Posttraumatic Stress Disorder Checklist Scale Research Articles

Effets médiateurs de la symptomatologie de stress post-traumatique et des symptômes de dissociation somatoforme sur la relation entre l’attachement et la qualité de vie liée à la santé après un infarctus du myocarde

Myocardial infarction (MI) is a particularly frequent coronary disease: the number of new cases of MI recorded each year amounts to nearly 90,000 in France and nearly 790,000 in the United States. Over the past 15 years, the number of people who can survive this major cardiac event has substantially increased, as a result of advances in medical treatment and a reduction in delay to intervention. However, patients often report a decrease in their health-related quality of life following myocardial infarction. In other words, some patients perceive that the disease negatively affects various aspects of their daily lives, including physical functioning, emotional state, social relationships, and overall well-being. Furthermore, studies have shown that health-related quality of life is a prognostic indicator of the evolution of patients’ health status: the more health-related quality of life is reduced, the greater the risk of all-cause mortality, recurrence of cardiovascular events, and re-hospitalization for heart disease. In view of these elements, the identification of potentially modifiable factors, and in particular psychological factors, having an impact on health-related quality of life is particularly relevant. More specifically, insecure attachment, post-traumatic stress symptomatology and somatoform dissociation symptoms could have an impact on the health related-quality of life of people who have experienced a major cardiac event. ObjectivesThe objective of this study was to investigate the mediating role of posttraumatic stress symptoms and somatoform dissociative symptomatology in the relationship between insecure attachment and health related-quality of life after a myocardial infarction. Materials and methodsA total of 73 participants, having suffered a myocardial infarction and participating in a cardiovascular rehabilitation program, completed questionnaires to assess the degree of insecurity of their attachment (Experiences in Close Relationship Scale-12; ECR-12), the severity of post-traumatic stress symptoms (Post-Traumatic Stress Disorder Checklist Scale; PCL-5) and somatoform dissociation symptoms (Somatoform Dissociation Questionnaire; SDQ-20), and their health related-quality of life (MacNew Heart Disease-Health Related Quality of Life; MacNew). Mediation analyses were conducted according to the recommendations formulated by Baron and Kenny. ResultsOur results showed that only anxious attachment was positively and significantly associated with the severity of posttraumatic stress symptomatology, whereas such a link was not observed for avoidant attachment. The importance of posttraumatic symptomatology fully explained why individuals with high levels of fear of abandonment also have the poorest emotional, physical, and social quality of life after myocardial infarction. The importance of dissociative somatoform symptomatology partially explained why individuals with an insecure attachment style characterized by a high level of abandonmen were also those with the poorest health-related quality of life following myocardial infarction. ConclusionsThe results of this study tend to demonstrate the importance of taking into account the specificities of attachment, posttraumatic stress symptoms and somatoform dissociation phenomena in the context of interventions aimed at improving the health related-quality of life of people after a myocardial infarction. Insofar as secure attachment appears to be a protective factor against the risk of developing posttraumatic stress disorder, a psychotherapeutic approach aimed at promoting this form of attachment seems to be well justified. Specifically, it may be helpful to provide patients with a psychotherapeutic framework that takes into account their attachment experiences to allow them to change their beliefs about themselves and others, while helping them develop coping strategies appropriate to the stress. Psychotherapeutic interventions aimed jointly at increasing of the degree of attachment security and reducing the symptoms of posttraumatic stress and somatoform dissociation could be relevant to improve the health-related quality of life after a myocardial infarction.

