans without a medical record-based PTSD diagnosis, to also allow for case-control analyses. Data are collected from administrative databases, electronic medical records, a self-administered questionnaire, and a semi-structured diagnostic telephone interview. Project VALOR is a unique and timely registry study that will evaluate the clinical course of PTSD, psychosocial correlates, and health outcomes in a carefully selected cohort of returning OEF/OIF Veterans.

Abstract P248: Posttraumatic Stress Disorder Intrusions Are Associated with Prehospital Delay in Patients with Myocardial Infarction

INTRODUCTION: Increased pre-hospital delay prior to presentation for myocardial infarction (MI) is associated with poor outcomes. A history of post-traumatic stress disorder (PTSD), particularly intrusive reexperiencing of trauma, may also be associated with poor outcomes after MI. It is unknown, however, whether PTSD intrusions are associated with pre-hospital delay. METHODS: Patients (n=151) presenting to the emergency room with an MI in the Prescription Use, Lifestyle, Stress Evaluation (PULSE) study were included in this study. Patients reporting a traumatic event with intrusive reexperiencing prior to their MI, as recorded on a questionnaire administered by study staff, were considered to have PTSD intrusions. Pre-hospital delay was defined as the difference between patient-reported symptom onset and presentation time as documented in the medical record. RESULTS: Patients who had PTSD intrusions ( N = 26, 17%) versus those without intrusions ( N = 125; 83%) were younger (mean age: 58 vs. 63 years), more likely to be depressed (68% vs. 37%), and had a higher LVEF (53% vs. 46%). Pre-hospital delay was longer for participants with, compared to without, PTSD intrusions [geometric mean: 11.6 hours (95% CI 6.2-21.6) vs. 6.2 hours (95% CI 4.9-8.1)] P =0.05. After multivariable adjustment for age, sex, ethnicity, depression, LVEF, MI type (ST-elevation vs. non-ST-elevation) and history of prior MI, the mean pre-hospital delay was 136% (95% CI: 17% - 372%) longer for patients with versus without PTSD intrusions (Table). CONCLUSION: Among patients presenting with an MI, PTSD intrusions were associated with longer pre-hospital delays. Future studies should examine the behavioral mechanisms underlying longer pre-hospital delay for patients with PTSD intrusions. Model Covariate adjustment Percent delay (95% CI) intrusions vs. no intrusions p-value 1: Unadjusted 85% longer (0% - 244%) 0.05 2: Age, sex, ethnicity 97% longer (6% - 270%) 0.03 3: Model 2 and depression MI type, LVEF, prior MI 136% longer (17% - 372%) 0.02

Childhood trauma and posttraumatic stress disorder in patients with psychosis

To review the current literature on childhood trauma and emerging treatments for posttraumatic stress disorder (PTSD), one of its most prevalent consequences, in patients with psychotic disorders. Of patients with psychosis, 40-50% report either childhood sexual abuse or childhood physical abuse, and 11-46% fulfil a diagnosis of PTSD. About one-third of patients report childhood emotional abuse in the absence of other forms of childhood trauma. More robust evidence is mounting to support the role of childhood trauma in the aetiology of psychosis, but more research is needed to understand the underlying mechanisms. Patients with a history of childhood trauma and/or PTSD have a more severe clinical profile compared with those without these experiences, worse overall functioning, and lower remission rates. Research suggests that instruments assessing childhood trauma and PTSD developed for the general population are also appropriate for use among people with psychosis, and trauma-focussed treatments can be used safely and effectively in this group. Childhood trauma and its consequences are highly prevalent among patients with psychosis and severely affect the course and outcome. Treatment approaches appropriate for this population need to be further evaluated and implemented into routine practice.