Prevalence of Post-traumatic Stress Disorder in People With a History of Hospitalization With COVID-19 and Its Relationship With Socio-economic Status

Background: COVID-19 has had many negative consequences in all aspects of human life, especially physical and mental health. This study aims to determine the prevalence of post-traumatic stress disorder (PTSD) in people with a history of hospitalization with COVID-19 and its relationship with socio-economic status (SES). Materials and Methods: The present study was a cross-sectional descriptive study and the statistical population of the study included all people with a history of being infected with COVID-19 and subsequent hospitalization in Shohada Hospital of Sarpol-e Zahab, Kermanshah Province, Iran. The sample members were randomly selected from the list of hospitalized patients. A total of 479 people were evaluated face to face using the PTSD Checklist Scale (PCL-S) questionnaire to examine PTSD, as well as the Ghodrat Nama et al.’s SES questionnaire to determine the SES. The data were analyzed using SPSS software, version 21 and by Chi-square test, one-way ANOVA, and Pearson correlation coefficient (P≤0.05). Results: The prevalence of PTSD was 31.10%. No significant relationship was observed between socioeconomic status and the prevalence of PTSD (P=0.97). Among the demographic variables, only gender had a significant relationship with the prevalence of this disorder (P=0.00) and the prevalence was higher in women than in men. Conclusion: The prevalence of PTSD is high in people with a history of hospitalization with COVID-19. Getting infected with COVID-19 and subsequent hospitalization hurts people’s mental health. Maintaining the mental health of this group of people should be considered.

Post-traumatic symptoms in patients with acute coronary syndrome: Maybe an outcome predictor after the ED visit!

ObjectivesWe aimed to assess the patients' experience of threat during management of an acute coronary syndrome (ACS) in the Emergency Department (ED) and to analyze the impact of this acute stress on day-30 outcomes. Study designThis is a prospective study. MethodsWe included patients with ACS in the ED. After discharge, the perceived stress (Perceived Stress Scale (PSS); Visual Analogic Scale (VAS) in stress evaluation; Patient Health Questionnaire (PHQ); and Posttraumatic Stress Disorder Checklist Scale (PCLS) were used. Results35 patients have developed PTSD on day-30 (31.8%). The independent predictors of developing PTSD at day-30 were high PSS score on admission (OR = 1.4; CI = 1.1–1.8; p = 0.004) and/or elevated PHQ-9 score at day-30 (OR = 1.5; CI = 1.2–1.9; p < 0.001).The recurrence of the chest pain was more frequent in the PTSD group of patients. Patients with PTSD symptoms were more likely to report a non-therapeutic adherence to their cardiovascular medication. ConclusionStress management in EDs should become a systematic step in the management of patients with ACS. This study emphasizes the importance of multidisciplinary follow-up and early screening of patients at risk of PTSD to improve their outcomes after discharge.

Evaluation of the self-reported questionnaires used to assess mental health after the January 2015 terrorist attacks in the Paris Region: IMPACTS survey

IntroductionStructured clinical interviews are the gold standard for assessing mental health. However limited resources may allow the use of only self-report questionnaires. In the context of emergency, such as terrorist attacks, the performance and thresholds of such tools still unclear.ObjectivesWe investigated the performance of the Posttraumatic stress disorder CheckList Scale (PCL-S) and of the Hospital Anxiety and Depression scale (HADS), both compared to the MINI Interview, among civilians and first responders involved in terrorist attacks.MethodsThe data came from the IMPACTS survey which was conducted from 6-10 months among civilians (N=190) and first responders (N=232) after the January 2015 terrorist attacks in the Paris Region, France. Sensitivity and specificity of the PCL-S and HADS were estimated by the ROC curve, and the optimal threshold was defined using the Youden index.ResultsRegarding the PCL-S: for civilians and first responders respectively, the overall AUC was 0.947 and 0.899, and the optimal threshold were 38.5 and 39.5. Regarding the HADS-D: for civilians and first responders respectively, the overall AUC was 0.908 and 0.617 and the optimal thresholds were 7.5 and 1.5. For the HADS-A for civilians and first responders respectively, the overall AUC was 0.823 and 0.717, the optimal threshold were 9.5 and 6.5.ConclusionsIn the context of a terrorist attack, compared to the MINI, our study underlined satisfactory performance of the PCL-S and the HADS-D in screening for PTSD and depression respectively, while the screening of anxiety using the HADS-A was unsatisfactory.DisclosureNo significant relationships.

Determinants of sexual dysfunction in women recovered from COVID-19

IntroductionWhile several studies have assessed the impact of the COVID-19 pandemic on sexuality and sexual behavior in the general population, very few studies have assessed sexuality in patients recovered from Sars-Cov 2 infection.ObjectivesThe objectives of our study were to assess factors associated with sexuality dysfunction in women recovered from covid-19.MethodsThis is a case-control study.The women in the case group have been infected with Sars-Cov 2, and cured for one to two months at the time of the study, women in the control group have not been infected with Sars-Cov 2. We assessed depression, anxiety, post-traumatic stress disorder (PTSD) and sexuality in both groups using the Beck Depression Inventory (BDI), the Coronavirus Anxiety Scale (CAS), the Post traumatic stress disorder Checklist Scale (PCLS) and the Female Sexual Function Index (FSFI).ResultsIn total, we recruited 30 women in the case group and 30 women in the control group. An FSFI score &lt;26.55 and corresponding to impaired sexual function was found in 63.33% of women in the case group versus 53.33% of women in the control group (p=0.009). Factors influencing sexual activity were depression (OR = 17.86, CI95% = [1.1-290.12]) and PTSD (OR = 18.51, CI95% = [1.43-240.30]).ConclusionsDepression and PTSD are significantly associated with sexual dysfunction in women recovered from COVID-19, even in mild or pauci-symptomatic clinical forms.DisclosureNo significant relationships.

The negative association between trait mindfulness and post-traumatic stress disorder: A 4.5-year prospective cohort study.

ObjectivePost‐traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to investigate the association between trait mindfulness and PTSD over a period of 54 months. The secondary objective is to provide an exhaustive description of PTSD trajectories after the Bataclan attack.MethodsWe designed a prospective cohort study of 133 subjects present in the Bataclan concert hall during the November 2015 terrorist attack in Paris, France. Data were recorded 6, 18, 30, and 54 months after the attack. The primary endpoint was evaluated using the PTSD Check List Scale. Trait mindfulness was measured by the 14‐item Freiburg Mindfulness Inventory.ResultsFMI scores were consistently, significantly, and negatively associated with PCL‐5 scores. Adjusted odds ratios were at 0.81 (6 months), 0.88 (18 months) 0.82 (30 months), and 0.81 (54 months). PTSD prevalence 6 months after the event was 77%; it remained at 41% after 54 months. PTSD status of subjects is fluctuating. Latent class analysis divided the cohort into 3 groups: 21% of subject who remained below PTSD threshold throughout, 30% who remained above throughout, and 49% who steadily reduced their PTSD scores over time.ConclusionIn our cohort, mindfulness is negatively associated with PTSD. Mindfulness programs are designed to improve global resilience and treat anxiety and mood disorders. Further research is needed to investigate if improving trait mindfulness is possible and beneficial for patients suffering from PTSD.

Otosclerosis surgery under local anesthesia with sedation: Assessment of quality of life and stress

ObjectivesThe main study endpoint was tolerance of stapedotomy under local anesthesia with sedation and under general anesthesia using stress and quality of life assessment questionnaires. Secondary endpoints comprised operative time and functional results. Material and methodIn a consecutive series of stapedotomy patients operated on over a 12-month period, quality of life and perioperative stress were analysed by 3 questionnaires: the Glasgow Benefit Inventory, Cohen's perceived stress scale and the Post-traumatic stress disorder checklist scale. Questionnaire responses and audiometric data were compared between groups treated under local anesthesia with sedation and under general anesthesia. ResultsTwenty-two patients were included in the local anesthesia with sedation group and 6 in the general anesthesia group. There was no difference between the groups for quality of life, onset of post-traumatic stress, or perceived pre- and postoperative stress. There was also no difference in operative time. The audiometric data confirmed the reliability of stapedotomy. Stapedotomy under local anesthesia with sedation improved air conduction with≤10dB air-bone gap (ABG), comparable to results under general anesthesia. The rate of ABG≤10dB was 71.4%; no labyrinthisation was observed. ConclusionUnder local anesthesia with sedation, stapedotomy was well tolerated without increasing the stress associated with otosclerosis surgery. By correcting hearing loss, the procedure improves quality of life.