Altered amygdala activation during face processing in Iraqi and Afghanistani war veterans

BackgroundExposure to combat can have a significant impact across a wide array of domains, and may manifest as post-traumatic stress disorder (PTSD), a debilitating mental illness that is associated with neural and affective sequelae. This study tested the hypothesis that combat-exposed individuals with and without PTSD, relative to healthy control subjects with no history of PTSD or combat exposure, would show amygdala hyperactivity during performance of a well-validated face processing task. We further hypothesized that differences in the prefrontal cortex would best differentiate the combat-exposed groups with and without PTSD.MethodsTwelve men with PTSD related to combat in Operations Enduring Freedom and/or Iraqi Freedom, 12 male combat-exposed control patients with a history of Operations Enduring Freedom and/or Iraqi Freedom combat exposure but no history of PTSD, and 12 healthy control male patients with no history of combat exposure or PTSD completed a face-matching task during functional magnetic resonance imaging.ResultsThe PTSD group showed greater amygdala activation to fearful versus happy faces than both the combat-exposed control and healthy control groups. Both the PTSD and the combat-exposed control groups showed greater amygdala activation to all faces versus shapes relative to the healthy control group. However, the combat-exposed control group relative to the PTSD group showed greater prefrontal/parietal connectivity with the amygdala, while the PTSD group showed greater connectivity with the subgenual cingulate. The strength of connectivity in the PTSD group was inversely related to avoidance scores.ConclusionsThese observations are consistent with the hypothesis that PTSD is associated with a deficiency in top-down modulation of amygdala activation by the prefrontal cortex and shows specific sensitivity to fearful faces.

Relationship between post-traumatic stress disorder and diabetes among 105 180 asylum seekers in the Netherlands

Several reports have demonstrated a relationship between post-traumatic stress disorder (PTSD) and type 2 diabetes (T2DM) mainly in combat veterans. The relationship between PTSD and T2DM has not been evaluated among vulnerable migrant populations. The main objective of this study was therefore to assess the relationship between PTSD and T2DM among asylum seekers in the Netherlands. Analysis of a national electronic database of the Dutch Community Health Services for Asylum seekers aged≥18 years (N=105,180). Asylum seekers with PTSD had a higher prevalence of T2DM compared with those without PTSD. The age-adjusted prevalence ratios (APR) were 1.40 (95% CI, 1.12-1.76) in men and 1.22 (95% CI, 0.95-1.56) in women compared with individuals without PTSD, respectively. There was an interaction between PTSD and comorbid depression (P<0.05) in men and women, indicating that the effect of PTSD and comorbid depression on T2DM differed. When the analyses were stratified by depression status, among non-depressed group, individuals with PTSD had a higher prevalence of T2DM compared with those without PTSD [APR=1.47 (95% CI, 1.15-1.87) in men and APR=1.27 (95% CI, 0.97-1.66) in women]. Among the depressed individuals, however, there was no association between PTSD and T2DM [APR=0.87 (95% CI, 0.43-1.76) in men, and APR=1.00, (95% CI, 0.54-1.83) in women]. The findings suggest that history of PTSD is related to high levels of T2DM among asylum seekers independent of comorbid depression. Clinicians and policy makers need to take PTSD into account when assessing and treating diabetes among vulnerable migrant populations.

Posttraumatic stress disorder and hypertension in Australian veterans of the 1991 Gulf War

ObjectiveMilitary veterans experience a high prevalence of psychopathologies such as posttraumatic stress disorder (PTSD). Relationships between physical and psychological health are increasingly recognised. This study investigated associations between PTSD and hypertension in male Australian Gulf War veterans. MethodsIn 2000–02, 1456 veterans underwent medical and psychological assessments. Medical practitioners rated self-reported medical conditions as probable diagnoses, possible, unlikely or non-medical. The Composite International Diagnostic Interview (CIDI) assessed psychological symptomatology present in the 12months preceding evaluation, and lifetime prevalence. Odds of hypertension among those with and without PTSD were calculated for each timeframe using logistic regression. ResultsAnalysis was restricted to the 1381 veterans for whom CIDI and medical data were available. Hypertension was considered probable in 100 subjects (7.2%). Adjusted odds ratios of hypertension were 2.90 (95% CI 1.19–7.09) amongst veterans with PTSD in the past 12months and 2.27 (95% CI 1.01–5.10) for lifetime prevalence, compared with those without PTSD. Hypertension was over seven times more likely amongst veterans with PTSD alone than those with no mental illness in the past 12months. ConclusionsVeterans with a history of PTSD had increased odds of having hypertension. Given the array of disabling psychosocial associations of PTSD, and the numerous potential clinical sequelae of hypertension, co-existence of these conditions may have implications for prevention and management at the individual, clinical, and public health policy and practice level. Early identification of PTSD in military samples may help to ameliorate longer-term adverse physical health outcomes.