Long-term effects of treatment for chronic nightmares: is imagery rehearsal therapy robust in the COVID-19 pandemic?

Citation:Sierro C, Leslie W, Putois B. Long-term effects of treatment for chronic nightmares: is imagery rehearsal therapy robust in the COVID-19 pandemic? J Clin Sleep Med. 2020;16(11):1993.

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact.

Background Chronic pain (CP) is a real public health concern. It is a common cause of poor quality of life and workplace absenteeism. It is well studied in many medical and surgical fields. However, only few data are available as regards to its occurrence in trauma patients. Purpose To assess the prevalence, associated factors, and psychosocial impact of CP following chest trauma. Methods This is an observational, descriptive, and analytic cross-sectional study performed in a Tunisian department of anesthesia and intensive care over a two-month period. Adult patients admitted one year ago for isolated chest trauma were enrolled. Data were collected by a phone interview. Studied variables were sociodemographic characteristics, traumatic injuries and their management, the occurrence of CP, and its psychosocial impact. CP was diagnosed by the Brief Pain Inventory (BPI) considering an evolution period of at least 3 months. Its impact was assessed by the BPI and the Posttraumatic stress disorder Checklist Scale (PCLS). Results Fifty-four patients were included in the study. The prevalence of CP was 79.6%. The average CP intensity was 3.18 ± 1.4. It was neuropathic in 90.7%. Its main associated factors were pleural effusion (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (Conclusion CP following chest trauma is frequent and severe requiring preventive measures such as high risk patients screening, better management of acute pain, and a multidisciplinary approach for patients with diagnosed CP.

Relationship between the prevalence of polycythemia and factors observed in the mental health and lifestyle survey after the Great East Japan Earthquake.

We have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE). Our findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.We analyzed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design: traumatic symptoms, depression status, socioeconomic factors such as residential environment, and working situation after the GEJE. Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government. Participants analyzed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13). Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as being aged 65 years and older, highly educated, obese (body mass index ≥ 25), hypertensive, diabetic, having liver dysfunction, and a smoker being significantly related to the prevalence of polycythemia.Our findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.

Otosclerosis surgery: Assessment of patient comfort

ObjectivesTo evaluate operative comfort and stress in patients undergoing stapedotomy for otosclerosis under local versus general anesthesia. Material and methodsConsecutive otosclerosis patients managed over a 9-month period responded to 3 validated questionnaires to assess peri- and post-operative comfort: Glasgow Benefit Inventory, Cohen's Perceived Stress Scale and the Posttraumatic Stress Disorder Checklist Scale. These results and audiometric data were compared between local and general anesthesia groups. ResultsTwenty-one patients were included in the local anesthesia group and 7 in the general anesthesia group, after exclusion of patients with history of otosclerosis surgery. There was no significant inter-group difference on Glasgow Benefit Inventory (P=0.38) or Posttraumatic Stress Disorder Checklist Scale (P=0.86). Perceived Stress Scale scores were higher in the general anesthesia group (P=0.038). In total, 67% of patients reported no discomfort under local anesthesia, and 86% were ready to undergo the procedure under local anesthesia again. There were no significant differences in postoperative symptoms, or in air-bone gap≤10dB (local anesthesia 81%, general anesthesia 71%; P=0.156). ConclusionsLocal anesthesia in otosclerosis surgery did not increase stress or postoperative symptoms compared to general anesthesia. Audiometric results were not affected by type of anesthesia.

Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war.

The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features. We recruited 15military veterans suffering from PTSD who performed an 18F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS). The metabolic activity of the precuneus was increased after EMDR therapy (p< 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = -0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = -0.667 and p < 0.006). The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.

Peritraumatic dissociation and post-traumatic stress disorder in individuals exposed to armed conflict in the Democratic Republic of Congo

ABSTRACTThe purpose of this study was to verify the hypothesis that there is an association between peritraumatic dissociation (PD) and post-traumatic stress disorder (PTSD) in individuals exposed to recurrent armed conflict. More specifically, we sought to evaluate whether PD differentially predicts PTSD according to the degree of exposure to the potentially traumatic event (PTE), the level of education, and gender. A total of 120 individuals between 17 and 75 years of age, including 51 women, completed the Traumatic Events List, the Peritraumatic Dissociative Experiences Questionnaire, and the French version of the Posttraumatic Stress Disorder Checklist Scale, as well as a questionnaire providing information regarding sociodemographic details. The group of participants with high scores for PD had significantly more PTSD. PD differentially predicts PTSD depending on the level of education and gender of the individual. Those who had been physically assaulted and raped, as well as the less educated, were more likely to be dissociated during PTE· exposure compared to witnesses and those with a higher level of education. The primary target population for prevention and early management should comprise individuals with high levels of PD, low levels of education, and women.

Relationship between the big five personality traits and PTSD among French police officers

IntroductionPost-traumatic stress disorder (PTSD) is rare among police officers, but the symptoms of PTSD are not. Personality traits can be a contributing factor of stress disorders. Based on the big five personality traits, three personality profiles can be identified: resilient, overcontrolled and undercontrolled. Resilient people are characterized by high emotional stability (low neuroticism), high social skills and self-confidence. Overcontrollers have higher scores on neuroticism and they tend to internalize their negative emotions. Undercontrollers are characterized by low conscientiousness (impulsivity), a tendency toward social withdrawal and low self-esteem. ObjectiveThe aim of this study was to examine the role of personality traits and profiles in the emergence of PTSD symptoms among French police officers. MethodParticipants were French national police officers (n=100, M=32.9 years, SD=9.8, 19–57) who completed the Posttraumatic Stress Disorder Checklist Scale (PCLS) and the Big Five Inventory (BFI). ResultsResults revealed the three expected personality profiles: resilients (n=31), overcontrollers (n=43) and undercontrollers (n=19). The resilients presented with the fewest PTSD symptoms and the undercontrollers with the most (particularly reexperiencing). The latter also scored the highest on neuroticism and the lowest on extraversion and agreeableness. Police officers with an undercontrolled profile were also the oldest or those who had served the longest in the police force. Neuroticism and length of service were the two predictors of PTSD symptoms for reexperiencing and avoidance. ConclusionThis study demonstrates the contribution of each personality trait and length of service to PTSD symptoms in French police officers.

Hypnosis for Awake Surgery of Low-grade Gliomas: Description of the Method and Psychological Assessment.

Awake craniotomy with intraoperative electric stimulation is a reliable method for extensive removal of low-grade gliomas while preserving the functional integrity of eloquent surrounding brain structures. Although fully awake procedures have been proposed, asleep-awake-asleep remains the standard technique. Anesthetic contraindications are the only limitation of this method, which is therefore not reliable for older patients with high-grade gliomas. To describe and assess a novel method for awake craniotomy based on hypnosis. We proposed a novel hypnosedation procedure to patients undergoing awake surgery for low-grade gliomas in our institution between May 2011 and April 2015. Surgical data were retrospectively recorded. The subjective experience of hypnosis was assessed by 3 standardized questionnaires: the Cohen Perceived Stress Scale, the Posttraumatic Stress Disorder Checklist Scale, the Peritraumatic Dissociative Experience Questionnaire, and a fourth questionnaire designed specifically for this study. Twenty-eight questionnaires were retrieved from 43 procedures performed on 37 patients. The Peritraumatic Dissociative Experience Questionnaire revealed a dissociation state in 17 cases. The Perceived Stress Scale was pathological in 8 patients. Two patients in this group stated that they would not accept a second hypnosedation procedure. The Posttraumatic Stress Disorder Checklist Scale revealed 1 case of posttraumatic stress disorder. Burr hole and bone flap procedures were the most frequently reported unpleasant events during opening (15 of 52 events). The main findings of our study are the effectiveness of the technique, which in all cases allowed resection of the tumor up to functional boundaries, and the positive psychological impact of the technique in most of the patients.

Abstract 19204: Symptoms of Depression and Posttraumatic Stress Disorder are Associated with Differential Autonomic Influences to Standing

Introduction: Depression and posttraumatic stress disorder (PTSD) are associated with impaired baroreflex sensitivity, a risk factor for sudden death. Unlike depression, PTSD is associated with hyperarousal. We hypothesized that, in patients with CAD, depressive and PTSD symptoms associate with different autonomic responses to standing (baroreflex response). Methods: We examined 178 patients with CAD for autonomic dysfunction with the ANSAR test (ANX 3.0, ANSAR Inc. Philadelphia, PA) in which heart rate variability was measured in both sitting (5 minutes) and standing (5 minutes) positions. Sympathetic (SNS) and parasympathetic (PNS) nervous system activity was measured using continuous wavelet transform and log-transformed. PTSD symptoms were assessed using the PTSD checklist scale (PCL), and depressive symptoms were assessed using the Beck Depression Inventory-II (BDI). Both BDI and PCL were examined in multivariate models simultaneously, adjusting for CAD risk factors, beta blockers, and antidepressants. Results: The mean (SD) age, BDI, and PCL scores were 62.4 (9.1), 7.2 (7.6), and 26.2 (10.2), respectively. For the group as a whole, the mean baseline SNS and PNS tones were -0.49 and -0.60 log beats per minute squared (log BPM 2 ). In multivariable models, PCL score associated with higher baseline SNS tone (β=0.03, p=0.046). With standing, PCL score associated with decrease in the levels of SNS tone (β=-0.02, p=0.02) vs. sitting, and BDI associated with an increased PNS tone (β=0.03, p=0.03) vs. sitting. In both cases, these responses are the opposite of the expected autonomic response to standing, which is an increase in SNS tone and decrease in PNS tone vs. sitting. Conclusion: Depressive and PTSD symptoms have opposite autonomic pathologies in CAD patients. While PTSD symptoms are associated with higher SNS tone at baseline, they are also associated with lower sympathetic activation with standing. Depressive symptoms, on the other hand, are associated with reduced vagal withdrawal with standing. This suggests that both depressive and PTSD symptoms are associated with an abnormal baroreceptor function, but through different autonomic pathways.

Lower limb trauma and posttraumatic stress disorder: A single UK trauma unit's experience

The incidence and factors influencing posttraumatic stress disorder (PTSD) in victims of severe lower extremity injuries are largely unknown. We studied a cohort of patients treated in a specialist centre to try and elucidate these unknowns. The Posttraumatic Stress Disorder Checklist Scale (PCL-S) was used as a reliable and reproducible patient-reported outcome measure (PROM) assessing all patients for PTSD. Sixty patients were included in the study. This was a prospective analysis of the progression of the PCL-S scores. The data were analysed using a non-parametric Wilcoxon test. Sixty patients were recruited into the study cohort. We found that the incidence in this cohort of PTSD was 30%. We found that age had an influence on outcome. Those who were 50 years old or over had a significantly lower incidence of PTSD according to the PCL-S scores and appeared to recover from it significantly more effectively. Up to a third of patients suffering from a severe lower extremity injury will develop PTSD. Patients of the younger age group are more severely affected and will need psychological support to overcome their distress.

Randomized Controlled Comparison of Cognitive Behavior Therapy with Rogerian Supportive Therapy in Chronic Post-Traumatic Stress Disorder: A 2-Year Follow-Up

Background: To date, there have been no studies comparing cognitive behavior therapy (CBT) with Rogerian therapy in post-traumatic stress disorder. Method: Sixty outpatients with DSM-IV chronic post-traumatic stress disorder were randomized into two groups for 16 weekly individual sessions of CBT or Rogerian supportive therapy (ST) at two centers. No medication was prescribed. Measures included the Post-Traumatic Stress Disorder Checklist Scale (PCLS), the Hamilton Anxiety Scale, Beck Depression Inventory, and Quality of Life. The general criterion of improvement (GCI) was a score of less than 44 on the PCLS. Results: Forty-two patients were evaluated at post-test, 38 at week 52 and 25 at week 104. At post-test, the rate of patients leaving the trial due to worsening or lack of effectiveness was significantly higher in the ST group (p = 0.004). At this point, no between-group difference was found on the GCI and any of the rating scales. Intent-to-treat analysis found no difference for the GCI, but patients in the CBT group showed greater improvement on the PCLS and Hamilton Anxiety Scale. Naturalistic follow-up showed sustained improvement without between-group differences at weeks 52 and 104. Conclusions: CBT retained significantly more patients in treatment than ST, but its effects were equivalent to those of ST in the completers. CBT was better in the dimensional intent-to-treat analysis at post-test.

État de stress post-traumatique dans une unité de traitement de l’anxiété et dans une association d’aide aux victimes

The post-traumatic stress disorder (PTSD) represents an original and frequent pathological entity concerning people confronted with one or more significant traumatic events. We present here a comparative study concerning subjects who present a post-traumatic stress disorder received in an anxiety disorder unit (ADU) or in a victims support association (VSA). One hundred and twenty seven people have been included in the study, according to DSMIV for PTSD, during three years. Fifty-seven came from a victim support association, 54 came from an anxiety disorder unit and 16 were common to both structures. The PCL-S (PTSD Checklist Scale) was used to rate the intensity of the PTSD. Age, sex, marital statute, type of traumatism, comorbidity and previous traumatisms were compared. PCLS scores were equivalent in the two settings. More women, younger subjects and more aggression were received in the victim support association. In the anxiety disorder unit more psychiatric comorbidity and more frequent antecedents of traumatism were seen. In the whole sample, two thirds of the people lived alone. Our results show that a victim support association receives people suffering from a definite post-traumatic stress disorder as intense on the PCL-S as in an anxiety disorder unit. More work has to be done on support association in the community, as they are confronted with significant PTSD problems.

The Validation of the Posttraumatic Stress Disorder Checklist Scale in Posttraumatic Stress Disorder and Nonclinical Subjects

Background: The Posttraumatic Stress Disorder Checklist Scale (PCLS) is a short self-report inventory for assessing the 3 main syndromes of Posttraumatic Stress Disorder (PTSD). The aim of this study was the validation of the French version of the PCLS in PTSD subjects and nonclinical subjects. Methods: One-hundred and thirteen outpatients suffering from PTSD according to DSM-IV were administered the PCLS. The patients’ scores on the PCLS were then compared to those of 31 nonclinical control subjects. Thirty-five of the patients were administered the PCLS twice over an interval of 1–2 weeks and also completed questionnaires measuring depression, phobia and anxiety. Results: The patients’ total score and subscores on the PCLS were found to be significantly higher than those of control subjects. The cutoff score of 44 on the French version PCLS distinguishes well between the PTSD group and control group with a high diagnostic efficacy (0.94). Factor analysis revealed 3 main factors corresponding to the reexperiencing, numbing and hyperarousal syndromes. The PCLS showed satisfactory test-retest reliability and internal consistency. Conclusions: The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in psychiatric as well as in primary-care settings.